Differences In Margins Research Articles

Comparison of Modified Cap-Assisted Endoscopic Mucosal Resection and Endoscopic Submucosal Dissection in Treating Intraluminal Gastric Gastrointestinal Stromal Tumor (≤20 mm).

A modified cap-assisted endoscopic mucosal resection (mEMR-C), introduced in this study, was a novel variation of the standard EMR. We aimed to compare the outcomes of mEMR-C and endoscopic submucosal dissection (ESD) for the treatment of small (≤20 mm) intraluminal gastric gastrointestinal stromal tumors (gGISTs). This retrospective study included 43 patients who underwent mEMR-C and 156 patients who received ESD at Nanjing Drum Tower Hospital. Baseline characteristics, adverse events, and clinical outcomes were compared between the 2 groups. Univariate and multivariable analyses were conducted to adjust for confounders. After propensity score matching using sex, year, location, and tumor size, outcomes were compared with 41 patients in each group. A total of 199 patients underwent endoscopic resection and the en bloc resection rate was 100%. The complete resection rate was comparable in both groups ( P = 1.000). Approximately 9.5% of all patients had a positive margin. There was no significant difference in positive margin for patients undergoing mEMR-C or ESD (9.3% vs 9.6%, P = 1.000). No difference in adverse events in both groups ( P = 0.724). The mEMR-C was associated with shorter operation time and lower cost than the ESD. Recurrence was reported in 2 patients at 1 and 5 years after ESD during a median follow-up of 62 months. No metastasis and disease-related death were identified in both groups. Propensity score matching analysis revealed similar results. The mEMR-C was found to be the preferable technique for small (≤20 mm) intraluminal gGISTs with shorter operation time and lower cost as compared with ESD.

MP32-12 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP32-12 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER Joseph Black, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Ma Boston, Simon Kim, Joaquim Bellmunt, Irving Kaplan, Aria Olumi, and Boris Gershman Joseph BlackJoseph Black More articles by this author , Sumedh KaulSumedh Kaul More articles by this author , Aaron FleishmanAaron Fleishman More articles by this author , Ruslan KoretsRuslan Korets More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , Ma BostonMa Boston More articles by this author , Simon KimSimon Kim More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Irving KaplanIrving Kaplan More articles by this author , Aria OlumiAria Olumi More articles by this author , and Boris GershmanBoris Gershman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The comparative effectiveness of robotic-assisted (RARC) versus open radical cystectomy (ORC) in the management of urothelial carcinoma of the bladder (UCB) remains uncertain. Limited randomized trial evidence suggests similar perioperative outcomes and 2-year progression-free survival, but long-term survival outcomes and real-world data are lacking. We therefore evaluated the comparative effectiveness of RARC and ORC using a nationwide oncology dataset. METHODS: We conducted observational analyses designed to emulate the complete RAZOR trial using the NCDB. Specifically, we identified adults age 37-89 years with Charlson 0-1 diagnosed with cT1-4 cN0-1 cM0 UCB from 2010-2015 and treated with RARC or ORC with LND at a hospital performing an average of >10 RCs per year. We then examined the associations of surgical approach with perioperative outcomes and overall survival (OS) using propensity score methods with stabilized inverse probability of treatment weights (sIPW), with Cox models further adjusted for imbalanced pathologic features (pT and pN stage). RESULTS: A total of 3,493 patients were included in the cohort, of whom 2,492 (71%) underwent ORC and 1001 (29%) underwent RARC. Median follow-up was 29.5 months. After sIPW reweighting, pre-treatment baseline characteristics were well-balanced. After adjustment, RARC was associated with a statistically significant but clinically insignificant higher lymph node (LN) yield (median 20 vs 18 LNs; p<0.01) and shorter length of hospitalization (median 7 [IQR 5-8] vs 7 [IQR 6-10]; p<0.01), but there were no differences in positive surgical margins (8% vs 8%; p=0.64) or 30-day readmissions (10% vs 9%; p=0.80). After adjustment, there was no difference in OS between RARC and ORC (Figure 1; 5-year OS 57% vs 55%; p=0.28; HR 0.93, 95%CI 0.80-1.07). OS treatment effects were similar when examined across cT stage, cN stage, and age. CONCLUSIONS: In observational analyses designed to emulate the complete RAZOR trial, RARC was not associated with statistically significant differences in positive surgical margins, 30-day readmissions, or OS compared to ORC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e445 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Black More articles by this author Sumedh Kaul More articles by this author Aaron Fleishman More articles by this author Ruslan Korets More articles by this author Peter Chang More articles by this author Andrew Wagner More articles by this author Ma Boston More articles by this author Simon Kim More articles by this author Joaquim Bellmunt More articles by this author Irving Kaplan More articles by this author Aria Olumi More articles by this author Boris Gershman More articles by this author Expand All Advertisement PDF downloadLoading ...

Study of thyroid lesions for Sudanese patients

This was a deceptive cross sectional study aimed to differentiate between benign and malignant tumor using ultrasonography, done in Khartoum area hospital during the period from January 2022 to January 2023. 200 patients with thyroid nodules (20%) 40 males and 160 (80%) females. The study found that most patients had well define margin nodules were 145 (73%) and ill define margin nodules were 54 (27%), most patients had taller-than-wider capsule were 192 (96%) and wider-than-taller capsule were 8(4%), most patients had internal vascularity were 150 (75%) and peripheral were 50 (25%), most patients had No calcification170 (85%) and had calcification 30(15%), most patients had hyper echogenicity were 156 (78%), hypo echogenicity were 30(15%) and iso echogenicity were 14 (7%), most patients had multi lesion were 118(59%) and solitary lesion had 82 (41%), most patients had benign lesion were 150 (75%) and malignant lesion were 50(25%), study confirmed that there was statistically significant correlation between age and margins (p-value = 0.00), vascularity (p-value = 0.003) and there was statistically insignificant correlation between age and capsule, number of lesions, between gender and margins, capsule, vascularity, number of lesions and between weight and margins, capsule, vascularity, number of lesions (p-value &gt; 0.05). there was statistically insignificant correlation between age, gender and echogenicity (p-value &gt; 0.05), there was statistically significant correlation between calcification and type of lesion (p-value =0.001), there was statistically significant difference in margins (sig=0.001), in vascularity (sig=0.00) .The study concluded that the most patients had benign lesion, there was statistically significant correlation between age and margins, vascularity, between calcification and type of lesion, there was statistically significant difference in margins, in vascularity, and in calcification between benign and malignant lesion and there was statistically insignificant difference in capsule and echogenicity between benign and malignant lesion.

Perioperative and long-term survival outcomes of laparoscopic versus open hepatectomy for BCLC stage A large hepatocellular carcinoma patients in difficult segments: A two-centre, propensity score matching analysis.

The differences in short- and long-term outcome between laparoscopic liver resection (LLR) and open liver resection (OLR) for BCLC stage A large hepatocellular carcinoma (HCC) in difficult segments (I, IVa, VII, VIII) remain unclear. This PSM two-centre study aimed to compare perioperative and long-term survival outcomes of LLR with OLR for this HCC. HCC patients with BCLC stage A who underwent OLR or LLR in two medical centres were enrolled in the study. PSM analysis was performed to match patients between the LLR cohort and OLR cohort. Survival was analysed based on the Kaplan-Meier method. Independent risk factors were identified by Cox regression. After PSM, 35 patients remained in the LLR cohort, and 84 remained in the OLR cohort. Patients in the LLR cohort had more intraoperative blood loss (p=0.036) and shorter hospital stays after surgery (p<0.001). The LLR cohort and OLR cohort had no difference in intraoperative blood transfusion, surgical margin or postoperative short-term outcomes. The OS and RFS were not significantly different between the two cohorts. The OS and RFS of these two cohorts were not different in the subgroup analysis. Surgical margin was identified as an independent risk factor for tumour recurrence. For BCLC stage A large HCC patients with lesions in difficult segments, LLR was feasible and had shorter hospital stay than OLR. In addition, a surgical margin ≥1 cm could significantly decrease the recurrence probability for large HCC located in different segments without compromising short-term outcomes.

Application of deep learning algorithms to confluent flow-rate forecast with multivariate decomposed variables

Study regionSong bengue confluent in Cameroon regulates the river flow rate for hydro energy production with input from four upstream reservoirs. Study focusDeep learning models forecast a day flow rate of the Song bengue confluent. Decomposed time series multivariate variables of flow rate, precipitation, and upstream reservoir inflows, outflows, and precipitation are used. Different windows and horizons for the forecast are analyzed using deep learning models. A comparative study among the models is carried out. Input parameters are decomposed and different partitions are used as scenarios for the best partition. New hydrological insightA 7-day window and 1-day forecast yield the lowest error. The dense model is the best among the models followed by the Long-short term memory (LSTM) model, and lastly, the one-dimensional convolutional neural network (Conv1D) based on mean absolute error (MAE), mean square error (MSE), root mean squared error (RMSE), and Nash Sutcliff Efficiency (NSE). Using the scenario with all decomposed variables produces the best result with about a 50% difference in error margin. The second-best result is obtained by using only undecomposed data. The remainder component should not be ignored as it contains important hydrological information.

Abstract P1-09-05: Effect of Wire vs Magnetic Seed Localization on Lumpectomy Cavity Size

Abstract Purpose/Objectives To assess whether an association exists between surgical localization technique and size of lumpectomy cavity on radiation (RT) planning CT scan. Adjuvant RT with boost to lumpectomy cavity has been shown to improve local control compared to adjuvant whole breast radiation alone, but larger cavity sizes can lead to worse cosmetic outcomes following boost administration, which could lead providers to omit boost. Therefore, decreasing cavity size could increase guideline-concordant boost administration and minimize adverse cosmetic outcomes. Materials/Methods A retrospective review was conducted of all patients undergoing breast conserving surgery with either wire- or magnetic seed -guided lumpectomy followed by adjuvant RT at a single institution from 2018 to 2021. Data were collected from pre-surgical work-up, surgical pathology, and radiation planning. Women undergoing bracketed wire localization and patients treated by a surgeon who only performed wire localized procedures were excluded. The primary outcome was lumpectomy cavity size as measured on planning CT. We first conducted an overlapping weights propensity score analysis to account for imbalance between groups in age, BMI, breast size as measured on planning CT scan, pre-operative imaging tumor volume, neoadjuvant therapies, lumpectomy histology (DCIS alone vs DCIS + invasive vs invasive alone vs invasive with lobular features vs no residual), and multifocality. Multivariable analysis (MVA) of CT cavity volume included the above weighted variables as well as surgeon and radiation oncologist. Secondary analyses included MVA of total pathologic volume, bivariable analysis of boost delivery, bivariable analysis of electron vs photon boost, stratification by surgeon, and fixed effect model for year of surgery. Results Of 617 women who received lumpectomy during the study period, 387 were included in final analysis. Patients who underwent seed localization were less likely to have multifocal disease, less likely to have calcifications on mammogram, more likely to have ultrasound measurements for pre-op imaging, and had smaller tumor size on pre-op imaging. Four surgeons performed all cases, with rates of seed use per surgeon ranging from 27.7% to 70.7% but generally increasing throughout the study period. There was no difference between wire and seed localization in the need for additional margins based on intra-operative margin analysis (58.4 vs 62.7%, p = 0.5). There was no difference in positive margins (6.4 vs 5.4%, p = 0.81) or second surgeries (9.4 vs 8.1%, p = 0.79). Rates of close margins were the same for DCIS (23.4 vs 17.3%, p = 0.35) and invasive carcinoma (7.6 vs 6.8%, p = 0.97) between techniques. Initial uncorrected bivariable analysis shows wire localization has a non-significant trend toward increased CT cavity volume (4.56cc, p = 0.15) and a significant association with total pathology volume (21.7cc, p = 0.004). For the primary outcome, breast size, time from surgery to simulation, and surgeon were all significantly associated with CT cavity volume but there was no significant difference by localization technique (p=0.38). For pathology volume, there was a non-significant trend toward increased specimen volume with wire localization (p = 0.07), and significant associations with BMI, histology, and pre-op imaging volume. When stratified by surgeon, there was no surgeon for whom one localization technique led to significantly different CT or pathology volume over the other. There were no significant changes of the treatment effect over time (p = 0.79). There was no significant difference between wire and seed localization in indicated boost delivery (85% vs 79%, p = 0.14) or electron boost (42% vs 56%, p = 0.13). Conclusion There was no significant difference in CT cavity size between wire localization and magnetic seed localization, suggesting that the choice between these surgical techniques does not impede RT boost delivery. Citation Format: Michael Dykstra, Jessica Thompson, Jessica Aldous, Shannon Jiang, Tasha Hughes, James Hayman, Aleksandar Dragovic, Jennifer Shah, Alfred Chang, Corey W. Speers, Michael Sabel, Lesly Dossett, Matthew Schipper, Reshma Jagsi. Effect of Wire vs Magnetic Seed Localization on Lumpectomy Cavity Size [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-09-05.

Influence of splenic flexure mobilization on postoperative and oncological outcomes following anterior resection.

Splenic flexure mobilization (SFM) during anterior resection is often debated given its increased operative complexity and lack of clear data suggesting oncological benefit. This study aimed to compare postoperative complications and 3-year oncological outcomes in patients undergoing anterior resection with and without SFM. A retrospective single center observational study was performed. Notes review was performed for all patients undergoing anterior resection over a one-year period at a high-volume institution for sigmoid and rectal cancers. Anterior resections performed for benign disease or non-colorectal cancers were excluded. One hundred seventeen patients were included and 49 (41.9%) underwent SFM. 75 (64.1%) cases were completed laparoscopically and 48 (41%) resulted in stoma formation. SFM significantly increased the risk of minor Clavien Dindo Grade 1 postoperative complications (18.4% vs. . 5.9%, P=0.03), however, it had no impact on more major postoperative complications, including anastomotic leaks (4.2% vs. . 7.1%, P=0.52). There were no significant differences in median total lymph node yield (21.0% vs. . 21.1, P=0.57) or R0 resection margin (93.9% vs. . 94.1%, P=0.96). There was a non-significant trend towards lower overall recurrence rates in the SFM group (10.2% vs. . 19.1%, P=0.19). In patients undergoing anterior resection for colorectal cancer, SFM provides no clear oncological benefit, but does increase the likelihood of minor postoperative complications. Whilst a trend towards lower overall recurrence rates was observed in the SFM group, this was not statistically significant. Therefore, SFM should be carefully considered on a case-by-case basis.

Analisis Perbandingan Profitabilitas Bank Syariah BUMN Sebelum dan Sesudah Merger Menjadi Bank Syariah Indonesia

This study is entitled Comparative Analysis of the Profitability of State-Owned Sharia Banks Before and After the Merger to Become a Bank Syariah Indonesia (BSI). The purpose of this study is to determine whether there is a difference in the profitability of the three BUMN Syariah Banks, namely BRI Syariah, BNI Syariah, and Bank Syariah Mandiri, 1 year before the merger, namely 2020 to 1 year after the merger, namely in 2021. The type of data used in this study is secondary data sourced from the financial statements of BRI Syariah, BNI Syariah, Bank Syariah Mandiri, and Bank Syariah Indonesia, with a quarterly timeline from 2020-2021. The method used in this study is the normality test and the different tests using the Independent Simple T-Test for normally distributed data and the Mann-Whitney U test for data not normally distributed. The results obtained from this study are that there is a difference in Gross Profit Margin between BRI Syariah, Bank Syariah Mandiri, and the average of the three state-owned Islamic banks 1 year before the merger and 1 year after the merger (when it has become a Bank Syariah Indonesia). At the same time, between BNI Syariah with Bank Syariah Indonesia, there is no difference. Likewise, with Net Profit Margin, there is a difference in Net Profit Margin between BRI Syariah, Bank Syariah Mandiri, and the average of the three state-owned Islamic banks 1 year before the merger and 1 year after the merger (when it has become a Bank Syariah Indonesia), while between BNI Syariah and There is no difference between Islamic Banks in Indonesia. Furthermore, there is no difference in Return on Assets and Return on Equity between BRI Syariah, BNI Syariah, Bank Syariah Mandiri, and the average of the three state-owned Islamic banks is 1 year before the merger with 1 year after the merger (when it has become a Bank Syariah Indonesia).

Is pathological upstaging to T3a renal cell carcinoma associated with a similar prognosis to non-upstaged pathologic T3a disease? A multicenter analysis.

656 Background: Pathological upstaging to T3a disease may occur following radical (RN) or partial nephrectomy (PN) for patients with T1/T2 renal cell carcinoma (RCC). While a number of studies have demonstrated increased risk of T1/T2 upstaging to pT3a compared to initial staging, a comparison of pathologically upstaged T3a RCC and T3a RCC which was not upstaged has not been performed. We sought to compare survival outcomes and predictors of outcomes in patients who underwent surgical therapy for upstaged T3a RCC versus non-upstaged pT3a RCC. Methods: We conducted a retrospective analysis of a multi-institutional dataset of patients who underwent radical (RN) or partial nephrectomy (PN) with final pathologic stage of pT3a. Patients were classified as being upstaged (US) from cT1 or cT2 or non-upstaged (NUS) with cT3a disease. Primary outcome was Overall Survival (OS)/all-cause mortality (ACM). Secondary outcomes were Cancer-Specific Survival (CSS)/Cancer-Specific Mortality (CSM), and Recurrence-Free survival (PFS)/Recurrence. Multivariable Cox regression analysis (MVA) were conducted for predictors of mortality outcomes and Kaplan Meier Analyses (KMA) were conducted to elucidate survival outcomes comparing US and NUS groups. Results: We analyzed 879 patients [US 691 (cT1 389/cT2 302); NUS 188; median follow-up 48 months). NUS had significantly greater tumor size (9.3 vs. US 7.3 cm, p&lt;0.001), but no difference in positive surgical margins (6.9% vs. 3.9%, p=0.16). MVA for ACM revealed RN (HR 4.35, p&lt;0.001), clear-cell RCC (HR 2.38, p&lt;0.001), and positive surgical margin (HR 2.24, p=0.023) were independently associated, while upstaging status was not (p=0.78). MVA for CSM demonstrated age (HR 1.04, p=0.024) and positive margin (HR 5.28, p=0.029) were independently associated, while upstaging status was not (p=0.14). MVA for recurrence revealed positive margin (HR 6.7, p=0.003) and NUS (HR 3.85, p=0.001) to be associated with increased risk. KMA Comparing NUS and US groups, revealed no difference in 5-year OS (57% NUS vs. US 56%, p=0.38), and worsened 5-year CSS (NUS 66% vs. US 75%, p=0.04) and 5-year RFS (NUS 60% vs. US 84%, p&lt;0.001). Conclusions: Pathologic upstaging to T3a RCC was associated with a lower risk of recurrence compared to non-pathologically upstaged T3a RCC; nonetheless in our analysis upstaging status was not independently associated with increased risk of cancer-specific or overall mortality in T3a RCC. Our findings also highlight the importance of complete surgical resection in the setting of T3a disease and should prompt consideration of intensified follow up, aggressive re-salvage resection and use of adjuvant therapy.

The Delta-shaped Maltese Cross Cowry Barycypraea fultoni deltoidean. ssp., (Gastropoda: Cypraeidae) and a Further Discussion About Mozambican Populations and Observations of Barycypraea and Related Genera

A new subspecies, Barycypraea fultoni deltoidei found at shallo wdepths in then orthern Transkei, South Africa is described herein. It differs from the nominate B. fultoni by the deltoidal shape and also by stronger development of the margins. A further analysis and discussion about Mozambican populations and a comparison of all four B. fultoni taxa are included. Differences in size, ratios, shape, margins and bases between the taxa are described. Further observations of Barycypraea and related genera are discussed.

The Study of Seaweed Pond Cultivation (Gracilaria sp.) in West Malangke District, North Luwu Regency

Gracilaria sp. is the most widely cultivated and traded type of seaweed because it has high economic value and has market prospects both domestically and abroad. This study aims to determine the amount of production costs, income and to determine the dynamics of marketing seaweed (Gracilaria sp.) in West Malangke District, North Luwu Regency. The research was conducted from April to May 2021. This type of research is descriptive using qualitative and quantitative approaches. The sampling method used is purposive sampling with a total sample of 42 people. Sources of data used are primary data and secondary data. Quantitative descriptive data analysis includes economic aspects and marketing aspects. The results showed; the wider the land owned by seaweed cultivators Gracilaria sp. the greater the cost (output) incurred. The average net profit received by cultivators on land &lt;1 ha is Rp. 47,040,000 per year, then on a land of 1-2 Ha earn a profit of Rp. 77,103,158 per year and on an area of ​​2-3 Ha earn a profit of Rp. 147,000,000 per year. Meanwhile, in the marketing aspect, there are two marketing institutions, namely collectors and wholesalers. In the marketing process there are differences in margins, profits and marketing efficiency obtained at each marketing agency for seaweed Gracilaria sp. The highest marketing margin for sales of seaweed Gracilaria sp. found in wholesalers, namely Rp. 2.500,-/Kg. The highest marketing profit is also found in wholesalers, which is Rp. 2,260,859,-/Kg.

Comparative analysis of setup margin calculation in cone beam CT, by van Herk formula, using two different image registration methods

ABSTRACT Introduction: This study aimed to quantify the difference in setup margin in cone beam computed tomography (CBCT) setup imaging, utilising the van Herk formula for two different image registration methods. Two alternative techniques of registration, bony landmark (BL) matching and soft tissue matching (ST) for head and neck cancer patients, were investigated. Methods: This study included 30 head and neck cancer patients who received a simultaneous integrated boost of 54–60–66 Gy in 30 fractions, using volumetric modulated arc treatment. A total of 867 CBCT images were acquired during patient setup and further analysed for setup margin calculation. A region of interest was described using a clip box between the reference and CBCT image to calculate the patient’s positional inaccuracy in three translational directions, X, Y and Z, where X was mediolateral, Y was the cranial-caudal, and Z was the anterior-posterior direction in the patient-based coordinate system, respectively. The shifts were captured by altering the BL and ST matching, and the setup margin was calculated using the van Herk formula (=2·5Σ + 0·7σ where Σ was the systematic and σ was the random error). Results: The difference between bony and ST matching in most cases was observed to be 1·4 mm in all translational directions at a 95% confidence interval and &lt;1° in all rotational directions. The rotational error was found to be below the action level (±3°); hence, no corrections related to rotational error were made. The translational setup margin for bone and ST-based registration was X (BL) = 4·6 mm, X (ST) = 4·4 mm, Y (BL) = 6·3 mm, Y (ST) = 4·7 mm, Z (BL) = 3·0 mm, Z (ST) = 3·6mm. Conclusion: Two distinct registration approaches for head-neck patient setup did not yield any significant difference in the setup margin calculation. A suitable approach for CBCT and reference CT registration technique was required for the setup margin calculation. Confusion in selecting the correct image registration procedure can result in incorrect treatment execution. The compatibility of the two registration approaches was established in this study. Image fusion was neutralised before the second match (ST) to avoid hysteresis. For setup verification using CBCT for the head and neck region, both bone and ST registration were compatible for setup verification.

Evaluation of the short-term outcomes of robotic-assisted radical resection for perihilar cholangiocarcinoma: a propensity-scored matching analysis.

The application of robotic-assisted radical resection in perihilar cholangiocarcinoma (pCCA) remains poorly defined. This study aimed to evaluate the safety and efficacy of robotic-assisted radical resection for pCCA in our institute. Between July 2017 and July 2022, pCCA patients undergoing robotic-assisted and open radical resection at First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China) were included. The short-term outcomes were compared by using propensity-scored matching (PSM) analysis. Eighty-six pCCA patients were enrolled. After PSM at a ratio of 1:2, 10 and 20 patients were assigned to the robotic-assisted and open groups, respectively. There were no significant disparities in the clinicopathological features between the two groups. The robotic-assisted group had significantly longer operation time (median: 548 vs 353 min, P = 0.004) and larger total number of lymph nodes examined (median: 11 vs 5, P = 0.010) than the open group. The robotic-assisted group tended to have a lower intraoperative blood loss (median: 125 vs 350 mL, P = 0.067), blood transfusion rates (30.0% vs 70.0%, P = 0.056), and post-operative overall morbidities (30.0% vs 70.0%, P = 0.056) than the open group, even though the differences were not statistically significant. There were no significant differences in the negative resection margin, post-operative major morbidities, or post-operative length-of-stay between the robotic-assisted and open groups (all P > 0.05). Robotic-assisted radical resection of pCCA may get a larger total number of lymph nodes examined than open surgery. Provided robotic-assisted surgery may be a feasible and safe technique for selected pCCA patients.

Pedestrians’ Road Crossing Behavior at Unprotected Mid-Blocks among Adolescents and Adults

Traffic crashes involving pedestrians often occur when the gap acceptance selected is below the minimum critical gap. Social cues and situational awareness play a key role in pedestrians’ choices when crossing roads at unprotected mid-blocks. This paper investigates the effects of conformist behavior on pedestrians’ cautiousness relative to their age group. In particular, we examine differences between adolescents (aged 13–18 years) and adults (aged 18 years or over). Video cameras were set at three urban locations in Auckland City, New Zealand. A total of 1,330 pedestrians were divided into four age groups, with adolescence used as the reference group. Risk ratios and regression analysis were used to measure the association between variables. The key finding from the observed behavior shows that group dynamics can reduce individuals’ attention to the road crossing regardless of age and gender. Although both adolescents and adults display self-regulation with various cautious behaviors, the presence of others affects their selection of the safety margin (time left to spare after crossing). Differences in the safety margins for groups of adolescents and adults largely involved the relationship amongst the group members rather than the number of people. Such findings present evidence that injury prevention strategies need to reflect the instincts and behavioral habits of different pedestrians. Encouraging a safety culture targeted specifically at various age groups that aligns with road design facilities and recognizes these behaviors will assist in the reduction of crashes involving pedestrians.

Ultrasound-assisted resection of oral tongue cancer

Background In surgical resection of squamous cell carcinoma of the oral tongue (SCCOT), achieving clear margins is important for prognosis. Insufficient histopathological margins are common, particularly deep margins. Aims/objectives The aim of the present study was to determine whether ultrasound (US)-assisted resection could decrease the proportion of insufficient histopathological deep margins in SCCOT. Material and methods 34 patients with SCCOT undergoing US-assisted resection (study group) were compared to 76 whose resections were performed without US (conventional group). Outcome measures were insufficient deep histopathological resection margins and mean difference in deep margins. Results Insufficient deep resection margins (<5.0 mm) were seen in 8 of 34 (23.5%) in the study group, compared to 31 of 76 (40.8%) in the conventional group, unadjusted RR 0.58 [95% CI 0.30–1.12; p = .11], adjusted RR 0.82 [95% CI 0.35–1.92; p = .64]. Unadjusted mean difference was 1.4 mm (95% CI 0.1–2.7, p = .04), adjusted mean difference 1.1 mm (95% CI −2.7 to 0.5, p = .19). Conclusions Intraoperative US can visualize the deep resection margins in T1/T2 SCCOT. US-assisted resection seems to decrease the number of insufficient histopathological deep margins, though the results are not statistically significant. Comparatively good results in the conventional group is one explanation for the lack of significance. Clinicaltrials.gov ID NCT04059861

Diagnostic potential of endosonography in primary and secondary esophageal tumors: retrospective study

Aim. To determine the diagnostic value of endosonography in primary and secondary esophageal tumors.&#x0D; Materials and methods. Between 2018 and 2022, 118 patients with primary and secondary esophageal changes were managed at the Blokhin National Medical Research Center for Oncology. Primary changes imply invasion of the esophagus directly by a tumor, secondary changes mean invasion of the esophageal wall by a tumor from outside, and the transition of a tumor from the stomach to the esophagus.&#x0D; Results. All patients had esophagogastroduodenoscopy combined with endoscopic ultrasound performed. Besides estimating the tumor invasion depth in the esophageal wall and the possible involvement of other structures at a distance up to 5 cm from the esophagus, the proximal margin of the tumor was examined. According to esophagogastroduodenoscopy and endoscopic ultrasound examination, the difference in the proximal margin was not more than 1.0 cm. The difference in results may be due to the submucosal nature of tumor growth.&#x0D; Conclusion. Endoscopic ultrasound examination is the most important diagnostic method to determine the proximal margin of the primary and secondary esophageal tumors and evaluate the degree of invasion into the esophageal wall, which is an essential factor for the treatment choice.

Subepithelial tumors: How does endoscopic full-thickness resection & submucosal tunneling with endoscopic resection compare with laparoscopic endoscopic cooperative surgery?

Background and study aims Endoscopic techniques are rapidly emerging for resection of subepithelial tumors (SETs). Submucosal tunneling for endoscopic resection (STER), endoscopic full-thickness resection (EFTR) and laparoscopic endoscopic cooperative surgery (LECS) are current alternatives to open surgery. In this study, we aimed to compare the three endoscopic techniques. Patients and methods Consecutive patients who underwent resection of a submucosal esophageal or gastric lesion at several tertiary care centers were included in a dedicated registry over 3 years. Demographics, size and location of resected lesion, histology of specimen, length of procedure, adverse events (AEs), duration of hospital stay, and follow-up data were collected. Results Ninety-six patients were included (47.7 % male, mean age 62): STER n = 34, EFTR n = 34, LECS n = 280. The lesions included leiomyoma, gastrointestinal stromal tumors (GISTs) and other. The mean lesion size was 28 mm (STD 16, range 20-72 mm). The majority of lesions in the EFTR and laparoscopic-assisted resection group were GISTs. There was no significant difference in clear resection margins, post-procedure complication rates, recurrence rate and total follow-up duration between the groups. However, the LECS group had a procedure time at least 30 minutes longer than STER or EFTR ( P < 0.01). Total hospital stay for the laparoscopic-assisted resection group was also longer when compared to STER (1.5) and EFTR (1.8) ( P < 0.01). Conclusions STER, EFTR, and laparoscopic-assisted resection are efficacious approaches for resection of SETs with similar R0 resection rates, complication rates, and AE rates. Laparoscopic assisted resection appears more time-consuming and is associated with a longer hospital stay.

Comparison of single-port and multi-port Retzius-sparing robot-assisted laparoscopic prostatectomy.

Dissemination of robotic surgical technology for robot-assisted laparoscopic prostatectomy (RALP) has yielded advancements including the Retzius-sparing (RS) approach and the single-port (SP) platform. The safety and feasibility of each individual advancement have been evaluated, yet there is a lack of literature comparing SP RS-RALP to conventional multi-port (MP) RS-RALP. All patients who underwent RS-RALP at our institution between January 2019 and February 2021 were retrospectively reviewed. Data regarding baseline patient and tumor characteristics, operative characteristics, and surgical outcomes were collected and analyzed using the Fisher's exact test and two-tailed unpaired t tests. 62 patients were evaluated: 31 received SP RS-RALP and 31 received MP RS-RALP. Differences in patient age, BMI, and initial PSA were not observed. Lower median lymph node yield (SP: 4 vs MP: 12, p < 0.01), lower estimated blood loss (SP: 111.2 vs. MP 157.8mL, p < 0.01), shorter operative time (SP: 207.7 vs. MP: 255.9min, p < 0.01) and decreased length of stay (SP: 0.39 vs. MP: 1.23days, p < 0.01) were observed in the SP RS-RALP cohort. No differences in positive surgical margins, complications, or biochemical recurrence rates were observed. SP RS-RALP is non-inferior to MP RS-RALP in terms of both perioperative and early oncologic outcomes. Despite the small sample size, the SP platform is a safe and feasible option for RS-RALP and confers potential benefits in the form of shorter operative time and reduced length of stay.

Prognosis of tongue squamous cell carcinoma associated with individual surgical margin and pathological features

The specific muscular structure of the tongue greatly affects margin shrinkage and tumor invasion, making the optimal surgical margin controversial. This study investigated surgical margin correlated prognosis of TSCC (tongue squamous cell carcinoma) according to margin location and its value, and the histopathologic factors which are suggestive of tumor invasion. And we would like to propose defining of the surgical margin for TSCC via prognosis according to location and margin values. We reviewed 45 patients diagnosed with TSCC who visited Seoul National University Dental Hospital (SNUDH) (Seoul, Republic of Korea) from 2010 to 2019, who were managed by a single surgical team. Patient clinical and pathological data of patients were retrospectively reviewed, and in 36 out of 45 patients, the pathologic parameters including the worst pattern of invasion (WPOI) and tumor budding were investigated via diagnostic histopathology slide reading. When standardized with as 0.25 cm anterior margins, as 0.35 cm deep margin, there was no significant difference in disease specific survival (DSS) or loco-regional recurrence-free survival (LRFS). Additionally, there was a non-significant difference in DSS and LRFS at the nearest margin of 0.35 cm (PDSS=0.276, PLRFS=0.162). Aggressive WPOI and high tumor budding showed lower survival and recurrence-free survival, and there were significant differences in close margin and involved margin frequencies. In TSCC, the value and location of the surgical margin did not have a significant relationship with prognosis, but WPOI and tumor budding suggesting the pattern of muscle invasion affected survival and recurrence-free survival. WPOI and tumor budding should be considered when setting an optimal surgical margin.

Neoadjuvant Simultaneous Integrated Boost Radiotherapy Improves Outcome for Retroperitoneal Sarcoma

<h3>Purpose/Objective(s)</h3> Standard neoadjuvant radiotherapy (RT) offers a modest abdominal control benefit in retroperitoneal sarcoma (RPS), with dose escalation limited by adjacent organs at risk. The highest risk of positive margin and recurrence are surgically defined as the region abutting vessels and the posterior retroperitoneum. Techniques selectively escalating dose in this high-risk region through simultaneous integrated boost (SIB) have been employed to eradicate the increased microscopic disease burden. We hypothesized that neoadjuvant RT with SIB will improve abdominal control, compared to the standard technique (ST). <h3>Materials/Methods</h3> Patients with non-metastatic RPS, treated with definitive intent with either ST or SIB neoadjuvant RT followed by radical resection, were identified retrospectively. The ST was defined as 1.8-2Gy/fraction homogenously encompassing the treatment volume, whereas SIB treated the entire treatment volume (1.8-2Gy/fraction) with a boost (2-2.3Gy/fraction) to the high-risk region. Differences between the two groups were assessed with Chi-square or Mann-Whitney U test, when appropriate. Abdominopelvic control (APC) was defined from the date of diagnosis, estimated with Kaplan-Meier methods, and compared via log-rank test. Age, histology, grade, and T-stage were then included with RT modality in a cox-regression multivariable analysis (MVA). <h3>Results</h3> We identified 81 patients, treated between 1/2003 and 12/2021, who received either ST (n=54) or SIB (n=27) neoadjuvant RT followed by radical resection. The cohort had an average age of 62 (26-82 years), average tumor size of 16cm (1.4-40cm), and the majority were dedifferentiated liposarcoma (58%), cT4 (27.5%), and grade 3 (66%). The average RT dose was 50Gy (32.5-59.4Gy) vs 58.2Gy (57.4-63Gy) for ST and SIB groups, respectively (p < 0.0001). There were no significant differences in age, performance status, histology, or surgical margins between SIB and ST RT groups, but SIB patients had higher proportion of cT4 tumors (57% vs 11%, p < 0.0001). With an average follow-up of 45 months (5-188 months), the overall 5-year APC was 76%, with a significant improvement utilizing SIB (96% vs. 70%, p = 0.043), when compared to ST. On MVA, SIB remained an independent predictor for APC (HR 8.7, 95%CI 1.003-75.8, p = 0.05). <h3>Conclusion</h3> Neoadjuvant RT with SIB is associated with improved abdominopelvic control in retroperitoneal sarcoma, when compared to standard RT techniques. This is remarkable given the equivalent margin status in SIB and much higher proportion of T4 disease. Prospective studies are necessary to further validate these findings.