Higher Rate Of Surgical Complications Research Articles

Abstract PO2-22-10: Surgical outcomes after neoadjuvant chemotherapy with and without immunotherapy in patients with triple negative breast cancer

Abstract Background: The KEYNOTE-522 trial demonstrated that the addition of neoadjuvant pembrolizumab to neoadjuvant chemotherapy (NAC) for the treatment of early-stage triple negative breast cancer (TNBC) significantly improves rates of both pathologic complete response (pCR) and event-free survival. The impact of adding immunotherapy to NAC on surgical outcomes, however, is unknown. The purpose of this study is to compare 90-day surgical complication rates and timing to subsequent adjuvant therapy of patients undergoing neoadjuvant chemotherapy for stage I-III TNBC with and without immunotherapy. Methods: Patients treated at University of California, Los Angeles with neoadjuvant therapy for TNBC between 2018-2022 were identified retrospectively. Patient comorbidities, tumor characteristics, type of surgery, 90-day postoperative minor and major complications, timing to adjuvant therapy, and oncologic outcomes were reviewed and analyzed. Major complications were defined as those requiring reoperation or hospitalization. Results: A total of 44 patients were included, 15 patients received neoadjuvant chemotherapy with immunotherapy (NAC-I) and 29 patients received neoadjuvant chemotherapy alone (NAC). There was no difference in patient comorbidities between the groups. Compared to the NAC group, significantly more patients in the NAC-I group had stage II or III tumors (58.6% vs. 86.7%, respectively, p=0.028). 73% of patients in the NAC-I group underwent mastectomy compared to only 44% of patients in the NAC group (p=0.111). In total, 23 patients underwent reconstruction with mastectomy, 6 patients underwent immediate DIEP flap (4 in NAC-I group and 2 in NAC group) and 17 underwent immediate tissue expander (7 in NAC-I and 10 in NAC group). 80% of patients in the NAC-I experienced a pCR compared to only 44% in the NAC group (p=0.026). A total of 15 patients (34.1%) experienced surgical complications and there was no significant difference in the complication rate between the groups (p= 0.552). Five patients (33%) in the NAC-I group experienced minor complications of seroma requiring aspiration (n=4), cellulitis requiring antibiotics (n=1), or wound dehiscence requiring local wound care (n=2). No patients in the NAC-I group had major complications. Ten patients (33%) in the NAC group experienced complications, including 6 minor complications and 4 major complications including postoperative bleeding or flap necrosis requiring unplanned return to surgery or hyperbaric oxygen treatment. On multivariable regression analysis, controlling for patient characteristics, tumor stage, and preoperative immunotherapy, only younger age was a statistically significant variable associated with increased risk of surgical complications (p=0.012). Median time to adjuvant therapy, including radiation and/or systemic therapy, was similar between NAC-I and NAC groups, at 32 and 36 days, respectively (p=0.37). In the NAC-I group, 14 patients (93.3%) had adjuvant systemic therapy including pembrolizumab alone (n=12), pembrolizumab with olaparib (n=1) or capecitabine alone (n=1). In the NAC group, 11 patients (37.9%) underwent adjuvant systemic treatment including chemotherapy with either capecitabine (n=1), pembrolizumab (n=1), or olaparib (n=2); or single agent capecitabine (n=6) or olaparib (n=1). Conclusions: Despite patients in the NAC-I group having more advanced stage tumors and undergoing more extensive surgery and reconstruction compared to those in the NAC alone group, a significantly higher rate of surgical complications was not observed in the NAC-I group and there was no significant difference in time to adjuvant therapy between the two groups. Similar to results from the KEYNOTE-522 trial, more patients in the NAC-I group experienced a pCR compared to NAC alone. Larger studies are needed to continue to assess and optimize the surgical safety of neoadjuvant immunotherapy with chemotherapy in patients with TNBC. Citation Format: Anouchka Coste Holt, Maurice Berkowitz, Nicholas McAndrew, Courtney Smith, Jennifer Baker, Nimmi Kapoor. Surgical outcomes after neoadjuvant chemotherapy with and without immunotherapy in patients with triple negative breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-10.

Nutritional care for cancer patients: are we doing enough?

Malnutrition is associated with higher rates of surgical complications, increased anticancer treatment toxicities, longer hospital stays, higher healthcare costs, poorer patient quality of life, and lower survival rates. Nutritional support has been shown to improve all of these outcomes. However, the nutritional care of cancer patients is still suboptimal and several issues remain unresolved. Although the effectiveness of nutritional support depends on the timeliness of intervention, assessment of nutritional status is often delayed and perceived as unimportant. When diagnoses of malnutrition are made, they are rarely recorded in medical records. Hospitals lack medical staff dedicated to clinical nutrition, making it difficult to integrate nutritional care into the multidisciplinary management of cancer patients. Outside the hospital, nutritional support is hampered by heterogeneous reimbursement policies and a lack of adequate community nutrition services. In addition, an increasing number of patients are turning to potentially harmful "anti-cancer" diets as trust in medicine declines. Adopting mandatory nutrition screening, monitoring quality of care metrics, providing nutrition education to care providers, and implementing telehealth systems are some of the most urgent interventions that need to be established in the future.

Comparative analysis of surgical treatment modalities for a popliteal pterygium: a meta-analysis.

Popliteal pterygium syndrome is a rare congenital disorder characterized by orofacial, cutaneous, musculoskeletal, and genital anomalies. The popliteal pterygium (PP) affects ambulation due to severe knee flexion contracture and equinovarus deformities. Surgical treatment aims to correct these deformities while preserving limb sensibility. However, due to its rarity, surgical guidelines are lacking. A meta-analysis according to PRISMA guidelines was conducted to summarize and compare surgical methods for PP. 183 paper were identified in PubMed and data from 32 articles were analyzed, including patient demographics, treatment modalities (Ilizarov fixator, femoral osteotomy, skin/soft tissue procedures, hamstring release, nerve surgery, and amputation), pre- and post-operative abilities to walk, knee joint parameters, complications, and recurrent contractions. Among 58 patients (87 limbs), Ilizarov fixator demonstrated improved knee and ankle mobility postoperatively, but showed a relatively high surgical session count and complication rates. Femoral osteotomy achieved successful knee posture correction with fewer sessions and no complications. Isolated skin/soft tissue procedures improved flexion contracture and mobility, though they required several procedures. Hamstring release achieved notable contracture reduction but also necessitated multiple interventions. Nerve surgery and amputation had limited data, warranting further investigation. The management of PP demands a comprehensive approach, considering individual patient characteristics and treatment outcomes. While different surgical modalities offer distinct benefits, a classification or guideline to treat this deformity is still lacking. Further research is essential to validate findings, refine treatment approaches, and enhance the quality of life for individuals with PP.

342 Systematic Review of Disparities in Treatment, Surgical Management, Outcomes by Race and Insurance Status Disparities in Spine Oncology

INTRODUCTION: Healthcare disparities within neurosurgery and spine surgery have been documented with respect to race and insurance type. To date, there has not been a systematic review of disparities in spinal oncology access, treatment and outcomes. METHODS: A systematic review was performed following PRISMA guidelines with a strategy to identify disparities broadly within spine oncology using the following MeSH terms: “spinal neoplasms,” “healthcare disparities,” “race,” “insurance status,” and “socioeconomic status.” Studies were included and excluded based on pre-established criteria. RESULTS: Out of a total of 400 papers, 17 papers were reviewed. Black patients with spine oncologic conditions experienced decreased access to care and disparities in treatment modalities offered when compared to non-Black patients. Further, when minority and white patients were compared, differences were seen in the clinical presentation of symptoms and in-hospital outcomes. Minority patients were found to have longer postoperative length of stay and higher rates of surgical complications. A similar trend is seen when comparing Medicaid patients versus privately insured patients with respect to access to treatment and differences in treatment modality. Furthermore, patients with public insurance experienced higher rates of postoperative mortality compared to those with private insurance. CONCLUSIONS: Disparities within the treatment of spine oncology patients are present with respect to factors such as race, socioeconomic status, and insurance type. Further exploration into the root causes for these disparities should be performed to inform policy and programs aimed at establishing equity for the care of spine oncology patients.

Glucose Lability and Complications in Diabetic Ankle Fractures

Introduction/Purpose: Rotational ankle fractures in diabetics have long posed difficult clinical challenges, with several observational studies noting increased risk of complications and amputation following treatment of unstable ankle fractures in diabetics. Several treatment options exist, including non-operative management, external fixation, open reduction internal fixation, staged fixation, and fusion. Hemoglobin A1C produces a mean blood glucose level over a three-month period. There is mounting evidence that glucose variability may be an alternative predictor of complication profile in non-orthopedic procedures, as well as in the total joint arthroplasty literature. The purpose of this investigation is to retrospectively analyze complication rates for diabetics with rotational ankle fractures at a single institution and assess their association with both the hemoglobin A1C and glucose variability. Methods: After obtaining Institutional Review Board approval, all patients from 2015-2022 with a diagnosis of diabetes and ankle fracture were retrospectively identified based on ICD-9/ICD-10 codes. These charts were manually reviewed to determine fracture classification and treatment. For operatively and non-operatively managed ankle fractures, the patient’s hemoglobin A1C was recorded when available within 3 months of the date of injury. Glucose variability was calculated using a coefficient of variation. Results: Two-hundred patients were included for analysis, of which 29% (n=58) were treated non-operatively. The majority of surgically treated patients underwent acute ORIF (58%, n=116). 8.5% were treated with staged fixation, 3.5% with acute hindfoot fusion, and 1% with external fixation alone. The overall complication rate was 27.5% (n=55). There were no statistically significant differences in both A1C (7.81 +/- 1.89 vs 7.73 +/- 1.96) and glucose variability, as measured by the covariance of variation (0.23 +/- 0.15 vs 0.20 +/- 0.13) in patients who did and did not experience postoperative complications. Higher glucose variability did trend towards predicting complications, though not in a statistically significant fashion (OR=1.57, p=0.35). Conclusion: Ankle fractures in patients with diabetes pose a challenge for orthopedic surgeons, as evidenced by the high medical and surgical complication rate observed in this study and others. No statistical significance was found between higher A1C and complication rate or between glucose variability and complication rate. Further investigation on the impact of glucose variability on complication rates in a larger cohort of this patient population is warranted. Univariable logistic Regression Results for the association of the odds of post-operative complication with patient characteristics.

The Negative Impacts of Sarcopenia on Primary Total Knee Arthroplasty under the Enhanced Recovery after Surgery Protocol.

Sarcopenia, as an emerging public health concern, has been associated with postoperative adverse outcomes in various surgical procedures. However, the evidence regarding the impacts of sarcopenia on total knee arthroplasty (TKA) remained limited. This study aimed to assess the impacts of sarcopenia on primary TKA based on the enhanced recovery after surgery (ERAS) protocol. This retrospective study included 291 patients who received unilateral TKA from October 2017 to May 2018 in our institution. Sarcopenia was diagnosed based on the algorithm of Asian Working Group for Sarcopenia 2019. The handgrip strength was measured using a handheld dynamometer and the muscle mass was estimated by a previously validated anthropometric equation. Patients were classified into sarcopenia group and non-sarcopenia group. The outcomes included complications, postoperative length of stay (LOS), total hospitalization cost, operative time, total estimated blood loss, blood transfusion rate, and the 12-item forgotten joint score (FJS-12) at the follow-up. The propensity score matching (PSM) was used to adjust confounding factors. We compared continuous variables using Student's t-test and the Wilcoxon Mann-Whitney U test for normal and non-normal distributions, respectively, and categorical variables with chi-square tests. Of the 291 patients, 58 (19.9%) patients were identified as having sarcopenia. After PSM, each group matched 42 patients. All matched patients were followed-up at least 5 years. Patients with sarcopenia had higher rates of surgical complications compared to the non-sarcopenia group (p = 0.019), and no significant difference was observed in 30-day readmission, and periprosthetic joint infection. The sarcopenia group had significantly longer LOS (p = 0.038), higher total hospitalization (p = 0.015) than the non-sarcopenia group. For the FJS-12 scores at follow-up, patients with sarcopenia had significantly higher scores than the non-sarcopenia group (p = 0.024). Our findings indicated sarcopenia may be a risk factor for postoperative complications, prolonged LOS, increased hospitalization cost and reduced patient satisfaction.

Does complete pathological response increase perioperative morbidity risk in rectal cancer?

The optimal management of patients with clinical complete response after neoadjuvant treatment for rectal cancer is controversial. The aim of this study is to compare the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The study hypothesis was that pCR may impact the surgical complication rate. A retrospective cohort study was conducted of a prospectively maintained database in Australia and New Zealand, the Binational Colorectal Cancer Audit, that identified patients with locally advanced rectal cancer (<15 cm from anal verge) from 1 January 2007 to 31 December 2019. Patients were included if they had locally advanced rectal cancer and had undergone NCRT and proceeded to surgical resection. There were 4584 patients who satisfied the inclusion criteria, 65% being male. The mean age was 63 years and 11% had a pCR (ypT0N0). TME with anastomosis was performed in 67.8% of patients, and the majority of the cohort received long-course radiotherapy (81.7%). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs. 14.7% and 30.6% vs. 20.8%, respectively), and the 30-day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p < 0.0012), age (p < 0.0001), preoperative N stage (p = 0.0092) and American Society of Anesthesologists (ASA) score ≥3 (p < 0.0002) did. In addition, pCR had no significant effect (p = 0.44) but male gender (p = 0.0047) and interval to surgery (p = 0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA score ≥3 (p = 0.033). Patients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not.

Challenges in treating children with optic pathway gliomas: an 18-year experience from a middle-income country.

Patients with optic pathway gliomas (OPG) have good survival rates although their long-term quality of life can be affected by the tumor or treatment-related morbidity. This retrospective study sought to describe the clinical presentation and outcomes of children with OPG at a tertiary center in Mexico. Consecutive patients <18 years-of-age with newly diagnosed OPG between January 2002 and December 2020 at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca in Guadalajara, Mexico were included. Thirty patients were identified with a median age of six years. The most frequent clinical manifestations were loss of visual acuity (40%) and headaches (23%). Neurofibromatosis-1 was found in 23.3% of the patients. Surgery, either biopsy or resection, was done in 20 of 30 patients. Two patients died shortly after initial surgery. The 5-year event-free survival (EFS) was 79.3% ± 10.8% and the 5-year overall survival was 89.5% ± 6.9%. Lower EFS was associated with age less than 3 years, intracranial hypertension at presentation, and diencephalic syndrome. Patients who received surgery as first-line treatment had a 3.1 times greater risk of achieving a performance score of less than 90 points at 6 months after diagnosis (p=0.006). Of 10 patients with vision testing, 5 had improvement in visual acuity, 4 had no changes, and one patient showed worsening. Our data suggests that favorable outcomes can be achieved with OPG in low- and middle-income countries, although a high rate of surgical complications was described leading to a lower overall survival. These data can be used prospectively to optimize treatment at this institute and other middle-income countries through a comprehensive, multidisciplinary approach.

Surgical complications of bariatric surgery among patients with rheumatic diseases.

Obesity is one the most prevalent diseases all around the world. Some studies have shown a relationship between obesity and the worsening of rheumatic disorders. Higher rates of surgical complications might also be seen among these patients. This retrospective-descriptive study was performed on 25 patients with rheumatic disease referred to Loghman Hakim Hospital (Tehran- Iran) and candidates for bariatric surgery (laparoscopic Roux-en-Y gastric and laparoscopic sleeve gastrectomy) from 2018 to 2020. Duration of hospitalization after surgery and history of post-operation surgical and rheumatic complications were assessed. Patients were followed through 6 months after surgery. The age (Mean±SD) of recruited patients was (38.4 ±10.0) years. The mean body mass index was 45.54 kg/m2 with the minimum and maximum values of 37.5 kg/m2 and 56.5 kg/m2. Among them, the prevalence of rheumatic disorders was rheumatoid arthritis 32%, psoriasis 28%, gout 16%, lupus erythematosus 8%, and other rheumatologic disorders 16%, respectively. One patient had a surgical complication that was a port site infection. One patient had a relapse of gout and other patients had remission and also, their therapeutic drugs were discontinued or reduced. Patients with rheumatic disorders revealed no higher surgical complication rate after bariatric surgery, and bariatric surgery helped disease remission among these patients.

Pedicle Subtraction Osteotomy Versus Multilevel Anterior Lumbar Interbody Fusion and Lateral Lumbar Interbody Fusion in the Treatment of Adult Spinal Deformity: Trends, Outcomes, and Cost.

Retrospective cohort study. The aim of this study was to compare the outcomes of pedicle subtraction osteotomy (PSO) with multilevel anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion (LLIF) in posterior long-segment fusion. PSO and ALIF/LLIF are 2 techniques used to restore lumbar lordosis and correct sagittal alignment, with each holding its unique advantages and disadvantages. As there are situations where both techniques can be employed, it is important to compare the risks and benefits of both. Patients aged 18 years or older who underwent PSO or multilevel ALIF/LLIF with posterior fusion of 7-12 levels and pelvic fixation were identified. 1:1 propensity score was used to match PSO and ALIF/LLIF cohorts for age, sex, and relevant comorbidities, including smoking status. Logistic regression was used to compare medical and surgical outcomes. Trends and costs were generated for both groups as well. ALIF/LLIF utilization in posterior long fusion has been steadily increasing since 2010, whereas PSO utilization has significantly dropped since 2017. PSO was associated with an increased risk of durotomy (P < 0.001) and neurological injury (P = 0.018). ALIF/LLIF was associated with increased rates of postoperative radiculopathy (P = 0.005). Patients who underwent PSO had higher rates of pseudarthrosis within 1 and 2 years (P = 0.015; P = 0.010), 1-year hardware failure (P = 0.028), and 2-year reinsertion of instrumentation (P = 0.009). Reoperation rates for both approaches were not statistically different at any time point throughout the 5-year period. In addition, there were no significant differences in both procedural and 90-day postoperative costs. PSO was associated with higher rates of surgical complications compared with anterior approaches. However, there was no significant difference in overall reoperation rates. Spine surgeons should select the optimal technique for a given patient and the type of lordotic correction required.

Life Expectancy After Diagnosis of a Vestibular Schwannoma in Patients 70 Years and Older

Over the past decades, the number of patients, especially in the older adult patient group, diagnosed with vestibular schwannoma (VS) has increased. Assuming that older adult patients have more comorbidities, a longer recovery period after surgery, a higher rate of surgical complications, and a higher mortality rate after VS surgery, a treatment strategy for this group of patients is warranted, based on clinical evidence on postsurgical survival. To evaluate the survival after diagnosis of a VS in patients 70 years and older, treated with either observation or surgery, and to compare these findings with the life span of an age-matched background population in Denmark. This was a retrospective cohort study of 624 patients 70 years and older diagnosed with VS in Denmark from 1976 to 2016. Since 1976, all patients with a VS have been registered in a national database, which contains 3637 patients. Of the included patients in this study, 477 were treated conservatively with the "wait-and-scan" strategy, and 147 were treated surgically with removal of the tumor. The survival of the patients was compared with a matched background population in Denmark. Data analysis was performed from January 1976 to January 2017. Surgery, radiotherapy, or none. The main outcome was survival among the patients and compared with the matched background population. A total of 624 patients were included (317 female patients [50.8%] and 307 male patients [49.2%]). The mean (SD) survival in the observed patients was 9.2 (4.7) years after diagnosis, whereas for the background population, the expected survival was 11 years from the mean age at diagnosis. For the surgically treated patients, the mean (SD) survival was 11.8 (6.6) years, and expected survival was 11 years for the matched background population. The mean (SD) survival was 10.7 (5.5) years in female patients and 8.9 (5.0) years in male patients. There was no significant difference in survival between treatment modalities, irrespective of tumor size. In this cohort study, survival after diagnosis of a VS in patients 70 years and older was similar in the surgical group compared with the age-matched background population. In the wait-and-scan group, the survival after diagnosis was marginally shorter, which may be associated with increased comorbidity.

Ganglioneuromas in Childhood: Hacettepe Experience With 70 Cases

BackgroundGanglioneuromas (GNs) are rare benign peripheral neuroblastic tumors (PNTs). We shared our institutional experience with childhood GNs. MethodsRecords of the children with PNTs between January 1995 and December 2021 were reviewed, and cases with histopathological diagnoses of GN were identified. Clinical, laboratory, radiological, and histopathological findings, image-defined risk factors (IDRFs), procedures, and overall outcomes were recorded. ResultsOf 668 cases with PNTs, 70 (10.4%) had GNs. The median age was 7.4 years (range, 2.6–15.7 years) (girls/boys, 41/29). Common presenting complaints were abdominal pain and cough; 33/70 cases (47.1%) were diagnosed incidentally. Primary tumors were in the abdomen in 41/70, the thorax in 25/70, the neck in 3 cases, and the pelvis in one. The median tumor size was 6.5 cm (range, 1.4–17). Fifty cases (71.4%) were staged as INRG-L1; 20 cases with IDRFs (15 single, five >1) were staged as INRG-L2. Complete and partial tumor resections were performed in 58/70 and 6/70 cases, while 6 had no resection. The overall complication rate was 17.1% (11/64). At a median follow-up of 9 years, five were lost to follow-up; 65 were alive. One patient with gross residue underwent total resection due to progression 13 years after the surgery, and one in the unresected group was lost to follow-up. Ten other cases without a complete resection experienced no tumor progression. ConclusionsGanglioneuromas are benign PNTs, and most are free of IDRFs. Even without complete resection, long-term outcomes are excellent. Guidelines should be devised considering the high surgical complication rates and benign course of GNs. Level of EvidenceCase series, IV.

Isolated Liner Exchange Versus All-Component Revision for Instability After Total Knee Arthroplasty

BackgroundInstability is a common cause for revision total knee arthroplasty (TKA). The risks and benefits of polyethylene liner exchange (LE) as compared to full metal component revision continue to be debated. The purpose of this study was to investigate the success rate and complication profiles of revision TKA for instability based on surgical procedure. MethodsThis was a retrospective study of patients undergoing revision TKA for instability from 2015 to 2019. Patients with prior revisions were excluded. 42 patients undergoing isolated polyethylene LE without an increase in constraint were compared with 48 patients undergoing full component revision revision (FCR) of both tibial and femoral components. The primary outcome was differences in rerevision for instability. Noninstability reoperations, 90-day readmissions, and lengths-of-stay were also compared. ResultsLEs had a 10.1% higher rerevision for instability rate that approached statistical significance (LE 14.3% versus FCR 4.2%, P = .092). Additionally, FCR had a 4.2% rate of aseptic loosening and a 4.2% rate of periprosthetic-joint-infection, whereas LE had none (P = .181). FCR also had a longer length-of-stay (FCR 3.0 ± 1.3 versus LE: 1.8 ± 0.9 days, P < .001). No differences were found in 90-day readmissions (LE 7.1% versus FCR 4.2%, P = .661). ConclusionAll component revision may have a higher success rate than isolated LE in addressing instability but is associated with higher rates of surgical complications. With appropriate patient selection and risk-benefit discussion, isolated LE may be a reasonable surgical option for TKA instability with a lower complication profile and length-of-stay.

Rotational gland dissection for refractory granulomatous mastitis: A single-center retrospective study

BackgroundRefractory granulomatous mastitis (RGM) is a chronic benign breast disease that commonly occurred in women of childbearing age and is usually treated with surgery, with numerous cases suffering from unsatisfied postoperative recovery of breast shape, high rates of surgical complications, and even high recurrence. This study tries to evaluate the efficacy of an innovative surgical procedure, the rotational gland dissection for the treatment of RGM. Methods129 patients with RGM who underwent surgical treatment at the Second Affiliated Hospital of Xi'an Jiaotong University between Apr. 2017 and May. 2021 were retrospectively included in this study. The article analyzed the age, local symptoms, lesion location, and size, days in hospital, recurrence rate, and satisfaction rate of the patients. ResultsPatients ranged in age from 19 to 58 years, with a median age of onset of 32 years. In 63 patients (48.84%), their lesions coverage exceeded two quadrants, and 52.71% of patients had lesions larger than 10 cm2. The average days in hospital of patients was 7.5 days, and 85.27% of them were satisfied with their post-surgery breast appearance. Within the median follow-up of 56 months, only 3.10% of patients experienced a recurrence of mastitis on the operation side. ConclusionThis novel surgical procedure we created is an effective treatment for RGM with a high success rate, high patient satisfaction, and low recurrence rate, and is significantly superior to other studies for it has the largest sample size and longest follow-up in this field.

Association of body composition and surgical outcomes in patients with early-stage breast cancer.

Breast cancer is a disease that requires multimodality treatment, and surgical resection of the tumor is a critical component of curative intent treatment. Obesity, defined as a body mass index (BMI) > 30, has been associated with increased surgical complications. Additionally, sarcopenia, a condition of gradual loss of muscle mass, has been associated with worse breast cancer treatment outcomes. Sarcopenia occurs with increased age, inactivity, and poor diet leading to patient frailty, which can increase medical treatment complications. Even patients with high BMI can have sarcopenia (termed sarcopenic obesity). We investigated the association of sarcopenia with surgical complications for breast cancer. A retrospective review was performed of patients diagnosed with breast cancer who received bioelectrical impedance spectrometry analysis of skeletal muscle mass and had surgery at our institution. Patient characteristics, treatment data, surgical type and complications were obtained from medical records. Multivariate logistic regression models were used to associate sarcopenia status and BMI with surgical complications, adjusted for other patient characteristics. We analyzed 682 patients with stage I to III breast cancer. On multivariable logistic regression controlling for age, BMI, comorbidities, and types of surgeries (lumpectomy, mastectomy with or without reconstruction), sarcopenia (p = 0.66) was not associated with surgical complications. Obesity was associated with a higher rate of surgical complications in patients who received mastectomy with reconstruction (p = 0.01). More complex surgical approaches were associated with a higher risk of surgical complications in our series. Compared with those undergoing lumpectomy or mastectomy without reconstruction, patients undergoing mastectomy with reconstruction were more likely to experience postoperative complications and obesity was associated with higher risk of complication in the latter group. We did not identify a correlation between sarcopenia and rate of adverse surgical outcomes.

Endoprosthetic reconstruction for lower extremity soft tissue sarcomas with bone involvement.

Bone resection and endoprosthetic reconstruction (EPR) in the setting of soft tissue sarcoma (STS) management is rare and incurs unique challenges. We aim to report on the surgical and oncological outcomes of this relatively previously undocumented cohort. This is a single-center retrospective review of prospectively collected data for patients who required EPRs following resection of STSs of the lower extremity. Following inclusion criteria, we assessed 29 cases of EPR for primary STS of the lower limb. The mean age was 54 years (range 18-84). Of the 29 patients, there were 6 total femur, 11 proximal femur, 4 intercalary, and 8 distal femur EPRs. Fourteen of 29 patients (48%) underwent re-operations for surgical complications, with 9 relating to infection (31%). When a matched cohort analysis was performed comparing our cohort to STSs that did not necessitate EPR, a reduced rate of overall survival and metastasis-free survival was found in those requiring EPR. This series identifies a high rate of complication from EPRs performed for STS. Patients should be cautioned about the high rate of infection, surgical complications, and lower overall survival in this setting.

A teaching video for cesarean myomectomy

Myomectomy at the time of Cesarean delivery has traditionally been avoided due to fears of excessive bleeding and higher rates of surgical complications. However, recent literature has demonstrated the safety of Cesarean myomectomy when performed by an experienced surgical team. Myomectomy at the time of Cesarean section offers many advantages, including prevention of a second surgery to remove the fibroid.At present, there are no comprehensive, reliable educational videos for teaching this procedure. Curated instructional videos on surgical procedures can teach key surgical steps without needing to enter the operating room.This video is an excerpt from a full length teaching video demonstrating the key steps in performing a Cesarean myomectomy, including patient positioning, relevant anatomy, and surgical technique. This video combines real-time operating room footage with high fidelity 3-D animation.

The effect of Parkinson’s disease on total knee arthroplasty: a systematic review and meta-analysis

PurposeThe purpose of this systematic review was to determine the effect of Parkinson’s disease (PD) on clinical outcomes and complications after total knee arthroplasty (TKA). Our systematic review was conducted to answer the following questions: (1) does TKA negatively affect clinical outcomes in patients with PD? and (2) does TKA cause more complications in patients with PD?MethodsA rigorous and systematic approach was used, and each selected study was evaluated for methodological quality. Data on study design, total number of cases enrolled, follow-up duration, PD severity, clinical outcome, and complications after TKA were analyzed.ResultsFourteen studies were included. Nine studies reported clinical scores. TKA significantly increased knee and functional scores in the PD group. However, compared with knee and functional scores in the non-PD group, the increase in scores in the PD group was not statistically significant, but tended to be less than that in the non-PD group. Eleven studies reported complications. In six studies, there was no difference in the complication rate between the PD and non-PD group or did not include a control group. In five studies, the PD group had higher medical complication rates and similar or higher surgical complication rates than the non-PD group.ConclusionsPatients with PD who underwent TKA showed satisfactory functional improvement and pain reduction. However, these outcomes were not as good as those in the non-PD group. The PD group had a higher probability of occurrence of medical complications than the non-PD group. Further, the PD group had a similar or higher surgical complication rate than the non-PD group.

Single-Stage Free Flap Reconstruction Following Extremity Sarcoma Resection: a Regional Cancer Center Experience.

Surgery remains mainstay modality of treatment of STS of extremity. In majority of patients, primary closure is possible following surgical resection of the tumor. Primary closure of wound may not be feasible in tumors with large area of skin involvement and sometimes following a whoopsprocedure. We analyzed postoperative complications and oncological outcomes in patients who underwent free flap reconstruction. Thirty-seven patients who required a free flap for reconstruction of the defect following resection of the STS were included in the study. There were 26 men and 11 women with a mean age of 40years. Seventy-three percent tumors were in lower limb; 62% patients had undergone a whoops procedure elsewhere. Flaps were fasciocutaneous in 19, myocutaneous in 15, and free muscle transfers in 3 patients. Seventeen patients had early surgical site complications. Nine patients had early flap failures. Of the 9, 6 patients had total loss of flap and in 3 the flaps were salvaged. Two patients had partial loss (< 50% of total area) of flap. Four patients had edge necrosis and two had suture diastasis. Nine patients had late surgical site complications. Four had post-radiotherapy wound dehiscence. Late SSI was noted in two. Late joint contracture and chronic lymphedema was seen in one patient each. One died due to sepsis. Statistically significant association was not found between patient, tumor or treatment-related factors and complications or flap failures. Mean duration of surgery was 7.73h. Twenty-three patients required multiple surgeries due to complications. Mean time to initiate adjuvant therapy from the date of surgery was 47days. Mean OS of the group was 67 ± 7.3months. Mean RFS was 58 ± 7.8months. Single-stage free flap reconstruction following surgical resection of extremity sarcoma is a viable option of reconstruction while salvaging the limb. Though associated with high rate of early surgical site complications, they are manageable.

Surgical and Functional Outcome after Resection of 64 Petroclival Meningiomas.

Simple SummaryMeningiomas are common brain tumors, which are generally treated by surgery or radiation. When these tumors are situated in difficult to reach locations within the skull, such as petroclival meningiomas, surgery may elicit impairments of cranial nerve function postoperatively. These may have a substantial impact on the postoperative quality of life of patients. Modern surgical strategies accept incomplete tumor removal in favor of preservation of cranial nerve function. With our study, we investigated the occurrence of these impairments and their recovery over time in a series of surgically treated petroclival meningiomas, applying different surgical approaches and postoperative radiation therapy in some patients. We were able to find favorable recovery rates of most postoperative impairments with a high rate of complete tumor removal. Preoperatively, we identified tumors unsuitable for complete removal due to their infiltration of the cavernous sinus or brain stem affection on magnetic resonance imaging.Objective: The management of petroclival meningiomas (PCMs) remains notoriously difficult due to their close association with neurovascular structures and their complex anatomy, hence the surgical paradigm change from radical to functional resection in the past. With this study, we aimed to analyze surgical and functional outcomes of a modern consecutive series of patients with PCMs. Methods: We reviewed patient charts and imaging data of 64 consecutive patients from 2006 to 2018 with a PCM resected at our institution and compared surgical and functional outcomes between subgroups stratified by surgical approach. Results: Females comprised 67.2% of patients (n = 43), with a mean age of 55 years (median 56; range 21–84). Follow-up data were available for 68.8% and reached a mean of 42.3 months (range 1–129) with a median of 28.5 months. The mean tumor diameter was 37.3 mm (standard deviation (SD) 15.4; median 37.0). Infiltration of the cavernous sinus was observed in 34 cases (53.1%), and the lesions affected the brain stem in 28 cases (43.8%). Preoperative cranial nerve palsy was observed in 73.4% of cases; trigeminal neuropathy (42.2%), hearing loss (32.8%), and impairment of vision (18.8%) were the most common. A retrosigmoid approach was employed in 47 cases (78.1%), pterional in 10 (15.6%), combined petrosal in 2 (3.1%), and transnasal and subtemporal in 1 (1.6%). Fifteen cases (23.4%) were resected in a two-staged fashion. Gross total resection (GTR) was attempted in 30 (46.9%) cases without cavernous sinus infiltration and was achieved in 21 (70.0%) of these cases. Surgical complications occurred in 13 cases (20.3%), most commonly meningitis (n = 4; 6.3%). Postoperatively, 56 patients (87.5%) developed new cranial nerve palsy, of which 36 (63.6%) had improved or resolved on last follow up. Achieving GTR was not significantly associated with higher rates of surgical complications (chi-square; p = 0.288) or postoperative cranial nerve palsy (chi-square; p = 0.842). Of all cases, 20 (31.3%) underwent postoperative radiation. Tumor progression was observed in 10 patients (15.9%) after a mean 102 months (median 124). Conclusions: Surgical resection remains the mainstay of treatment for PCMs, with perioperative cranial neuropathies exhibiting favorable recovery rates. Most essentially, the preselection of patients with hallmarks of brain stem affection and cavernous sinus infiltration should dictate whether to strive for a functionally oriented strategy in favor of radical resection.