High Risk Of Surgical Complications Research Articles

Society of Surgical Oncology Breast Disease Site Working Group Statement on Bilateral Risk-Reducing Mastectomy: Indications, Outcomes, and Risks.

Bilateral risk-reducing mastectomy (BRRM) is the surgical removal of both breasts to reduce the risk of cancer. In this Society of Surgical Oncology position statement, we review the literature addressing the indications, outcomes, and risks of BRRM to update the society's 2017 statement. We held a virtual meeting to outline key topics and conducted a literature search using PubMed to identify relevant articles. After literature review, recommendations were made according to group consensus. Individuals with a high lifetime risk of breast cancer due to pathogenic variants in high penetrance breast cancer-predisposition genes, early chest or breast radiation exposure, or a compelling family history should be counseled on the option of BRRM. However, BRRM is not recommended for most patients with high-risk lesions and may be contraindicated in patients who have other competing cancers and/or a high risk of surgical complications. BRRM effectively reduces the risk of breast cancer development, although the survival benefit is unclear. For patients with low-to-moderate breast cancer risk, alternative management strategies should be encouraged, including lifestyle modifications, high-risk screening, and risk-reducing medications. Discussions of BRRM should cover: (1) breast-cancer risk estimates; (2) the procedure's degree of risk reduction and impact on survival; (3) surgical techniques, potential surgical complications and long-term sequelae; and (4) alternatives to surgery. Surgeons should encourage shared and informed decision making with patients who have an elevated lifetime risk of developing breast cancer.

Surgical approach to hypertrophic cardiomyopathy: septoplasty versus transaortic myomectomy

Introduction: Hypertrophic cardiomyopathy (HCM) is a genetic disorder characterized by asymmetric hypertrophy of the myocardium, often resulting in left ventricular outflow tract (LVOT) obstruction. This condition affects approximately 1 in 500 individuals in the general population and is one of the leading causes of sudden death in young people. Surgical treatment is indicated when clinical management fails to relieve symptoms and reduce the risk of adverse events. The two main surgical approaches for obstructive HCM are septoplasty and transaortic myomectomy, aiming to improve blood flow and reduce the intraventricular gradient. However, there is disagreement in the literature regarding which technique offers better long-term outcomes. Objective: The study aims to compare the surgical outcomes of septoplasty and transaortic myomectomy in patients with obstructive hypertrophic cardiomyopathy, evaluating the efficacy of both techniques in reducing symptoms, relieving LVOT obstruction, incidence of postoperative complications, and long-term survival. Methodology: A systematic review was conducted following PRISMA guidelines, with a search in PubMed, Embase, Scopus, Web of Science, and Cochrane Library databases, covering January 2000 to September 2024. Randomized studies, cohorts, and case series that directly compared septoplasty and transaortic myomectomy in patients with obstructive HCM were included. Exclusion criteria included studies that did not directly compare the two techniques, isolated case reports, and narrative reviews. Two independent reviewers conducted study selection, with a third reviewer resolving any discrepancies. Results: Septoplasty showed greater efficacy in reducing symptoms and left ventricular outflow gradient, and was associated with a lower risk of immediate complications such as infection and the need for reoperation. Transaortic myomectomy, while also effective, was associated with a slightly higher risk of surgical complications, particularly in cases of complex septal anatomy. Both procedures showed comparable operative mortality rates, but septoplasty demonstrated better long-term outcomes in terms of survival and preservation of cardiac function. Conclusion: Both septoplasty and transaortic myomectomy are effective techniques for the treatment of obstructive HCM, with septoplasty being preferred due to its lower morbidity profile and better long-term outcomes. However, transaortic myomectomy may be indicated in cases of extensive septal hypertrophy or complex anatomy. Surgical decisions should be individualized, taking into account patient characteristics and the surgical team's experience. Future studies are needed to evaluate the nuances of long-term outcomes in different patient populations.

Comparative efficacy of microimplant-assisted rapid palatal expansion versus surgically assisted rapid palatal expansion in the treatment of maxillary transverse discrepancy

Background: The maxillary transverse discrepancy is an arch-length reduction that has an unsatisfactory effect on the aesthetics of the face and position while resulting in functional damage. Because of these variations, the goal of this study is to assess the efficacy, stability, and potential adverse effects of Microimplant-Assisted Rapid Palatal Expansion (MARPE) and Surgically Assisted Rapid Palatal Expansion (SARPE) in MTD in adolescents and adults. Methods: An electronic search was conducted in five distinct databases, and the findings contained only peer-reviewed literature from 2018 to 2024. Randomised controlled studies comparing the efficacy of MARPE and SARPE in inducing skeletal and dental alterations, treatment stability, and relapse rates were among the study selection criteria. Data extraction included a review of patient demographics, types of therapies provided, outcomes obtained, and side effects noted. Results: The findings of the study demonstrate that both procedures are appropriate for the treatment of MTD, but MARPE provides advantages in terms of morbidity and patient satisfaction, whilst SARPE may provide faster and more stable outcomes in some circumstances. This study encourages doctors to consider individual patient needs before determining which maxillary transverse discrepancy treatment strategy to use. Conclusion: This study discovered that the MARPE has superior skeletal results and stability than the SARPE, albeit with a higher risk of surgical complications. It is critical to ensure that the unique patient population is carefully selected.

Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse

Background:Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms. Objective:A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus. Conclusion:The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove meshcarries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.

Unusual anatomical variants of infrahyoid muscles - case report.

Anatomical anomalies of neck muscles are rarely observed and usually comprise variations of digastric and omohyoid muscles. Neck muscles' abnormalities might be correlated with embryological development and are observed in individuals with aneuploidies such as Edward's syndrome (18-trisomy) or Down syndrome (21-trisomy). Some infrahyoid muscles are important landmarks during surgery, therefore their anatomical variations of these muscles are related to higher risk of surgical complications. Herein, we present a rare case of infrahyoid muscles anomalies found during routine dissection of male cadaver. Redundant muscle bellies of sternohyoid muscle (sternohyoid azygos muscle), presence of levator glandulae thyroideae and also one hypoplastic superior belly of the omohyoid muscle were observed. Presence of muscle fibers within found structures was confirmed using Masson's trichrome staining method.

Hartmann's Procedure Versus Intersphincteric Abdominoperineal Excision in Patients with Rectal Cancer: Report from the Swedish Colorectal Cancer Registry (SCRCR).

The primary outcome was to compare overall postoperative surgical complications within 30 days after Hartmann's procedure (HP) compared with intersphincteric abdominoperineal excision (iAPE). The secondary outcome was major surgical complications (Clavien-Dindo ≥ III). There is uncertainty regarding the optimal surgical method in patients with rectal cancer when an anastomosis is unsuitable. Rectal cancer patients with a tumor height >5 cm, registered in the Swedish Colorectal Cancer Registry who received HP or iAPE electively in 2017-2020 were included, (HP, n = 696; iAPE, n = 314). Logistic regression analysis adjusting for body mass index, American Society of Anesthesiologists classification, sex, age, preoperative radiotherapy, tumor height, cancer stage, operating hospital, and type of operation was performed. Patients in the HP group were older and had higher American Society of Anesthesiologists scores. The mean operating time was less for HP (290 vs 377 min). Intraoperative bowel perforations were less frequent in the HP group, 3.6% versus 10.2%. Overall surgical complication rates were 20.3% after HP and 15.9% after iAPE (P = 0.118). Major surgical complications were 7.5% after HP and 5.7% and after iAPE (P = 0.351). Multiple regression analysis indicated a higher risk of overall surgical complications after HP (odds ratio: 1.63; 95% confidence interval = 1.09-2.45). HP was associated with a higher risk of surgical complications compared with iAPE. In patients unfit for anastomosis, iAPE may be preferable. However, the lack of statistical power regarding major surgical complications, prolonged operating time, increased risk of bowel perforation, and lack of long-term outcomes, raises uncertainty regarding recommending intersphincteric abdominoperineal excision as the preferred surgical approach.

Advanced Imaging Guidance for Ductus Venosus Stenting in Obstructed Total Anomalous Pulmonary Venous Return.

Obstructed infracardiac total anomalous pulmonary venous return is nearly always a surgical emergency in which infants present in severe cardiopulmonary distress. Ductal venosus stenting can provide a temporizing option for premature, low birth weight infants with high risk for surgical complications. In challenging anatomic cases, virtual reality, 3D-printed models, and fusion image guidance can aid in procedural planning and provide support for successful intervention.

Distinct risk profiles for short-term surgical complications and venous thromboembolism exist among extensor mechanism repair procedures.

Extensor mechanism injuries, which comprise patella fractures, patella tendon tearsand quadriceps tendon tears, are severely debilitating injuries and a common cause of traumatic knee pathology that requires surgical intervention. Risk factors for short-term surgical complications and venous thromboembolism (VTE) in this population have not been well characterised. The aim of this study was to identify perioperative risk factors associated with these short-term complications. The National Surgical Quality Improvement Program database was used to identify patients who underwent an isolated, primary extensor mechanism repair from 2015 to 2020. Patients were stratified by injury type. Demographic data were collected and compared. A multivariate logistic regression was used to control for demographic and comorbid factors while assessing risk factors for developing short-term complications. A total of 8355 patients were identified for inclusion in this study. Overall, 3% of patients sustained short-term surgical complications and 1% were diagnosed with VTE within 30 days of surgery. Patella fracture fixation had a nearly twofold higher risk for surgical complications compared to quadriceps tendon repair (p = 0.004). Patella tendon repair had a twofold higher risk for VTE (p = 0.045), specifically deep vein thrombosis (p = 0.020), compared to patella fracture fixation. Increasing age, smokingand American Society of Anesthesiologists Classifications 3 and 4 were also found to be risk factors for surgical complications (p = 0.012, p = 0.004, p = 0.011 and p = 0.032, respectively). This study used a nationally representative, widely validated, peer-reviewed database to provide valuable insights into risk factors for short-term postoperative complications associated with extensor mechanism repair procedures, revealing notable differences in risk profiles among distinct surgical procedures. The results of this study will inform surgeons and patients in enhancing risk assessment, guiding procedure-specific decision-making, optimising preoperative care, improving postoperative monitoringand contributing to future research of extensor mechanism injuries. Level III.

The impact of sex on stroke care: From epidemiology to outcome

BackgroundCarotid stenosis and atrial fibrillation are key risk factors for development of hemispheric strokes. In this review we aim to identify sex-specific differences in the pathophysiology and treatment of these risk factors and areas for future study. Key findingsWomen are underrepresented in research studies of stroke in patients with carotid disease and atrial fibrillation. However, key differences have been found between men and women that suggest that the development of carotid disease and atrial fibrillation occur at later stages of life and are associated with higher severity of stroke. Some treatments, including surgical treatment, seem to have different rates of efficacy and women and women are at higher risk of surgical complications. This suggests that treatment recommendations may need to be sex specific. ConclusionEfforts should be made to address research and treatment gaps in women with stroke risk factors. This may lead to the development of sex-specific recommendations for stroke prevention and treatment.

Is Preoperative Bevacizumab Associated with Increased Complications After Urgent Hip Fracture Surgery? A Retrospective Review.

To investigate whether patients with impending or completed fracture of the proximal femur who were treated with bevacizumab in the six weeks prior to surgery are at higher risk of surgical complications than patients given bevacizumab outside of the six-week period. We retrospectively reviewed cases of hip fracture treated between 1995 and 2020 at our institution. Patients were included if they were age 18 years or older, underwent hip surgery for impending or completed fracture, and received bevacizumab preoperatively but not postoperatively. Charts were reviewed for demographic, surgical, and postoperative details. A Cox model was applied to assess whether the timing of preoperative bevacizumab administration (≤6 weeks vs. >6 weeks) was associated with the risk of a postoperative complication. Two of the 23 patients who received bevacizumab ≤6 weeks before surgery experienced complications (deep vein thrombosis [n=1] and intraoperative fracture related to progression of disease [n=1]). Of the 53 patients who received bevacizumab more than six weeks preoperatively, five experienced complications (wound drainage [n=2] and deep vein thrombosis [n=3]). In the Cox model, timing of bevacizumab was not associated with postoperative complications (univariable hazard ratio, 0.92; 95% confidence interval, 0.18-4.73). In this cohort of patients who underwent surgery for hip fractures, we did not observe an increased risk of postoperative complications among those who received bevacizumab within six weeks of surgery relative to those who received bevacizumab more than six weeks before surgery. The retrospective nature of the study and small sample size are limiting factors in this study.

Challenges in the care and treatment of patients with extreme obesity.

Obesity is a prevalent chronic disease. The management of extreme obesity - i.e., body mass index (BMI) ≥ 50 kg/m2 or obesity class IV and V - is still far from ideal. Individuals with extreme obesity have a high risk of surgical complications, mortality, comorbidities, and reduced weight loss following bariatric surgery. Although lifestyle changes and anti-obesity medications are recommended for all patients with extreme obesity as adjuvants to weight loss, these measures are less effective than bariatric surgery. As a first step, sleeve gastrectomy or an inpatient very-low-calorie diet should be incentivized to enhance weight loss before definitive surgery. Although malabsorptive procedures lead to greater weight loss, they are associated with an increased risk of early complications and malnutrition. Nonstandard techniques employed in clinical trial protocols, such as transit bipartition, may be performed as they maintain a weight loss potency comparable to that of the classic duodenal switch but with fewer nutritional problems. Anatomical causes should be investigated in patients with postoperative suboptimal clinical response or recurrent weight gain. In these cases, the initiation of anti-obesity drugs, endoscopic therapies, or a conversion procedure might be recommended. More studies are needed to address the specific population of patients with extreme obesity, as their outcomes are expected to be distinct from those of patients with lower BMI.

MELD score predicts short-term outcomes after surgical management of proximal humerus fractures: a matched analysis.

We aimed to evaluate the difference in 30-day outcomes after surgical management of proximal humerus fractures (PHFs) between patients with and without chronic liver disease as defined by a MELD score greater than 10. This was a retrospective database review. All centers participating in the American College of Surgeons National Surgical Quality Improvement Program database were included. Patients with proximal humerus fractures who (1) underwent ORIF, HA, or SA and (2) had calculable MELD scores were included. Open reduction and internal fixation, hemiarthroplasty, or shoulder arthroplasty was used for treatment. Thirty-day complications, mortality, readmission, and reoperation rates were measured. Of the total 1732 PHF patients identified, 300 had a MELD score higher than 10. After propensity matching by significant covariates, MELD score higher than 10 was found to be significantly associated with higher rates of 30-day mortality, 30-day readmission, transfusion within 72 hours, and systemic complications. Among patients with a MELD score higher than 10, treatment with SA or HA instead of ORIF was associated with a higher rate of transfusion and longer operative time. There were no significant differences between treatment cohorts regarding mortality, reoperation, readmission, or complications. A MELD score higher than 10 is associated with higher risk of surgical complications, transfusion, and death in patients undergoing surgery for proximal humerus fractures. Among patients with a MELD score higher than 10, ORIF was associated with a lower transfusion rate and shorter operative time than arthroplasty or hemiarthroplasty. Prognostic Level III.

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.

Impact of preoperative frailty on the surgical and survival outcomes in older patients with solid cancer after elective abdominal surgery

Frailty is common in older patients with cancer; however, its clinical impact on the survival outcomes has seldom been examined in these patients. This study aimed to investigate the association of frailty with the survival outcomes and surgical complications in older patients with cancer after elective abdominal surgery in Taiwan. We prospectively enrolled 345 consecutive patients aged ≥65 years with newly diagnosed cancer who underwent elective abdominal surgery between 2016 and 2018. They were allocated into the fit, pre-frail, and frail groups according to comprehensive geriatric assessment (CGA) findings. The fit, pre-frail, and frail groups comprised 62 (18.0%), 181 (52.5%), and 102 (29.5%) patients, respectively. After a median follow-up of 48 (interquartile range, 40-53) months, the mortality rates were 12.9%, 31.5%, and 43.1%, respectively. The adjusted hazard ratio was 1.57 (95% confidence interval [CI], 0.73-3.39; p=0.25) and 2.87 (95% CI, 1.10-5.35; p=0.028) when the pre-frail and frail groups were compared with the fit group, respectively. The frail group had a significantly increased risk for a prolonged hospital stay (adjusted odds ratio, 2.22; 95% CI, 1.05-4.69; p=0.022) compared with the fit group. Pretreatment frailty was significantly associated with worse survival outcomes and more surgical complications, with prolonged hospital stay, in the older patients with cancer after elective abdominal surgery. Preoperative frailty assessment can assist physicians in identifying patients at a high risk for surgical complications and predicting the survival outcomes of older patients with cancer.

MIRIZZI SYNDROME, DESCRIPTION, ETIOLOGY, EPIDEMIOLOGY, PATHOPHYSIOLOGY, CLASSIFICATION, HISTOPATHOLOGY, PRESENTATION, DIAGNOSIS, TREATMENT, PROGNOSIS AND COMPLICATIONS

Introduction: Mirizzis syndrome, named after the Argentine surgeon Pablo Luis Mirizzi who first reported the syndrome in 1948, when he showed a history of a patient who presented a calculus of considerable size impacted in the infundibulum of the gallbladder, which generated jaundice due to extrinsic compression of the common bile duct. We speak of Mirizzi syndrome when there is an impaction of a calculus in the infundibulum of the gallbladder or the cystic duct that crushes the common hepatic duct, weakening it and forming a cholecystocholedochal fistula. Objective: to detail the current information related to Mirizzi syndrome, description, etiology, epidemiology, pathophysiology, classification, histopathology, presentation, diagnosis, treatment, prognosis and complications. Methodology: a total of 45 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 33 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: Mirizzi Syndrome, obstruction, common bile duct, gallstone, hepatic duct. Results: Mirizzi syndrome is relatively infrequent, occurring in only 0.1% of patients with gallstones with findings in 0.7% to 25% of patients who have undergone cholecystectomy. Between 5% to 28% of individuals with Mirizzi syndrome had gallbladder cancer following cholecystectomy. The modification of the anatomy and the cholecystocoledocian fistula increase the risk of damage to the biliary tract in the surgical act of cholecystectomy. Regarding classification type I was present in 40% of cases, type II, type III and type IV in 20% each. Conclusions: Mirizzi syndrome, also called extrinsic biliary compression syndrome, is an infrequent complication of chronic cholecystitis and cholelithiasis secondary to obliteration of the cystic duct or gallbladder infundibulum (Hartmanns pouch) generated due to the impact of one or more calculi. The impacted stone plus the inflammatory response produces the obstruction of the external biliary tract, with which the mucosa will erode and form a cholecystohepatic or cholecystocoledocian fistula. The risk of presenting gallbladder cancer increases with Mirizzi syndrome. The most common presentation is obstructive jaundice and right upper quadrant pain accompanied by epigastric pain, dark urine, nausea, tachycardia, vomiting, anorexia, fever and chills. The beginning of the diagnosis should be made with the usual tests for cholecystitis.Right upper quadrant abdominal ultrasound is currently the first-line study for the diagnosis of gallstones and acute cholecystitis. If a gallstone in the common bile duct is suspected by ultrasound, magnetic resonance cholangiopancreatography should be performed. This is followed by endoscopic retrograde cholangiopancreatography (ERCP) performed by a trained gastroenterologist. Conventionally the treatment of Mirizzi syndrome is surgical. Cholecystectomy is the first-line treatment; in case of fistula, open cholecystectomy with bilioenteric anastomosis, possibly with a Roux-en-Y is effective. In individuals without fistula, the prognosis is usually positive. In elderly patients with multiple comorbidities and high risk of surgical complications, non-surgical methods should be considered to minimize the morbidity associated with surgery. KEY WORDS: Mirizzi, syndrome, obstruction, duct, calculus, common bile duct, hepatic.

Malignant bowel obstruction: a comparison among pre-operative factors, surgical approaches, and survival. Is surgery worthwhile?

Background: Malignant bowel obstruction (MBO) is defined as the evidence of obstruction distally to the Treitz ligament in the presence of a malignant peritoneally disseminated neoplasm. Patients with this condition suffer from decreased quality of life due to impaired food intake, recurrent nausea, and abdominal pain. The objective was to investigate the outcome of patients with MBO surgically treated, considering post-treatment survival, surgical morbidity, and length of hospital stay, in order to assess the efficiency and impact of surgery at this advanced stage of disease. Methods: We reviewed retrospectively data collected from 198 patients diagnosed with MBO at Instituto do Câncer do Estado de São Paulo (ICESP), operated between 2018 and 2021. Results: Among preoperative factors, advanced stages and poor clinical status were associated with earlier death (stage IV had 4.53 higher chance of death). On the other hand, patients considered candidates for invasive life support measures had longer postoperative survival (non-candidates had a chance 1,000,000 times higher of death). Primary diagnosis also showed to be an important risk factor: ovary malignancies had higher risk of surgical complications (OR of 14.28), when compared to gastric and colon cancers. Considering intraoperative factors, patients who underwent resections had better long-term survival (9.9 months) than those who underwent bypass (1.3 months) or stomas (2 months); p=0.017. Finally, considering post-operative factors, long-term survival was associated with shorter hospital stay (p=0.001). Conclusions: Medical and surgical treatment should be employed on a case-by-case basis, after taking into consideration multiple pre-operative factors, such as KPS and primary tumor stage.

Case report of optimizer implantation to modulate cardiac contractility in patients with chronic heart failure and atrial fibrillation

A cardiac contractility modulation device is a new treatment used in patients with heart failure. CCM therapy is associated with an increase in physical activity tolerance, improved quality of life, reduced hospitalizations due to heart failure, and reverse remodeling of the left ventricle in patients with systolic heart failure. In this case, the clinical benefit of cardiac contractility modulation in a patient with chronic heart failure, atrial fibrillation and postinfarction left ventricle aneurysm was reported. Development of postinfarction left ventricle aneurysm in patients with reduced ejection fraction is associated with a high risk of surgical complications. However, an adequate assessment of the functional reserve of the left ventricle myocardium and the choice of surgical correction method allows for receiving favorable outcomes of surgery. We present a case of a successful combination of interventional and surgical treatment of a patient with heart failure and post-infarction left ventricular aneurysm.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Rate of occult neck nodal metastasis in primary and salvage laryngectomy.

Transcatheter aortic valve implantation in patient with Heyde’s syndrome

Clinical case of an 85-year-old patient with Heid’s syndrome is being reported: recurrent gastrointestinal bleeding due to angiodysplasia of the stomach and intestines in combination with acquired destruction of large von Willebrand factor multimers in severe aortic stenosis. Actually it remains difficult to make a diagnosis in these patients and perform timely surgical intervention. Considering the age of the patient, severity of manifestations of heart failure and high risk of surgical complications, transcatheter aortic valve implantation (TAVI) was the method of choice. Surgical correction of heart disease in this case is aimed not only at treating its clinical manifestations, but also at eliminating the cause of recurrent gastrointestinal bleeding in Hyde’s syndrome.

Surgical resection versus transarterial chemoembolization followed by moderately hypofractionated radiotherapy in hepatocellular carcinoma.

Transarterial chemoembolization (TACE) is the gold standard treatment in intermediate hepatocellular carcinoma (HCC), but long-term disease control rates remain low. Herein, we compared results of TACE followed by hypofractionated radiotherapy (TACE-hRT) to surgical resection (SR) in early single or paucinodular intrahepatic HCC. Between June 2004 and November 2016, data on 160 consecutive patients with Barcelona Clinic Liver Cancer (BCLC) stageA Child-PughA HCC treated with SR or TACE-hRT in our expert center were retrospectively reviewed. Time to progression (TTP), progression-free survival (PFS), and overall survival (OS) were evaluated. Clinical outcomes were compared using the stabilized-weights inverse probability of treatment weighting propensity score. Ninety-eight patients underwent SR and 62were treated by TACE-hRT. Median total dose of RT was 54 Gy (interquartile range [IQR] 54-54) in 3‑Gy fractions. Median OS follow-up was 93months. TTP did not significantly differ between patients following SR and TACE-hRT, with 1‑year rates of 68.2% and 82.6% (p = 0.17), respectively. In contrast, PFS and OS were lower in the TACE-hRT group (p = 0.015 and p = 0.006), with amedian OS of 37vs. 63months for patients with surgery and TACE-hRT, respectively. In multivariate analysis, asignificant negative impact on PFS and OS was seen for age at diagnosis, on TTP for alcohol-related liver disease, and on OS for total number of HCC nodules. Symptomatic grade ≥ 3 adverse events were presented by42 (42.9%) SR and19 (30.6%) TACE-hRT patients (p = 0.17). In patients presenting Child-PughA BCLC‑A HCC with high risk for surgical complications, TACE-hRT can be an effective and safe treatment. However, surgical management remains the standard of care whenever possible.