Invasive Treatment Modality Research Articles

Attributes Associated with Adherence to Glaucoma Medical Therapy and its Effects on Glaucoma Outcomes: An Evidence-Based Review and Potential Strategies to Improve Adherence

ABSTRACTThe treatment paradigm in glaucoma classically starts with exhausting all medical therapy prior to proceeding with laser or incisional surgery, although laser-first and surgery-first strategies have been explored in randomized clinical trials. Although glaucoma drops are proven to work well to lower intraocular pressure, slow the conversion from ocular hypertension, and slow the progression of disease in early open angle glaucoma, adherence to treatment is likely optimum in the randomized clinical trials that support these claims. In real-world scenarios, medical therapy often fails and practitioners are forced to proceed with more invasive treatment modalities to slow the progression of this blinding disease. This review aims to take an evidence-based approach to study the risk factors for poor adherence in glaucoma patients, to determine whether poor adherence is, in fact, associated with worse outcomes, and to seek potential strategies to improve adherence in these patients.

Endoscopic Ultrasound Guided Necrosectomy of Walled-Off Pancreatic Necrosis Using a Lumen-Apposing Fully Covered Metal Stent and Hydrogen Peroxide: A Single Center Experience

Introduction: A natural sequela of pancreatic necrosis is the development of cystic cavities containing necrotic pancreatic tissue and fluid known as walled-off pancreatic necrosis(WOPN). Historically, surgical necrosectomy has been the mainstay of treatment; however, advances in therapeutic endoscopy have led to increased utilization of less invasive treatment modalities. We studied the use of lumen-apposing fully covered metal stents(LAMS) and hydrogen peroxide(H2O2) lavage in the management of WOPN at our academic medical center. Methods: 10 patients underwent Endoscopic Ultrasound(EUS) guided necrosectomy using LAMS and H2O2 lavage for the management of WOPN from 4/2015-4/2016. EUS was performed using a linear echoendoscope at a frequency of 7.5 MHz with CO2 gas used for insufflation. The cyst cavity was punctured using a 19-gauge needle. After stylet withdrawal in patients 1-6, a 0.035” diameter x 480cm long, straight tip guidewire was used to facilitate the passage of a 10 Fr cystotome into the necrotic cavity. Using EUS and endoscopic guidance, a 15mm x 10mm LAMS was then placed in the necroma, with placement confirmed on fluoroscopy. In patients 7-10, an electrocautery-enhanced LAMS measuring 15mm x 10mm was placed directly into the cyst over the guidewire. In all cases, a balloon was then advanced over the guidewire, through the stent, and into the necroma, followed by inflation to 15mm. The echoendoscope was then withdrawn and a forward-viewing endoscope was utilized to perform direct endoscopic necrosectomy(DEN). Upon completion of DEN, the necroma was lavaged with 100cc of 0.3% H2O2, which was not suctioned out of the cavity. PPIs were held 30 days post initial intervention. Results: The patient cohort had a median age of 52.5±15.5 years and was 60% male. The median size of the WOPN was 10±4.4cm. The technical success rate was 100%, with all patients undergoing successful LAMS placement. Clinical success was achieved in 80% of patients and resolution of WOPN was confirmed via cross-sectional imaging in these patients. Patients had a median of 2 DENs and a median follow-up of 91 days. One patient required escalation to surgical necrosectomy and one patient died 13 days post stent placement due to multisystem organ failure, not related to the procedure. Conclusion: The use of LAMS and H2O2 appears to offer patients a safe, effective and minimally-invasive alternative to surgical necrosectomy, which is associated with significant morbidity and mortality.Table 1Figure 1Figure 2

Photodynamic Therapy in Gynecologic Malignancies: A Review of the Roswell Park Cancer Institute Experience.

Photodynamic therapy (PDT) is a treatment modality used in the management of solid tumor malignancies that employs the use of a photosensitizing agent, a light source and oxygen in order to illicit a direct cytotoxic effect. Its use in gynecologic malignancies is somewhat novel and has been used for palliative and curative intent. At the Roswell Park Cancer Institute, the use of PDT in the management of gynecologic cancers began in the mid 1980s and since that time 35 patients have received PDT as a treatment for recurrent or metastatic cutaneous and vulvar, vaginal, anal, and cervical recurrences. In our experience, 85% patients with metastatic cutaneous lesions had a complete response. Twenty-seven percent of patients with metastatic vaginal, cervical or anal recurrences had a complete response to therapy with a median response time of 28 months. Side effects from the treatment included moderate to severe burning sensation, pain and edema at the treatment site requiring narcotic pain medication for symptom management in patients who underwent treatment to cutaneous lesions as well as lower genital tract recurrences. PDT should be considered an option in patients who are too frail to undergo the standard of care or decline the standard of care in lieu of a less invasive treatment modality.

Usefulness of Reduced Port Surgery for Left Colon Cancer.

Although laparoscopic surgery has made minimally invasive treatment available for colon cancer, various innovations aimed at developing even more minimally invasive treatment modalities have been reported in recent years. Needlescopic surgery, in which forceps with a small-diameter shaft are used to safely reduce invasiveness without increasing surgeons' stress, has been reported. We introduced the reduced-port surgery (RPS) technique by using needle forceps for the treatment of sigmoidal colon cancer and cancer of the rectosigmoidal region, with the aim of safely reducing invasiveness while maintaining curability. The subjects of this study were patients with sigmoidal colon and rectosigmoidal cancer who underwent laparoscopic resection between January 2012 and December 2014. The patients were divided into a conventional multiport surgery (MPS) group and an RPS group for comparison and analysis. No significant difference was observed in the operative time, volume of blood loss, incidence of postoperative complications, especially anastomotic leak, intestinal obstruction, and surgical site infection. The length of postoperative hospital stay was significantly shorter in the RPS group. Without compromising safety and curability, RPS can reduce not only the number, but also the size of incisions, and make even more minimally invasive surgery feasible. Because this procedure is relatively easy to introduce to young surgeons, we consider it to be useful.

Flow reversal bypass surgery: a treatment option for giant serpentine and dolichoectatic aneurysms-internal maxillary artery bypass with an interposed radial artery graft followed by parent artery occlusion.

Giant serpentine and dolichoectatic aneurysms (GSDAs) are a small subgroup of intracranial aneurysms that often have poor clinical outcomes and are hardly to be treated by either conservative or endovascular management. We assessed seven patients who underwent internal maxillary artery bypass using radial artery graft interposition followed by parent artery occlusion to treat GSDAs. Intraoperative Doppler ultrasonography was used to assess the patency of the graft. CT angiogram or DSA were used postoperatively. The patients received follow-up after discharge and their neurological outcomes were measured using the Glasgow Outcome Score. Postoperative angiogram demonstrated that all the grafted conduits were patent, and the aneurysms were absent in two and collapsed or shrank in five of the patients. The rate of normal life or independent daily activities after internal maxillary artery bypass in the anterior and posterior GSDA patients was 66.7 and 75%, respectively. One patient experienced postoperative frontal ischemia and was managed conservatively. His symptoms had completely resolved at discharge. No patient encountered perforator's occlusion in the series. During 2.6years follow-up, six patients experienced favorable outcomes. One patient died in the third year after discharge attribute to unrelated disease. Based on the mechanism of flow reversal, internal maxillary artery bypass with radial artery graft followed by patent artery occlusion is an effective, minimally invasive treatment modality for select patients with GSDAs.

PWE-075 Changing Patterns of Management and Outcomes for Early Oesophageal Adenocarcinomas in England and Wales

Introduction Currently only 1 in 20 oesophageal adenocarcinomas are diagnosed at early stage.1 Where patients are diagnosed at an early stage, studies have suggested that up to 90% of patients managed with curative surgical intent survive 5 years.2 In this study we investigated the changing patterns of management for oesophageal adenocarcinomas in England and Wales, and associated patient outcomes. Methods This study uses data collected for the National Oesophago Gastric Cancer Audit (NOGCA), and compares patients diagnosed in the year following 1st April 2008 (Group 1), with those diagnosed five years later in 2013 (Group 2). The study was limited to patients diagnosed with early stage (T0/1, N0, M0) oesophageal adenocarcinoma. Outcomes considered included proportion of patients managed with curative intent, curative treatment modality and patient outcomes at 1 year. Results A similar number of patients were diagnosed with early stage cancer over both time frames, Group 1 (n = 202) and Group 2 (n = 193). The proportion of patients managed with curative intent increased over the five years from 77.4% to 83.4% (chi-square test, p = 0.13). However the proportion of patients aged ≥75 years managed with curative intent increased significantly between 2008 and 2013, from 48% to 67% (p = 0.02). These increases are likely to reflect changes in curative treatment modalities. Over the last five years, there has been a significant increase in the proportion of patients managed with less invasive curative treatment modalities, with the proportion being managed endoscopically increasing from 18% to 34%, while there was a corresponding decrease in the proportion managed surgically from 76% to 61% (p = 0.007). Patients diagnosed with early cancer in 2013 who were managed with curative intent were significantly more likely to survive 1 year than those who had been diagnosed in 2008 (98% vs 93%, p = 0.05). Conclusion Outcomes for patients diagnosed with early oesophageal adenocarcinomas have improved over the last five years. Over the same period, the proportion of patients managed with less invasive endoscopic treatment modalities has increased significantly. However, it should be noted that a sizeable minority of patients are still being managed with palliative intent. The NOGCA will continue to monitor the management of this group of patients in future. References 1 Chadwick G, et al. Management and survival of patients with early stage oesophageal adenocarcinomas in England: a population-based cohort study. British Journal of Surgery. 2 Wani S, et al. Comparison of endoscopic therapies and surgical resection in patients with early esophageal cancer: a population-based study. Gastrointest Endosc. 2014;79(2):224–32.e1. Disclosure of Interest None Declared

Mo1970 An International Multicenter Study Evaluating the Clinical Efficacy and Safety of PerOral Endoscopic Myotomy (POEM) in Octogenarians

Peroral endoscopic myotomy (POEM) is currently an accepted and growing treatment modality for patients with achalasia. It is particularly appealing as a less invasive treatment modality compared to Heller myotomy in older patients; however, data on POEM in octogenarian patients (age ≥ 80 years) are scarce.

A systematic review of low-level light therapy for treatment of diabetic foot ulcer.

Diabetes mellitus (DM) is a significant international health concern affecting more than 387 million individuals. A diabetic person has a 25% lifetime risk of developing a diabetic foot ulcer (DFU), leading to limb amputation in up to one in six DFU patients. Low-level light therapy (LLLT) uses low-power lasers or light-emitting diodes to alter cellular function and molecular pathways, and may be a promising treatment for DFU. The goal of this systematic review is to examine whether the clinical use of LLLT is effective in the healing of DFU at 12 and 20 weeks in comparison with the standard of care, and to provide evidence-based recommendation and future clinical guidelines for the treatment of DFU using LLLT. On September 30, 2015, we searched PubMed, EMBASE, CINAHL, and Web of Science databases using the following terms: "diabetic foot" AND "low level light therapy," OR "light emitting diode," OR "phototherapy," OR "laser." The relevant articles that met the following criteria were selected for inclusion: randomized control trials (RCTs) that investigated the use of LLLT for treatment of DFU. Four RCTs involving 131 participants were suitable for inclusion based upon our criteria. The clinical trials used sham irriadiation, low dose, or nontherapeutic LLLT as placebo or control in comparison to LLLT. The endpoints included ulcer size and time to complete healing with follow-up ranging from 2 to 16 weeks. Each article was assigned a level of evidence (LOE) and graded according to the Oxford Center for Evidence-based Medicine Levels of Evidence Grades of Recommendation criteria. Limitations of reviewed RCTs include a small sample size (N < 100), unclear allocation concealment, lack of screening phase to exclude rapid healers, unclear inclusion/exclusion criteria, short (<30 days) follow-up period, and unclear treatment settings (wavelength and treatment time). However, all reviewed RCTs demonstrated therapeutic outcomes with no adverse events using LLLT for treatment of DFU. This systematic review reports that LLLT has significant potential to become a portable, minimally invasive, easy-to-use, and cost effective modality for treatment of DFU. To enthusiastically recommend LLLT for treatment of DFU, additional studies with comparable laser parameters, screening period to exclude rapid healers, larger sample sizes and longer follow-up periods are required. We envision future stringent RCTs may validate LLLT for treatment of DFU. Systematic review registration number: PROSPERO CRD42015029825.

Tachyarrhythmia in patients with congenital heart disease: inevitable destiny?

The prevalence of patients with congenital heart disease (CHD) has increased over the last century. As a result, the number of CHD patients presenting with late, postoperative tachyarrhythmias has increased as well. The aim of this review is to discuss the present knowledge on the mechanisms underlying both atrial and ventricular tachyarrhythmia in patients with CHD and the advantages and disadvantages of the currently available invasive treatment modalities.

Management of pediatric epistaxis in different age group in a tertiary care centre

Background: Epistaxis is a common otorhinological emergency seen in children. Aetiology and treatment differ in different age group. Methods: A retrospective study conducted in a tertiary care hospital and data of pediatric patients (under 18 year) admitted with epistaxis were divided into three different age group. Group A (2 years to <5 years), group B (5 to <12 years) and group C (12 years to 18 years) and analysed. Results: Out of 216 total patients male outnumbered female in all age groups. Trauma including nose picking was most common cause in all the three age groups (54%, 45.4% and 31% respectively). 2 nd most common cause noted was blood dyscrasia in group A (17.5%), idiopathic in group B (23.8%) and group C (22.5%). Tumours accounted for 11.3% of patients in group C. Observation alone (i.e. nasal mucosal hydration, use of topical decongestants, topical antibiotics) were the main intervention needed (70% in group A, 50% in group B and 28% in group C). Nasal packing and other methods were needed mainly in the older age groups. 61% of traumatic patients managed with observation alone whereas 55.8% of inflammatory group and 66.7% of blood dyscrasia group needed nasal packing for control of epistaxis. Conclusions: Trauma including nose picking is the most common cause of pediatric epistaxis among all age groups and usually managed well with observation alone. Nasal packing and other invasive treatment modalities are mostly needed in older age group of pediatric patients and those with non-traumatic causes of epistaxis.

Absceso esplénico: ¿drenaje percutáneo o esplenectomía?

El absceso esplénico es una entidad poco común, su incidencia es de 0,2 a 0,7 %. El trabajo diagnóstico temprano y el tratamiento oportuno han permitido un mayor número de resultados exitosos. El tratamiento convencional ha sido la esplenectomía; sin embargo, por la importancia inmunológica del bazo y la morbimortalidad del tratamiento quirúrgico, hay una tendencia al tratamiento médico y de menor invasión. En este artículo se presenta una revisión narrativa del problema con base en la literatura médica con mayor ‘evidencia’, se discuten las diferentes alternativas de tratamiento y se concluye que el tratamiento debe individualizarse a cada paciente. El drenaje percutáneo es la primera línea de tratamiento; si este fracasa, debe considerarse la esplenectomía. Aunque con tiempos quirúrgicos más prolongados, la esplenectomía laparoscópica se asocia con una reducción significativa de la morbilidad posquirúrgica.

Large proximal ureteral stones: Ideal treatment modality?

Background and Purpose:Ideal treatment modality for patients with large impacted proximal ureteral stone remains controversial. We compared laparoscopic transperitoneal ureterolithotomy (Lap-TPUL) and semirigid ureteroscopy for large proximal ureteric stones to evaluate their efficacy and safety.Patients and Methods:From November 2012 to December 2014, we enrolled 122 patients with large (≥1.5 cm) proximal ureteral stone in the study. Patients were randomly divided into two groups: Group A (60 patients), retrograde ureteroscopic lithotripsy using a semirigid ureteroscope; Group B (62 patients), transperitoneal LU (Lap-TPUL).Results:The overall stone-free rate was 71.6% and 93.5% for Group A and Group B respectively (P = 0.008). Auxiliary procedure rate was higher in Group A than in Group B (27.3% vs. 5.6%). The complication rate was 11.2% in Group B versus 25% in Group A. Mean procedure time was higher in laparoscopy group as compared to ureterorenoscopy (URS) groups (84.07 ± 16.80 vs. 62.82 ± 12.71 min). Hospital stay was 4.16 ± 0.67 days in laparoscopy group and 1.18 ± 0.38 days in URS group (P < 0.0001).Conclusion:Laparoscopic transperitoneal ureterolithotomy is a minimally invasive, safe and effective treatment modality and should be recommended to all patients of impacted large proximal stones, which are not amenable to URS or extracorporeal shock-wave lithotripsy or as a primary modality of choice especially if patient is otherwise candidate for open surgery.

Minimally Invasive Treatment of White Spot Lesions--A Systematic Review.

To evaluate the efficacy of minimally invasive methods for the treatment of white-spot lesions involving fluorides, CPP-ACP (casein phosphopeptide-stabilised amorphous calcium phosphate) and resin infiltration vs a placebo or control. According to predetermined criteria, four databases were searched for eligible studies. References of the selected articles and relevant reviews were searched for any missed publications. Eight randomised controlled trials were selected as eligible studies, and only qualitative analyses were performed because of the diversity of the interventions and outcome measures. Three studies showed significant effects of three different fluoride preparations and used DIAGNOdent and ICDAS to assess the white spot lesions. Both studies comparing resin infiltration to a placebo showed significant effects in treating white spot lesions. One study using CPP-ACP showed a significant improvement in the lesions post treatment. Evidence suggests minimally invasive treatment modalities of white spot lesions produced significant improvement in the appearance and regression of white spot lesions following treatment when compared to a control or placebo.

Minimally invasive treatment of white spot lesions

This case report elaborates the management of white spot lesion (WSL) using air microabrasion as minimally invasive treatment modality. Air microabrasion can remove the outermost layer of enamel to manage superficial discolorations and incipient carious lesions. A WSL on the maxillary left incisor was treated conservatively with air microabrasion technique. This technique might be an alternative to chemical microabrasion, macroabrasion, and invasive restorative treatments for the management of WSLs.

Our experiences on intratympanic dexamethasone usage to vertigo control in m&amp;#233;ni&amp;#232;re disease / Meniere hastaliginda vertigo kontrolunde intra timpanik deksametazon kullanimi ile ilgili tecrubelerimiz

Objective: Meniere disease is a disorder defined with vertigo and disequilibrium attacks and followed by a considerable normal equilibrium until to the next vertigo attack. The frequency of these attacks changes not only patient to patient but also in particular patient himself/herself in varying degree. Although there are studies about intratympanic corticosteroid injection treatment for the disease in the literature, the long-term efficacy of this minimally invasive treatment modality is obscure regarding with this issue. In this study, we aimed to verify long-term results in the use of intratympanic dexamethasone in patients with Meniere disease. Materials and Methods: This is a retrospective study that was performed in a tertiary referral center in which eleven patients with vertigo due to Meniere disease were evaluated. Intratympanic dexamethasone was infiltrated to diseased ear of these patients. The ratio between the number of vertigo episodes in the 6 months prior to treatment and the number of episodes in the six months between the 18th and 24th month after treatment (according to the norms of the American committee for the hearing and the equilibrium, 1995) were examined. Results: All patients improved significantly. Treatment was repeated after one year in one of the patients. Conclusion: Similarly with the published literature, the use of intratympanic dexamethasone may be useful to control vertigo due to Meniere disease to avoid or to be a prior step to other more invasive treatments.

Trabekülektomi Sonrası Bleb Yetmezliğinde Fibröz Yanıtı Baskılayıcı Tedavi: Erken Dönem Sonuçları

Objective: To evaluate the efficacy of systemic anti-inflammatory fibrosis suppression treatment in patients with early failed filtering blebs after trabeculectomy. Material and Methods: Twenty two patients who had systemic anti-inflammatory fibrosis suppression therapy (prednisone 12 mg/day, colchicine 1.5 mg/day and tiaprofenic acid 900 mg/day in 3 doses) because of early bleb failure after trabeculectomy and scored under 6 according to Indiana Bleb Appearance Grading Scale were included in the study. Intraocular pressure (IOP) measurements and bleb scores of them were examined retrospectively before the therapy and weekly for one month after the treatment. Results:Medical records of the 8 (36.4%) female and 14 (63.6%) male patients were been evaluated. There was statistically significant difference between IOP values before and at 1-2-3 and 4 weeks after initiation of treatment (p<0.000, repeated measure test). We did not determine any statistically significant difference between pretreatment period and 1st week of treatment with regard to bleb scores (p=0.973). However; bleb scores of pretreatment period were significantly different from 2nd, 3rd and 4th weeks scores (respectively, p<0.000, p<0.000, p<0.000). IOP decrease and bleb modulation was highly correlated at 2nd, 3rd and 4th weeks (respectively; r=0.729, p<0.000; r=0.751, p<0.000; r=0.864, p<0.000). Conclusion: We observed that peroral anti-inflammatory treatment is effective on IOP management and bleb modulation in early postoperative period in our study. We think that it could be an alternative to invasive treatment modalities.

Age-adjusted Charlson comorbidity index is a significant prognostic factor for long-term survival of patients with high-risk prostate cancer after radical prostatectomy: a Bayesian model averaging approach.

We investigated the long-term prognostic impact of age-adjusted Charlson comorbidity index (ACCI) on overall mortality (OM), cancer-specific mortality (CSM), and other-cause mortality (OCM) according to risk stratification in patients with prostate cancer who underwent radical prostatectomy. Data from 542 patients who underwent radical prostatectomy between 1992 and 2006 were analyzed. The impact of preoperative variables including age, prostate-specific antigen, biopsy Gleason sum, clinical stage, and ACCI on OM, CSM, and OCM were analyzed according to risk groups, with a median follow-up of 101 months. Subjects were stratified into either the high-risk group (n = 241) or the non-high-risk group (n = 301). Cox proportional hazards model demonstrated that the ACCI was the only significant predictor for OM in all patients (hazard ratio, HR 1.41; 95 % confidence interval, CI 1.19-1.66), non-high-risk group (HR 1.45; 95 % CI 1.09-1.91), and high-risk group (HR 1.37; 95 % CI 1.11-1.69). In competing risk analysis, CSM was not associated with the ACCI in either risk group. However, the ACCI had a significant impact on OCM in both the non-high-risk (HR 1.55; 95 % CI 1.16-2.1) and high-risk groups (HR 1.60; 95 % CI 1.23-2.08). A Bayesian model averaging approach verified that the ACCI was the most powerful predictor for OM and OCM in the both high-risk and non-high-risk groups. A thorough assessment of comorbidities is mandatory in establishing prognoses, even when considering invasive treatment modalities in high-risk prostate cancer patients.

Clinical analysis of retroperitoneoscopic nephroureterectomy for renal tuberculosis

ObjectivesTo explore the feasibility and safety of retroperitoneoscopic nephroureterectomy for kidney tuberculosis. MethodsForty-eight retroperitoneoscopic nephroureterectomies and thirty-five nephroureterectomies for kidney tuberculosis procedures were performed from June 2008 to December 2014. The patients consisted of 53 males and 30 females with a mean age of 36 years (range: 26–51 years). The patients' data were reviewed and analyzed. ResultsThe retroperitoneoscopic nephroureterectomy procedures were completed successfully in 48 cases with no conversions to open surgery. The mean operating time was 170 minutes (range: 121–258 minutes), the mean blood loss was 110 ml (range: 70–250 ml), and the mean hospital stay was 5.70 days (range: 5–14 days); these were all much less than nephroureterectomy procedures (P < 0.05). A total of five minor complications (10.4%) occurred, injury to the peritoneum was observed in three patients, and infection at the incision site was observed in two patients, there were no obvious difference between the two surgical methods (P > 0.05). Seventy-five patients were followed up, and the average follow-up time was 12.5 months (range: 6–20 months). All the patients recovered without any lesions remaining. ConclusionsThe results of this study indicate that retroperitoneoscopic nephroureterectomy is a feasible, safe, effective, and less invasive treatment modality for treating renal tuberculosis.

How should patients with cystine stone disease be evaluated and treated in the twenty-first century?

Cystinuria continues to be one of the most challenging stone diseases. During the latest decades our knowledge of the molecular basis of cystinuria has expanded. Today 160 different mutations in the SLC3A1 gene and 116 in the SLC7A9 gene are listed. The full implications of type A, B or AB status are not yet fully understood but may have implications for prognosis, management and treatment. Despite better understanding of the molecular basis of cystinuria the principles of recurrence prevention have remained essentially the same through decades. No curative treatment of cystinuria exists, and patients will have a life long risk of stone formation, repeated surgery, impaired renal function and quality of life. Therapy to reduce stone formation is directed towards lowering urine cystine concentration and increasing cystine solubility. Different molecules that could play a role in promoting nucleation and have a modulating effect on cystine solubility may represent new targets for cystinuria research. Investigation of newer thiol-containing drugs with fewer adverse effects is also warranted. Determining cystine capacity may be an effective tool to monitor the individual patient's response. Compliance in cystinuric patients concerning both dietary and pharmacological intervention is poor. Frequent clinical follow-up visits in dedicated centres seem to improve compliance. Cystinuric patients should be managed in dedicated centres offering the complete range of minimal invasive treatment modalities, enabling a personalized treatment approach in order to reduce risk and morbidity of multiple procedures.

Is Breast Conserving Therapy a Safe Modality for Early-Stage Male Breast Cancer?

IntroductionMale breast cancer (MBC) is a rare disease and lacks data-based treatment guidelines. Most men are currently treated with modified radical mastectomy (MRM) or simple mastectomy (SM). We compared the oncologic treatment outcomes of early-stage MBC to determine whether breast conservation therapy (BCT) is appropriate. Materials and MethodsWe searched the Surveillance, Epidemiology, and End Results database for MBC cases. That cohort was narrowed to cases of stage I-II, T1-T2N0 MBC with surgical and radiation therapy (RT) data available. The patients had undergone MRM, SM, or breast conservation surgery (BCS) with or without postoperative RT. We calculated the actuarial 5-year cause-specific survival (CSS). ResultsWe identified 6263 MBC cases and included 1777 men with stage I or II, T1-T2, node-negative disease, who had the required treatment information available. MRM without RT was the most common treatment (43%). Only 17% underwent BCS. Of the BCS patients, 46% received adjuvant RT to complete the traditional BCT. No deaths were recorded in the BCT group, regardless of stage, or in the 3 stage I surgical groups if the men had received RT. The actuarial 5-year CSS was 100% in each BCT group. MRM alone resulted in an actuarial 5-year CSS of 97.3% for stage 1% and 91.2% for stage 2. ConclusionThe results from our study suggest that BCT for early-stage MBC yields comparable survival compared with more invasive treatment modalities (ie, MRM or SM alone). This could shift the treatment paradigm to less-invasive interventions and might have the added benefit of increased functional and psychological outcomes. Further prospective studies are needed to confirm our conclusions.