Left-sided Group Research Articles

Different Clinical Characteristics of Right-Sided Versus Left-Sided Colonic Diverticular Complications: A Four-Year Retrospective Study in a Chinese Population.

Aim: To determine whether right-sided and left-sided colonic diverticular complications have different clinical manifestations and treatment outcomes. Methods: Patients diagnosed with diverticulitis or diverticular hemorrhage from January 2019 to December 2023 were retrieved. Patients were assigned into the right-sided group and the left-sided group according to the colon affected by diverticular complications. For each patient, age, gender, body mass index (BMI), lifestyle, clinical presentation, and concomitant medication were recorded. Clinical characteristics and treatment outcomes were compared with between the two groups. Results: A total of 123 patients were included in this study, 89 in the right-sided group and 34 in the left-sided group. Patients in the right-sided group presented a significantly lower mean age (43.33 vs. 66.35 yrs old, p < 0.0001) and a smaller proportion of patients with BMI above 25 (10.11% vs. 24.76%, p = 0.02). Left-sided group diverticulitis had a significantly higher proportion of Hinchey III to IV (29.41% vs. 1.12%, p = 0.0001) and rate of intensified conservative treatment (30.77% vs. 2.38%, p = 0.0003). Patients in the left-sided group had a higher rate of crowding of diverticula (diverticular number counted >20) (35.29% vs. 1.12%, p < 0.01). Two patients in the right-sided group and eight in the left received laparotomy because of diverticulitis. All three cases of hemorrhage were in the right-sided group. Conclusion: Compared with the left, right-sided diverticulosis is characterized by a younger age, less-virulent diverticulitis, and potentially higher hemorrhagic propensity. Different mechanisms between the groups may exist to mediate the onset and development of diverticulosis and its complications.

Association between postoperative shoulder pain and left-side laparoscopic urologic surgery: a single-center retrospective cohort study.

Postoperative shoulder pain is a common problem after laparoscopic surgery. This study aimed to investigate the association between operative side and postoperative shoulder pain following urologic laparoscopic surgery performed in the lateral recumbent position. This was a retrospective cohort study conducted at a single tertiary care center. A total of 506 patients who underwent urologic laparoscopic surgery (including adrenalectomy, radical nephrectomy, partial nephrectomy, and pyeloplasty) between January 2010 and December 2019 were included. Patients who underwent total nephroureterectomy or resection of other organs were excluded. The primary outcome was the incidence of postoperative shoulder pain. A multivariable logistic regression analysis investigated the association between the operative side and postoperative shoulder pain. Among the 506 included patients, there were an equal number of surgeries on the left and right sides. Eighty-eight patients had postoperative shoulder pain. The incidence of postoperative shoulder pain in the left-side group was significantly higher than that in the right-side group (21.3% [54/253] versus 13.4% [34/253], crude odds ratio = 1.75, 95% confidence interval [CI] 1.07-2.89). After adjustment for potential confounders (age, sex, body mass index, operation duration, operative technique, epidural block, peripheral nerve block, American Society of Anesthesiologists physical status classification, and intraoperative rocuronium dose), the left operative side was found to be associated with postoperative shoulder pain (adjusted odds ratio = 1.89, 95% CI 1.15-3.09). The left operative side is associated with an increased incidence of postoperative shoulder pain after urologic laparoscopic surgery performed in the lateral recumbent position.

The importance of Epley maneuver in posterior canal benign paroxysmal positional vertigo.

We investigated symptom scores and quality of life in unilateral posterior canal benign paroxysmal positional vertigo (BPPV) patients. In this retrospective and multicentric study, 78 patients with unilateral posterior canal BPPV (47 right-sided and 31 left-sided) were included. All patients have performed the Standard Epley maneuver. Features of the nystagmus [nystagmus duration (second), latent period (second)] and features of the disease [side (right or left-sided), disease duration (years), and recurrence of disease (present or absent)] were noted. Before and 1 week after the Epley maneuver, all patients were evaluated using the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), and Vertigo Dizziness Imbalance health-related quality of life scale (VDI-HQoL). Our results showed that VSSs of the right-sided group were significantly higher than those in the left-sided group before and 1 week after the maneuver (p<0.05). One week after the maneuver, VDI-HQoLs of the left-sided group were significantly higher than those in the right-sided group (p<0.05). In all right-sided and left-sided groups, at 1 week after the maneuver, VSSs were significantly lower, and VDI-SSs and VDI-HQoLs were significantly higher than those before the maneuver (p<0.05). As VSS values increased, VDI-SS and VDI-HQoL values decreased (p<0.05). In the left-sided group, VSS values decreased, and VDI-HQoL values increased. As disease duration increased, VSS values increased before the maneuver (p<0.05). In females, VSS values increased, and VDI-SS and VDI-HQoL values decreased before the maneuver (p<0.05). In posterior canal BPPV, the Epley maneuver effectively decreased VSS values and increased VDI-SS and VDI-HQoL values. In the left-sided BPPV group, there were lower VSS values and higher VDI-HQoL values that showed better quality of life of the patients. Older age and female gender are other factors related to lower quality of life with higher symptom scores.

Analysis of clinicopathological features and prognosis of sporadic synchronous multiple primary colorectal cancers

Analysis of clinicopathological features and prognosis of sporadic synchronous multiple primary colorectal cancers

Prognostic Relevance of Primary Tumor Sidedness in Early-stage Colorectal Cancer: An Integrated Analysis of 4 Randomized Controlled Trials (JCOG2003A).

The aim of this study was to determine the genuine prognostic relevance of primary tumor sidedness (PTS) in patients with early-stage colorectal cancer (CRC). The prognostic relevance of PTS in early-stage CRC remains a topic of debate. Several large epidemiological studies investigated survival only and did not consider the risk of recurrence so far. Patients with stage II/III adenocarcinoma of the colon and upper rectum from 4 randomized controlled trials were analyzed. Survival outcomes were compared according to the tumor location: right-sided (cecum to transverse colon) or left-sided (descending colon to upper rectum). A total of 4113 patients were divided into a right-sided group (N=1349) and a left-sided group (N=2764). Relapse-free survival after primary surgery was not associated with PTS in all patients and each stage [hazard ratio (HR) adjusted =1.024 (95% CI: 0.886-1.183) in all patients; 1.327 (0.852-2.067) in stage II; and 0.990 (0.850-1.154) in stage III]. Also, overall survival after primary surgery was not associated with PTS in all patients and each stage [HR adjusted =0.879 (95% CI: 0.726-1.064) in all patients; 1.517 (0.738-3.115) in stage II; and 0.840 (0.689-1.024) in stage III]. In total, 795 patients (right-sided, N=257; left-sided, N=538) developed recurrence after primary surgery. PTS was significantly associated with overall survival after recurrence (HR adjusted =0.773, 95% CI: 0.627-0.954). PTS had no impact on the risk of recurrence for stage II/III CRC. Treatment stratification based on PTS is unnecessary for early-stage CRC.

Functional outcome in low-ASPECTS (0-5) acute ischemic stroke treated with mechanical thrombectomy: impact of laterality explored in a single-center study.

There is no consensus regarding the influence of infarct laterality in patients with acute ischemic stroke due to anterior large vessel occlusion (AIS-LVO) treated with mechanical thrombectomy (MT), particularly in low-ASPECT (0-5) patients who were excluded from the initial MT studies and that participated in dedicated randomized-controlled trials that do not consider the side of the occlusion. We aimed to evaluate the role of infarct laterality on the clinical outcome in low-ASPECT AIS patients treated with MT. We retrospectively analyzed our institutional stroke database in our Thrombectomy-Capable Stroke Center (TCSC), including patient characteristics, procedural variables, and outcomes, between January 2015 and January 2022. Patients with acute intracranial ICA and/or proximal MCA occlusions with ASPECT ≤ 5 either on CT or MRI were included and divided into 2 groups according to the location of ischemia. The primary endpoint was a good clinical outcome at 90 days (modified Rankin Scale (mRS) score of 0-3). Between January 2015 and November 2021, 817 MT were performed, of which 82 were low-ASPECT (10.0%): 41 left-sided and 41 right-sided strokes. The rates of good clinical outcome were 30.8% (12/41) for the left-sided group and 43.6% (17/41) for the right-sided group, with a p-value of 0.349. The morality rate showed no significant difference between the two groups: 39.0% (16/41) in the right stroke group and 36.6% (15/41) in the left stroke group. The clinical outcome was not significantly influenced by stroke laterality. The results of this single-center retrospective study indicate either a lack of strength or equal value in performing mechanical thrombectomy regardless of stroke laterality.

Left-Sided Colon Cancer and Right-Sided Colon Cancer: Are They the Same Cancer or Two Different Entities?

Background Colon cancer is one of the most common cancers in the world and one of the main causes of cancer-related deaths. In Morocco, it occupies the first place among digestive cancers. Right-sided and left-sided colon cancers have different embryological, epidemiological, pathological, genetic, and clinical characteristics. This distinction leads to differences in the evolution and prognosis of the disease. This study aimed to identify epidemiological factors and clinical and pathological characteristics that can influence perioperative and prognostic outcomes in patients with right-sided colon cancer compared to those with left-sided colon cancer. Methodology We conducted a retrospective cohortstudy over a period of nine years from January 2012 until December 2020. We included 277 patients divided into two groups, namely, right colon cancer (group 1) (n = 99) and left colon cancer (group 2) (n = 178). Results The average age of our series was 57.4 years, with extremes ranging from 19 to 89 years old (SD = ±13.6451 years). The average age in the right colon group was 55.97 (SD = ±13.341 years). The average age in the left colon group was 58.18 (SD = ±13.69 years). The male gender had a predominance, with a sex ratio of 1.3 for both groups. Among the patients in group 2, 65% showed lymph node involvement on the CT scan, whereas only 34% of patients in group 1 displayed the same condition. The recurrence rate in the right-sided colon cancer group was 22.2% compared to 24.9% in the left-sided group. The five-year overall survival was estimated for the right-sided and left-sided colon cancer groups at 87% and 96.5%, respectively. In patients with stage III and IV cancer, overall survival was better for those who underwent surgery for left-sided colon cancer compared to those who underwent surgery for right-sided colon cancer (p = 0.029). In the case of vascular emboli or involvement of the perineural sheath, there was no significant difference in overall survival (p = 0.446 and p = 0.655, respectively). The three-month survival without recurrence was almost identical in both groups (31% for right-sided colon cancers and 30.9% for left-sided colon cancers). Age over 61 years was a predictive factor of poor prognosis in recurrence-free survival (hazard ratio = 3.245; p = 0.023). Conclusions We identified factors that can influence perioperative outcomes and prognosis in patients with right-sided colon cancer compared to those with left-sided colon cancer. Our findings suggest that age and lymph node involvement along with other factors play a role in the overall survival and recurrence outcomes of these patients. Further research is necessary to explore these differences and develop personalized treatment plans for patients with colon cancer.

Prognostic relevance of primary tumor sidedness in stage II/III colorectal cancer: An integrated analysis of JCOG0205, JCOG0404, JCOG0910, and JCOG1006 (JCOG2003A).

197 Background: The prognostic relevance of primary tumor sidedness (PTS) in early-stage colorectal cancer (CRC) is still debated. Several epidemiologic studies have yielded different results due to the wide variation in the quality of CRC surgery and perioperative management. This integrated analysis aimed to investigate the true prognostic relevance of PTS in stage II/III CRC among patients who received standardized surgery and perioperative management. Methods: This analysis included patients from 4 randomized controlled trials (RCTs) conducted by the Japan Clinical Oncology Group (JCOG): JCOG0205, JCOG0404, JCOG0910, and JCOG1006. All patients enrolled in these RCTs received standardized surgery with Japanese D2/D3 lymphadenectomy, and adjuvant 5-FU monotherapy was planned for all stage III patients as a protocol treatment. The data were collated, and patients with stage II/III adenocarcinoma of the colon and upper rectum were identified. For comparison, all eligible patients were categorized into a right-sided (cecum to transverse colon) group or a left-sided (descending colon to upper rectum) group. Primary outcome measures were relapse-free survival (RFS) and overall survival (OS) after primary surgery, and secondary outcome measures included OS after recurrence. Results: A total of 4,113 patients from the 4 RCTs satisfied the eligibility criteria and were divided into two groups; 1,349 right-sided and 2,764 left-sided CRC patients. Five-year RFS after primary surgery for right-sided and left-sided CRC was 79.7% and 79.9% in all patients, 89.7% and 86.9% in stage II and 77.0% and 78.3% in stage III, respectively. There was no significant difference in RFS after adjustment for patient and treatment characteristics (HRadjusted 1.024 [95% CI 0.886-1.183] in all patients, 1.327 [0.852-2.067] in stage II and 0.990 [0.850-1.154] in stage III). Five-year OS after primary surgery was 89.7% and 91.7% in all patients, 97.2% and 96.0% in stage II and 87.6% and 90.7% in stage III, respectively. There was also no remarkable difference in OS after adjustment (HRadjusted 0.879 [95% CI 0.726-1.064] in all patients, 1.517 [0.738-3.115] in stage II and 0.840 [0.689-1.024] in stage III). In total, 795 patients, including 257 right-sided and 538 left-sided CRC, had any recurrence after primary surgery. Five-year OS after a recurrence of right-sided and left-sided CRC were 39.8% and 49.8%, respectively. After adjustment, right-sided CRC had significantly worse OS after recurrence (HRadjusted 0.773 [95% CI 0.627-0.954]). Conclusions: Our results provide more robust evidence for no impact of PTS on recurrence risk and survival after standard surgery and perioperative management for stage II/III CRC. These results indicate that treatment stratification based on PTS is not necessary in early-stage CRC.

Impacts of primary tumor location on outcomes in patients undergoing hepatectomy for colorectal liver metastasis vary according to tumor burden.

The purpose of this study was to verify whether the prognostic value of primary tumor location (PTL) for patients undergoing resection for colorectal liver metastasis (CRLM) is affected by tumor burden. Patients who underwent a first curative-intent surgery for CRLM from 2006 to 2017 were enrolled. The imaging tumor burden score (TBS) was calculated as TBS2 = (maximum tumor diameter in cm)2 + (number of lesions)2. Then, the prognostic role of PTL was assessed in different TBS zones. The patient population consisted of 524 left-sided (LS) and 118 right-sided (RS) primary tumors. The distribution of TBS in the patient cohort was: Zone1: TBS <3 [n = 161 (25.1%)], zone 2: TBS ≥3 to <7 [n = 343 (53.4%)], and zone 3: TBS ≥7 [n = 138 (21.5%)]. In the whole cohort, the 5-year overall survival (OS) in the RS group was worse than that in the LS group (35.6% vs. 45.4%). However, after adjustment for known prognostic confounders, the RS group was not independently associated with a poorer OS (HR 1.18, p = 0.247). Among patients with TBS <7, OS in the RS group was significantly shorter than that in the LS group in both univariate and multivariate analyses. The prognostic role of PTL remained significant after propensity score matching or excluding patients who received anti-EGFR agents. Conversely, the association between PTL and OS was no longer evident in patients with TBS ≥7. The current study demonstrates that the prognostic value of PTL varies by TBS, and RS tumors are only associated with shorter survival in patients with low or medium TBS.

Embryologic Origin of the Primary Tumor and RAS Status Predict Survival after Resection of Colorectal Liver Metastases.

Background and objectives. In colorectal cancers, the embryologic origin of the primary tumor determines important molecular dissimilarities between right-sided (RS) and left-sided (LS) carcinomas. Although important prognostic differences have been revealed between RS- and LS-patients with resected colorectal liver metastases (CLMs), it is still unclear if this observation depends on the RAS mutational status. To refine the impact of primary tumor location (PTL) on the long-term outcomes of patients with resected CLMs, the rates of overall survival (OS), relapse-free survival (RFS) and survival after recurrence (SAR) were compared between RS- vs. LS-patients, according to their RAS status. Material and Methods. All patients with known RAS status, operated until December 2019, were selected from a prospectively maintained database, including all patients who underwent hepatectomy for histologically-proven CLMs. A log-rank test was used to compare survival rates between the RS- vs. LS-group, in RAS-mut and RAS-wt patients, respectively. A multivariate analysis was performed to assess if PTL was independently associated with OS, RFS or SAR. Results. In 53 patients with RAS-mut CLMs, the OS, RFS and SAR rates were not significantly different (p = 0.753, 0.945 and 0.973, respectively) between the RS and LS group. In 89 patients with RAS-wt CLMs, the OS and SAR rates were significantly higher (p = 0.007 and 0.001, respectively) in the LS group vs. RS group, while RFS rates were similar (p = 0.438). The multivariate analysis performed in RAS-wt patients revealed that RS primary (p = 0.009), extrahepatic metastases (p = 0.001), N-positive (p = 0.014), age higher than 65 (p = 0.002) and preoperative chemotherapy (p = 0.004) were independently associated with worse OS, while RS location (p < 0.001) and N-positive (p = 0.007) were independent prognostic factors for poor SAR. Conclusions. After resection of CLMs, PTL had no impact on long-term outcomes in RAS-mut patients, while in RAS-wt patients, the RS primary was independently associated with worse OS and SAR.

Structural Covariance of the Ipsilesional Primary Motor Cortex in Subcortical Stroke Patients with Motor Deficits.

The analysis of structural covariance has emerged as a powerful tool to explore the morphometric correlations among broadly distributed brain regions. However, little is known about the interactions between the damaged primary motor cortex (M1) and other brain regions in stroke patients with motor deficits. This study is aimed at investigating the structural covariance pattern of the ipsilesional M1 in chronic subcortical stroke patients with motor deficits. High-resolution T1-weighted brain images were acquired from 58 chronic subcortical stroke patients with motor deficits (29 with left-sided lesions and 29 with right-sided lesions) and 50 healthy controls. Structural covariance patterns were identified by a seed-based structural covariance method based on gray matter (GM) volume. Group comparisons between stroke patients (left-sided or right-sided groups) and healthy controls were determined by a permutation test. The association between alterations in the regional GM volume and motor recovery after stroke was investigated by a multivariate regression approach. Structural covariance analysis revealed an extensive increase in the structural interactions between the ipsilesional M1 and other brain regions in stroke patients, involving not only motor-related brain regions but also non-motor-related brain regions. We also identified a slightly different pattern of structural covariance between the left-sided stroke group and the right-sided stroke group, thus indicating a lesion-side effect of cortical reorganization after stroke. Moreover, alterations in the GM volume of structural covariance brain regions were significantly correlated to the motor function scores in stroke patients. These findings indicated that the structural covariance patterns of the ipsilesional M1 in chronic subcortical stroke patients were induced by motor-related plasticity. Our findings may help us to better understand the neurobiological mechanisms of motor impairment and recovery in patients with subcortical stroke from different perspectives.

Is Radiation-Induced Cardiac Toxicity Reversible? Prospective Evaluation of Patients With Breast Cancer Enrolled in a Phase 3 Randomized Controlled Trial

Myocardial perfusion defects after breast radiation therapy (RT) correlate with volume of irradiated left ventricle (LV). We aimed to determine the relationship between myocardial perfusion, LV dosimetry, and grade ≥2 late cardiac events in patients with breast cancer undergoing adjuvant RT. A randomized study evaluated the benefit of inverse-planned intensity modulated radiation therapy over forward-planned intensity modulated radiation therapy for radiation toxicity in breast cancer. A secondary endpoint was evaluating cardiac perfusion by single-photon emission computed tomography done at baseline, 6 months, 1 year, 2 years, and 5 years post-RT. We used receiver operating curve and regression analysis to identify association between perfusion, radiation dose-volumes, and the risk of late cardiac events. Of 181 patients who received adjuvant RT, 102 were patients with cancer in the left breast (called in this study the left-sided group) and 79 were patients with cancer in the right breast (called in this study the right-sided group). Median follow-up was 127 months (range, 19-160 months). A significant worsening of perfusion defects occurred after RT in the left-sided group, which improved by 1 year. Late cardiac events were found among 16 patients (17.2%) in the left-sided group and 4 patients (5.5%) in the right-sided group. Perfusion changes did not correlate with late cardiac events, but LV dose-volumes correlated with late cardiac events. Maintaining the LV volume receiving 5 Gy and 10 Gy to <42 cc and <38cc, respectively, can reduce the risk of radiation-related late cardiac events at 10 years to <5% over baseline. RT was associated with short-term perfusion defects that improved within 1 year and was not correlated with late cardiac events. The ventricular volumes receiving 5 Gy and 10 Gy were correlated with late cardiac events.

EP.FRI.12Meta-analysis of demographic and prognostic significance of right-sided versus left-sided acute diverticulitis

Abstract Aims To compare the demographic and prognostic outcomes of right-sided versus left-sided acute colonic diverticulitis Methods We performed a systematic review in accordance with the PRISMA statement standards to identify all observational studies comparing demographic factors and outcomes of right-sided versus left-sided acute colonic diverticulitis. We used the ROBINS-I tool to assess the risk of bias of included studies. Random effects modelling was applied to calculate pooled outcome data. Results Analysis of 2933 patients from nine studies suggests that right-sided diverticulitis affects younger patients (MD:-14.16,P&amp;lt;0.00001) and more male patients (OR:1.33,P=0.02) compared with left-sided diverticulitis. Smoking (OR:2.23,P&amp;lt;0.0001), alcohol consumption (OR:1.85,P=0.002) and co-morbidity (OR:0.21,P&amp;lt;0.00001) were more common in patients with right-sided diverticulitis. The risk of complicated diverticulitis was lower in the right-sided group (OR:0.21,P=0.001). More patients in the right-sided diverticulitis group had modified Hinchey stage I disease (OR:10.21,P&amp;lt;0.0001) while more patients in the left-sided group had stage II (OR:0.19,P&amp;lt;0.00001), stage III (OR:0.08,P=0.009) or stage IV disease (OR:0.02,P&amp;lt;0.00001). Right-sided diverticulitis was associated with a lower risk of recurrence (OR:0.49,P=0.04), failure of conservative management (OR:0.14,P=0.0006), the need for emergency surgery (OR:0.13,&amp;lt;0.00001) and shorter length of hospital stay (MD:-1.70,P=0.02). Conclusions Right-sided acute colonic diverticulitis predominantly affects younger male patients compared with left-sided disease and is associated with favourable outcomes as indicated by the lower risk of complications, failure of conservative management, need for emergency surgery, recurrence, and shorter length of hospital stay. More studies are required to compare the postoperative outcomes in patients with right-sided and left-sided diverticulitis undergoing emergency surgery.

Left-side vs. right-side hepatectomy for hilar cholangiocarcinoma: a meta-analysis

GoalsWe aim to draw a conclusion which type of hepatectomy could be the priority for hilar cholangiocarcinoma patients.BackgroundSurgery is established as only potentially curative treatment for hilar cholangiocarcinoma. However, whether hepatectomy should be preferred to the left-side hepatectomy, which includes left hemihepatectomy, extended left hemihepatectomy, and left trisectionectomy, or right-side hepatectomy, which represents right hemihepatectomy, extended right hemihepatectomy, and right trisectionectomy, is debated. In this meta-analysis, we evaluated and compared the efficacy and safety of left-side hepatectomy and right-side hepatectomy in patients with hilar cholangiocarcinoma.StudyWe systematically retrieved the MEDLINE, PubMed, and Cochrane library and related bibliography up to February 2020. The primary outcome is overall survival, and the secondary outcome includes 1-, 3-, and 5-year survival rates, morbidity, mortality, R0 resection rate, and operation time. Based on heterogeneity, fixed-effects model or random-effects models were established through meta-analysis.ResultsEleven studies (11 cohort studies, totally 1031 patients) were involved in this study. The overall survival of patients who underwent left-side hepatectomy was comparable to that of patients who underwent right-side hepatectomy (hazard ratio, 1.27 [95% confidence interval, 0.98–1.63]). And there was no significant difference observed in 1-year (relative risk, 1.01 [95% CI, 0.89–1.15]), 3-year (relative risk, 0.94 [95% confidence interval, 0.80–1.11]), and 5-year survival (relative risk, 0.82 [95% confidence interval, 0.67–1.01]) rates between the left-side hepatectomy group and the right-side hepatectomy group. Comparing with the right-side hepatectomy cluster, the hilar cholangiocarcinoma patients in the left-side hepatectomy cluster presented better overall postoperative morbidity (relative risk, 0.82 [95% confidence interval, 0.71–0.96]) and major postoperative morbidity (relative risk, 0.73 [95% confidence interval, 0.56–0.95]). The post-hepatectomy liver failure rate (relative risk, 0.22 [95% confidence interval, 0.09–0.56]) and procedure-related mortality (relative risk, 0.41 [95% confidence interval, 0.23–0.70]) in the left-side hepatectomy group were better than those of the right-side hepatectomy group. Besides, the R0 resection rate was similar between the left-side hepatectomy group and the right-side hepatectomy group (relative risk, 0.95 [95% confidence interval, 0.87–1.03]). And the operation time for the left-side hepatectomy was significantly longer than that for the right-side hepatectomy (mean difference, 38.68 [95% confidence interval, 7.41–69.95]).ConclusionThrough meta-analysis, we explored the comparable long-term outcomes and better short-term outcomes in the left-side hepatectomy group as is compared to the right-side hepatectomy group of hilar cholangiocarcinoma patients. In this study, the evidence obtained might indicate that the choice of left-side hepatectomy or right-side hepatectomy depends on the site of hilar cholangiocarcinoma in every patient.

Cyclic variation of integrated backscatter detects radiotherapy-induced changes better than global longitudinal strain, a three-year follow-up study in early-stage breast cancer patients

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): Paavo and Eila Salonen Legacy The Finnish Foundation for Cardiovascular Research onbehalf - Aims To characterize the early phases of radiotherapy-induced changes in myocardial deformation echocardiography. Methods Ninety-nine breast cancer patients were studied prior adjuvant treatment, after chemotherapy (CT), after radiotherapy (RT) and three years after RT (3Y). Nineteen patients with left-sided breast cancer received adjuvant CTand RT (Group A). Sixty patients with left-sided (Group B) and 20 patients with right-sided breast cancer (Group C) were treated with RT only. Echocardiography with the analysis of cyclic variation of the integrated backscatter of the septum (sCV) and the posterior wall (pCV) and global longitudinal strain (GLS) were performed. Results Group A patients had a sCV decline from baseline to after CT, after RT and at 3Y by 1.2 ± 3.4 dB (p = 0.146), 2.6 ± 3.9 dB (p = 0.010) and 4.1 ± 5.4 dB (p = 0.011), and GLS decline by 0.9 ± 1.7 % (p = 0.027), 0.1 ± 2.4 % (p = 0.848), and 0.9 ± 2.9 % (p = 0.124), respectively. Group B displayed sCV changes after RT by 1.4 ± 3.5 dB (p = 0.007) and at 3Y by 2.4 ± 3.2 dB (p &amp;lt; 0.001) and the respective GLS changes were 1.1 ± 2.7 % (p = 0.003) and 1.7 ± 3.5 % (p = 0.001). sCV changes in Group C were 1.3 ± 3.9 dB (p = 0.159) after RT and 2.0 ± 4.1 dB (p = 0.049) at 3Y whereas GLS remained stable. A late decline in pCV was observed in all groups. In the whole patient population, sCV decline was independently associated with the mean LAD dose (p = 0.023, β= -0.251), CT (p = 0.044, β= -0.240) and with the use of aromatase inhibitor (AI) (p = 0.027, β=0.251). GLS impairment was independently associated with AI (p = 0.017, β= -0.281). Conclusions Radiation-exposed septal areas displayed a significant decline early after RT in Group A and B patients in contrast to posterior wall and patients with right-sided breast cancer. In addition, the changes were independently associated with the mean LAD radiation dose. GLS had no independent association with radiation dose . CV appears to be a more sensitive marker of radiotherapy-induced changes of the myocardial contractility than GLS.

Heart-related mortality after postoperative breast irradiation in patients with ductal carcinoma in situ in the contemporary radiotherapy era

Although radiation-induced cardiotoxicity has been addressed, its prognostic relevance to modern radiotherapy (RT) techniques is unclear. This study assessed the impact of adjuvant RT on heart-related deaths in patients with ductal carcinoma in situ. Patients who underwent adjuvant RT after breast-conserving surgery between 1988 and 2008 were identified from the Surveillance, Epidemiology, and End Results database. Kaplan‒Meier and competing risks analyses were conducted after propensity score-matching according to tumor laterality. A total of 41,526 propensity-matched patients were identified (n = 20,763 for either left- or right-sided tumor). In the analysis of the cumulative incidence of heart-related mortality events, there was a greater risk increment in the left-sided group over the first to second decades after RT in patients aged ≤ 50 years (P = 0.048). Competing risks analysis of the young patients showed that left-sided RT was associated with higher heart-related mortality rates (Grey’s test, P = 0.049). The statistical significance remained after adjusting for other covariates (subdistribution hazard ratio 2.35; 95% confidence interval 1.09‒5.10). Regarding the intrinsic effect of modern RT techniques, further strategies to reduce heart-related risks are needed for young patients. Close surveillance within an earlier follow-up period should be considered for these patients in clinics.

Bridge to Surgery for Obstructing Colonic Cancer: A Comparison between Right- and Left-sided Lesions.

Objectives: Few studies have compared management and outcomes of bridge to surgery (BTS) for obstructive colonic cancer according to the location of the tumor. Additional information is needed about this procedure's characteristics and short-term and long-term outcomes. We aimed to compare patient and tumor characteristics, and outcomes of BTS for obstructive right-sided versus left-sided colonic cancers. Methods: This was a retrospective, single center, cohort study. The study cohort comprised 149 patients, including 48 with right-sided and 101 with left-sided obstructive colonic cancers, who were treated with BTS between January 2007 and December 2017. Data on medical history, investigations, treatments, and prognosis were collected from an electronic database of a single hospital. The primary end points were overall (OS) and disease-free (DFS) survival and short-term surgical outcomes. Results: Significantly more patients with right-sided cancers had postoperative complications (29.2% vs. 14.9%, p = 0.039). Additionally, postoperative chemotherapy was administered to a marginally significantly greater proportion of patients with left-sided cancers (29.2% vs 45.5%, p = 0.057). The long-term outcomes were comparable between the two groups (the 5-year OS rates were 67.6% and 80.9% [p = 0.117] and the 5-year DFS rates were 62.2% and 58.6% [p = 0.671]). Multivariate analyses using all studied variables showed that lymphovascular invasion, advanced T stage, and adjuvant chemotherapy were independent poor prognostic factors. Conclusions: The long-term outcome was not different between the right- and left-sided groups. In a BTS setting, postoperative complications may reduce the compliance of adjuvant chemotherapy in right-sided cancers and affect long-term outcomes.

Comparing right- and left sided injection-drug related infective endocarditis

The aim of the study was to compare background characteristics, microbiology and outcome of patients with right-sided and left-sided intravenous drug use (IDU) associated infective endocarditis (IE). A nationwide retrospective study using the Swedish Registry on Infective Endocarditis between 2008 and 2019 was conducted. A total of 586 people with IDU-IE were identified and divided into left-sided (n = 204) and right-sided (n = 382) IE. Descriptive statistics, Cox-regression and Kaplan–Meier survival estimates were used. The mean age of patients in the left-sided group was 46 years compared to 35 years in the right-sided group, p < 0.001. Left-sided IE had a higher proportion of females. Staphylococcus aureus was the causative pathogen in 48% of cases in the left-sided group compared to 88% in the right-sided group. Unadjusted and adjusted long-term survival was better in right-sided IE compared to left-sided IE. Independent predictors of long-term mortality were increasing age, end-stage renal disease, nosocomial infection, brain emboli and left-sided IE. Left-sided IE was common in people with IDU but the proportion of females with left-sided IE was low. S. aureus was twice as common in right-sided IE compared to left-sided IE, and the long-term prognosis of right sided IDU-associated IE was better compared to left-sided IE despite the fact that few were operated.

Compensation capacities of brain in unilateral and bilateral auditory system damage in children

Neuroplasticity is a basic feature of neuronal system which provides function rebuilt or developmental dysfunction repair. Hearing impairment can have an impact on intelligence levels, organization and structure of cognitive processes. Cognitive capacities profiles of deaf people present neuropsychological results of functional reorganization of brain. 208 children were accepted for this study. Experimental group consisted of 126 children suffering from sensorineural hearing insufficiency. 26 children were diagnosed with right-sided hearing loss, 34 children were diagnosed with left-sided hearing loss and 66 children were diagnosed with bilateral hearing loss. Control group consisted of 82 normally hearing children, confirmed in audiometric assessment. In order to establish levels of cognitive abilities and intelligence in patients enrolled for the study polish adaptation of Wechsler Intelligence Scale for Children (WISC-R) was administered. Children with bilateral hearing loss obtained worse results in verbal scale compared to well hearing controls. Verbal intelligence in control group was statistically higher than in right-sided auditory dysfunction group. Control group average result in nonverbal scale was statistically significantly higher compared to left-sided hearing loss patients. Children with right-sided auditory dysfunction obtained higher results in nonverbal scale compared to children with left-sided auditory dysfunction. Left-sided hearing impairment group had higher scores in almost all subtests of verbal scale than right-sided hearing impairment group. Left-sided auditory disability enhances linguistic capacity, which indicates compensation abilities of left hemisphere responsible for verbal processes. Right-sided auditory disability enhances analytic processes, visual synthesis and image reasoning, which indicates compensation abilities of right hemisphere responsible for nonverbal processes.

Is left-sided involvement of hepatocellular carcinoma an important preoperative predictive factor of poor outcome?

BackgroundThe tumor location is the most simple clinical factor and important in liver surgery to make surgical procedure. However, no previous study has investigated the prognostic differences and clinical features of hepatocellular carcinoma showing specific laterality. This study is the first report to focus on the laterality and aimed to lead to more simple and useful predictive factor rather than recent complicated predictive models.MethodsPatients who underwent liver resection for the first time for single tumors located within each lobe between 2000 and 2018 were enrolled. We divided them into two groups based on tumor location: a right-sided group and a left-sided group. Univariable and multivariable analyses were performed to assess survival differences in relation to several other factors.ResultsThere were 595 eligible patients; the 5-year survival rates and disease-free survival rates were 49.5% and 19.1% in the left-sided group and 55.6% and 24.5% in the right-sided group, respectively (p = 0.026). Statistical analyses revealed that the following preoperative prognostic factors were independently significant (p < 0.05) in the left-sided group: indocyanine green retention rate at 15 min, alpha fetoprotein, protein induced by vitamin K absence or antagonists-II level, and larger tumor size.ConclusionThe left-sided group had a poorer prognosis than the right-sided group. A left-sided tumor location is a significant preoperative factor predictive of poor outcome in patients with hepatocellular carcinoma.