Low Recurrence Rate In Patients Research Articles

Identifying prognostic predictors for postoperative pituitary neuroendocrine tumour recurrence: an integrated clinical, radiological, and immunohistochemistry assessment

Objective Pituitary neuroendocrine tumours (PitNETs) are the second most common type of intracranial tumour. Several studies have explored the prognostic factors for PitNETs. However, prognostic factors for postoperative PitNET recurrence remain not fully understood. This study aimed to explore potential prognostic factors for PitNET recurrence, such as surrounding tissue invasion and the extent of surgical resection in patients with postoperative PitNETs. Methods We included 106 patients who underwent PitNET surgery between 2013 and 2018, dividing them into two groups: those with recurrence and those without recurrence. Tumours were classified based on demographics, neuroradiological, and immunohistological characteristics. Univariate and multivariate analyses were used to determine factors predicting recurrence. Kaplan–Meier plots and log-rank tests were used to analyse each independent factor based on the cumulative 5-year recurrence rate. Results During the 5-year follow-up period, 29.2% of the patients (n = 31) had disease recurrence. Univariate analysis showed that predictors of recurrence included cavernous and sphenoid sinus invasions, optic chiasm compression, larger tumour volume, giant adenoma >4 cm, and gross total resection (GTR). Multivariate analysis showed that lactotroph tumour type, sphenoid sinus invasion, and GTR were independent predictors. Kaplan–Meier analysis revealed significant differences in the 5-year recurrence rate among the three independent predictors, with significantly lower recurrence rate in patients with lactotroph tumours and GTR, and a significantly higher recurrence risk in patients with sphenoid sinus invasion. Conclusions Lactotroph tumour type, sphenoid sinus invasion, and GTR are independent predictors of postoperative PitNET recurrence. This study provides insights into the factors affecting postoperative PitNET recurrence.

Good clinical outcomes and low recurrence rate in patients undergoing arthroscopic revision Latarjet for failed arthroscopic Bankart repair

BackgroundThe role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. ObjectiveTo assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. MethodsBetween 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome score (CS), and Single Assessment Numeric Evaluation (SANE). Dislocations, subluxations, complications, pre and postoperative level of activity and degree of osteoarthritis were also assessed. ResultsA total of 77 patients, mean age at revision surgery 31.2 ± 9.1 and with either one (n = 59), two (n = 13), or three (n = 4) arthroscopic previous stabilizations underwent revision surgery using arthroscopic Latarjet procedure were studied. Postoperatively, the mean ROWE and CS scores increased from 41.8 ± 16 to 90.7 ± 14.3 (p<0.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (p<0.001), respectively. WOSI decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (p<0.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using SANE score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al were found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six dislocations after revision surgery were reported (7.8%). In four failed cases an Eden-Hybinette procedure was conducted and in remaining two patients an arthroscopic extraarticular anterior capsular reinforcement was performed. Significantly decreased level of athletic activity was observed postoperatively (p= 0.01). ConclusionsArthroscopic Latarjet for revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with low rate of recurrences and complications. However, decreased level of athletic activity is expected.

The impact of additional radiofrequency ablation for atrial fibrillation substrates using with ExTRa-Mapping analysis after Cryo-ablation in patients with persistent atrial fibrillation

Abstract Background Pulmonary vein isolation (PVI) for persistent atrial fibrillation (AF) is well established. Cryo-ablation for persistent AF has been reported to be safe and effective and comparable to radiofrequency (RF) ablation in long term arrhythmia-free survival, but the outcome is limited. Phase mapping using software of ExTRa-Mapping is a new tool to clarify the real-time imaging of the AF wave dynamics. Purpose We investigated the distribution of rotors of left atrium (LA) after PVI by Cryo-ablation, and the efficacy and safety of additional RF ablation for AF substrates (rotor modification) after Cryo-ablation. Methods A total of 50 patients who underwent persistent AF ablation in our hospital were enrolled. The Cryo-ablation alone group (Cryo group; n=25) and the Cryo-ablation + additional RF substrates ablation group (Cryo+RF group; n=25) were randomly divided. First, PVI with Cryo-ablation was performed. Second, if AF did not term after PVI, the rotor of LA were analyzed using the NAVX and ExTRa-Mapping system. In Cryo+RF group, the extensive RF ablation of the PV antrum to modify the rotor area were performed (Abstract Picture 1). The recurrence rate of any atrial tachy-arrhythmia without anti-arrhythmic drugs and safety were evaluated in both groups. Results The patient characteristics (69 ± 9.2 years old, body-mass index 24 ± 3.2 kg/m2, LA diameter 43 ± 5.1 mm, left ventricular ejection fraction 60 ± 7.8 %, persistent AF duration 4.2 ± 5.1 months) did not differ between the both groups. The distribution of rotors of LA were predominantly present in the anterior (n = 36) and inferior (n = 27) walls of the LA, with only a few in the posterior wall (n = 7) in the both groups. In Cryo+RF group, except for 4 cases in which AF was termed by PVI or a rotor was not detected, extensive RF modification in anterior antrum of right pulmonary vein was performed in 18 of 21 cases. In an average follow-up of 482 ± 273 days, the recurrence rate of any atrial tachy-arrhythmia was significantly lower in Cryo+RF group compared with Cryo group (p=0.029, Abstract Picture 2). No serious complications occurred in both groups. Conclusion Additional extensive RF ablation of the PV antrum to modify the Rotor area resulted in a lower recurrence rate in patients with persistent AF.Modify the rotor areaRecurrence rate

Comparative assessment of disease recurrence after transurethral resection of non-muscle-invasive bladder cancer with and without a photodynamic diagnosis using 5-aminolevulinic acid: a propensity score-matching analysis.

Among patients with non-muscle-invasive bladder cancer (NMIBC), systematic reviews showed lower recurrence rate in patients treated with photodynamic diagnosis (PDD)-assisted transurethral resection of bladder tumor (TURBT) than with white-light (WL) TURBT. However, the result is not consistent between clinical trials and the significance of preoperatively available factors in disease recurrence after PDD-TURBT remains unclear. The present study retrospectively analyzed 1174 NMIBC patients who underwent TURBT and were followed up for ≥ 6months. Among 1174 patients, 385 and 789 underwent PDD-TURBT with oral 5-aminolevulinic acid (the PDD group) and WL-TURBT (the WL group), respectively. Recurrence-free survival (RFS) was compared between the PDD and WL groups before and after propensity score matching, and the impact of several baseline parameters on RFS between the 2 groups was investigated after matching. Before propensity score matching, RFS was significantly longer in the PDD group than in the WL group (P = 0.006). After matching, 383 patients were included in both groups, and RFS was significantly longer in the PDD group than in the WL group (P < 0.001). In the cohort after matching, RFS between the two groups was compared in each subgroup classified according to baseline parameters, including age, sex, history of previous or concomitant upper urinary tract urothelial carcinoma, preoperative urinary cytology, tumor multiplicity, and tumor size, and significantly longer RFS was observed in the PDD group in all subgroups, except for the patients with tumors ≥ 30mm (P = 0.21). These results suggest that PDD-TURBT prolongs RFS in NMIBC patients, except for those with tumors ≥ 30mm.

Is There Re-staging Surgery Necessity for Borderline Ovarian Tumors.

This study assessed the necessity of surgical re-staging in women with borderline ovarian tumors (BOTs) and evaluated the impact of complete surgical staging, lymphadenectomy, and omentectomy on disease recurrence and survival. We retrospectively reviewed the medical records of patients with BOTs. A total of 901 patients were eligible for inclusion in the study, and we evaluated some of the variables and clinical/surgical characteristics of the cases. The effects of the type of surgical procedure, surgical staging, and complete or incomplete staging on recurrence were calculated. The rates of disease-free survival, overall survival, and recurrence were compared according to complete surgical staging. A Cox regression analysis was performed to identify potential prognostic factors, and survival curves were constructed using the Kaplan-Meier method. The overall recurrence rate was 13.9%, and recurrence was comparable between the complete surgical staging group and the incomplete groups (P>0.05). The performance of complete surgical staging did not show an effect on long-term survival, and complete surgical staging, omentectomy, and lymphadenectomy had no effect on recurrence. In multivariate analyses, only radical surgery and adjuvant chemotherapy were risk factors for the recurrence of BOTs. Furthermore, we found that omentectomy led to a relatively low recurrence rate in patients with International Federation of Gynecology and Obstetrics (FIGO) stage > I (P=0.022). Our results suggest that complete surgical staging should be considered a standard treatment for patients with advanced stage BOTs but not for those at FIGO stage I. It might be safe to reduce the scope of surgical procedures in patients with early-stage BOTs. However, it is not necessary to perform re-staging operations for BOTs with a macroscopically normal extra-ovarian appearance.

Conization before radical hysterectomy in patients with early-stage cervical cancer: A Korean multicenter study (COBRA-R)

ObjectiveTo investigate the impact of conization on survival outcomes and to identify a specific population that might benefit from conization before radical hysterectomy (RH) in patients with early-stage cervical cancer. MethodsFrom six institutions in Korea, we identified node-negative, margin-negative, parametria-negative, 2009 FIGO stage IB1 cervical cancer patients who underwent primary type C RH between 2006 and 2021. The patients were divided into multiple groups based on tumor size, surgical approach, and histology. We performed a series of independent 1:1 propensity score matching and compared the survival outcomes between the conization and non-conization groups. ResultsIn total, 1254 patients were included: conization (n = 355) and non-conization (n = 899). Among the matched patients with a tumor size of >2 cm, the conization group showed a significantly better 3-year disease-free survival (DFS) rate compared with the non-conization group when RH was conducted via minimally invasive surgery (MIS), in those with squamous cell carcinoma (96.3% vs. 87.4%, P = 0.007) and non-squamous cell carcinoma (97.0% vs. 74.8%, P = 0.021). However, no difference in DFS was observed between the two groups among the matched patients with a tumor size of ≤2 cm, regardless of surgical approach or histological type. In patients who underwent MIS RH, DFS significantly worsened as the residual tumor size increased (P < 0.001). ConclusionCervical conization was associated with a lower recurrence rate in patients with early-stage cervical cancer with a tumor size of >2 cm who underwent primary MIS RH. Cervical conization may be performed prior to MIS RH to minimize the uterine residual tumor.

Risk factors for recurrent pressure ulcers after reconstructive surgery: A retrospective study in a single medical centre.

Recurrence of pressure ulcers following reconstructive surgery occurs frequently, causing a significant burden on the patient and the public health care system. We assessed risk factors for the recurrence of pressure ulcers based on the experience of a single surgeon at our medical centre. We retrospectively analysed patients admitted to our medical centre with stage III and IV pressure ulcers who underwent reconstructive surgery. The hospital database was searched for patients diagnosed with pressure ulcers who underwent reconstructive surgery. Patient characteristics analysed included age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, duration of hospital stay, and wound complications. Recurrence and mortality rates were retrospectively examined. One hundred and eighty-nine patients were enrolled, and 166 patients with 176 pressure ulcers met our inclusion criteria. All 14 recurrences (7.95%) were followed for at least 1year. Logistic regression analysis indicated that recurrence was associated with albumin levels (P=0.001) and wound size (P=0.043); however, no association was found for body mass index, bacterial profile, comorbidities, localisation, previous surgery, operation time, or time to admission for reconstruction. In conclusion, higher albumin levels were associated with lower recurrence rates in patients who underwent reconstructive surgery.

Comparison of the cutaneous orbicularis oculi excision treatment with the inferior eyelid margin fixation treatment for congenital lower eyelid entropion.

To modify the traditional surgical approach to treat patients diagnosed with congenital lower eyelid entropion using inferior eyelid margin fixation of the orbicularis eyelid muscle. Ninety-six participants (180 eyes) with congenital lower eyelid entropion diagnosed between January 2019 and April 2021 were included in this study. The patients were divided into Group A (cutaneous orbicularis oculi excision treatment) and Group B (inferior eyelid margin fixation treatment). The efficiency and recurrence rate of treatments were used to compare the two treatments. There was no significant difference in age, sex, and eyes distribution in both groups. And higher efficiency rate was found in Group B (P < 0.05). And Group A had a higher recurrence rate in the follow-up after surgical treatment (P < 0.05). This modified inferior eyelid margin fixation of the orbicularis eyelid muscle treatment is an ideal procedure with a high degree of efficacy and low recurrence rate in patients with congenital lower eyelid entropion.

Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? - A systematic review.

Lateral elbow tendinopathy is one of the most common chronic and degenerative diseases which significantly affects quality of life and the activities of daily living of a person. The following is a systematic review reporting a comparison between physical therapy intervention and corticosteroid injection for the treatment of lateral elbow tendinopathy. PubMed, Web of Science, and Embase were searched using headings related to treatment options for Lateral elbow tendinopathy. The following keywords were used: lateral epicondylitis, physical therapy, and corticosteroid injection. We descriptively analyzed and reviewed a total of 12 studies including a total of 1253 patients for lateral elbow tendinopathy. The physical therapy intervention included interventions like electrotherapy, manual therapy, and exercise. The studies included had an overall low to unknown risk of bias. Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy. Although high-quality randomized control trials are required in order to have a better understanding of both intervention types.

Management of Medial Sphenoid Wing Meningioma Involving the Cavernous Sinus: A Single-Center Series of 105 Cases.

Simple SummaryMedial sphenoid wing meningiomas are among the three most common intracranial meningiomas. They present a challenge to neurosurgeons, especially when they invade critical neurovascular structures and the cavernous sinus. This study was designed to evaluate prognostic features influencing recurrence and progression-free survival of medial sphenoid meningiomas invading the cavernous sinus, with a particular focus on the impact of surgery and postoperative radiotherapy. A retrospective analysis was conducted of the database of our institution. Included were 105 cases of medial sphenoid wing meningiomas with invasion of the cavernous sinus, of which 64 were treated by surgery alone and 41 were treated by surgery plus radiotherapy. Near-total resection did reduce the risk of tumor recurrence significantly compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy. In conclusion, we found that performing a maximal safe resection is the factor most strongly associated with a lower recurrence rate in patients with medial sphenoid meningioma infiltrating the cavernous sinus, and that postoperative stereotactic radiotherapy of the residual tumor also significantly prolongs PFS.Objective: Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy. Methods: A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan–Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality. Results: The risk of recurrence was significantly reduced after near-total resection (NTR) (p-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (p-value = 0.0002). Conclusions: Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus.

Role of sentinel lymph node biopsy for gynecologic cancers.

To provide an overview of the current knowledge and recent advances of sentinel lymph node (SLN) assessment in uterine, cervical, vulvar, and ovarian cancers. In endometrial cancer, SLN evaluation has become increasingly utilized as part of the treatment of early-stage disease, with data showing improved detection of pelvic lymph node metastasis. In cervical cancer, SLN biopsy has also gained increasing traction with studies demonstrating the feasibility and accuracy of SLN detection. Evaluation with frozen section, however, remains limited in the detection of metastases. The prognostic significance of positive SLN in vulvar cancer is currently being investigated, with preliminary data showing lower recurrence rates in patients receiving adjuvant radiation. SLN evaluation remains standard of care to detect lymph node metastasis in early-staged endometrial cancer. In cervical cancer, SLN biopsy has been shown to be reliable, while decreasing morbidity without impacting disease-free survival in select patients. The technique and high sensitivity of SLN biopsy in vulvar cancer has been demonstrated in large prospective trials. There are no randomized controlled trials in ovarian cancer that evaluate the role of SLN biopsy on treatment and outcome; current SLN evaluation remains investigational.

The Need for Studies on Oral Corticosteroids After Sialendoscopy for Obstructive Salivary Gland Disease: Systematic Review.

This qualitative systematic review evaluates the evidence in support of the use of oral corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis. Qualitative systematic review. A literature search was conducted from January 1985 and September 2020. Inclusion criteria embraced peer-reviewed articles in which adult patients undergoing interventional sialendoscopy for obstructive salivary gland disease received oral corticosteroids. The results were initially screened based on title and abstract, and the remaining articles were reviewed for eligibility. About 218 papers were selected by title and abstract, 96 were selected for full-text review, and 9 met the inclusion criteria. Eight published reports were retrospective observational studies and 1 was a prospective comparative study. Overall, the heterogeneity of clinical data stood out in this systematic review. The pooled success rate in the studies was 873/979 (89%). Only 5 studies described a rationale for oral corticosteroid use as part of the post-operative management. In 4 studies, a prednisone total daily dose of 40 to 50 mg was used. One study clearly showed a lower recurrence rate in patients who received oral steroids for more than 7 days in addition to sialendoscopy for management of ductal stenoses. This systematic review showed that most centers that prescribe oral corticosteroids after sialendoscopy are unaware of the specific results with this treatment. For ductal stenoses, only 1 paper clearly showed the benefits of oral corticosteroids after sialendoscopy but more high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up.

Microvascular decompression for trigeminal neuralgia in the elderly: efficacy and safety

ObjectiveThe safety and efficacy of surgical microvascular decompression (MVD) in elderly patients with trigeminal neuralgia (TN) is controversially discussed in the literature. A widespread reluctance to expose this cohort to major intracranial surgery persists. Our aim was to compare the efficacy and safety between older and younger patients with TN.MethodsIn this cross-sectional study, 139 MVD procedures (103 patients < 70 and 36 patients ≥ 70) were included. Surgical fitness was assessed by the American Society of Anesthesiology (ASA) grade. The pain-free interval was evaluated using Kaplan–Meier analysis only in patients with a recent follow-up visit. Independent risk factors for recurrence in patients with a minimum 12-month follow-up were determined.ResultsPatients ≥ 70 showed a significantly higher number of comorbidities. Pain intensity, affection of trigeminal branches and symptom duration was similar between groups. No significant difference in treatment associated complications and permanent neurological deficits was shown. There was no treatment-related mortality. A tendency towards a lower recurrence rate in patients < 70 did not reach statistical significance (17.6% vs. 28.6%, P = 0.274). Pain-free interval was not different between both cohorts (78.7 vs. 73.5 months, P = 0.391).ConclusionDespite a higher prevalence of comorbidities in elderly patients, complication rates and neurological deficits after MVD were comparable to younger patients. Rates of immediate and long-term pain relief compared favorably to previous studies and were similar between elderly and younger patients. These data endorse MVD as a safe and effective first-line surgical procedure for elderly patients with TN and neurovascular conflict on MRI.

Prognostic value of Osteopontin (SPP1) in colorectal carcinoma requires a personalized molecular approach

Stratification of colorectal cancer for better management and tangible clinical outcomes is lacking in clinical practice. To reach this goal, the identification of reliable biomarker(s) is a prerequisite to deliver personalized colorectal cancer theranostics. Osteopontin (SPP1) is a key extracellular matrix protein involved in several pathophysiological processes including cancer progression and metastasis. However, the exact molecular mechanisms regulating its expression, localization, and molecular functions in cancer are still poorly understood. This study was designed to investigate the SPP1 expression profiles in Saudi colorectal cancer patients, and to assess its prognostic value. Hundred thirty-four (134) archival paraffin blocks of colorectal cancer were collected from King Abdulaziz University Hospital, Saudi Arabia. Tissue microarrays were constructed, and automated immunohistochemistry was performed to evaluate SPP1 protein expression patterns in colorectal cancer. About 20% and 23% of our colorectal cancer samples showed high SPP1 cytoplasmic and nuclear expression patterns, respectively. Cytoplasmic SPP1 did not correlate with age, gender, tumor size, and location. However, significant correlations were observed with tumor grade (p = 0.008), tumor invasion (p = 0.01), and distant metastasis (p = 0.04). Kaplan-Meier survival analysis showed a significantly lower recurrence rate in patients with higher SPP1 cytoplasmic expression (p = 0.05). At multivariate analysis, high SPP1 cytoplasmic expression was an independent favorable prognostic marker (p = 0.02). However, nuclear SPP1 expression did not show any prognostic value (p = 0.712). Our results showed a particular SPP1 prognostic relevance that is not in line with most colorectal cancer previous studies that may be attributed to the molecular pathophysiology of our colorectal cancer cohort. Saudi Arabia has both specific genomic makeup and particular environment that could lead to distinctive molecular roots of cancer. SPP1 has several isoforms, tissue localizations and molecular functions, signaling pathways, and downstream molecular functions. Therefore, a more individualized approach for CRC studies and particularly SPP1 prognosis outcomes' assessment is highly recommended toward precision oncology.

Chromosome 4q25 variants and biomarkers of myocardial fibrosis in patients with atrial fibrillation.

Little is known about how genetic predisposition and fibrosis relate in atrial fibrillation (AF). Hence, we sought to determine whether the genetic variants and biomarkers for fibrosis enhance prediction of outcomes after catheter ablation. Consecutive patients who underwent catheter ablation of AF (paroxysmal, 158; nonparoxysmal, 137) or supraventricular tachycardia without AF (n = 70) were studied retrospectively. Plasma levels of transforming growth factorβ1 (TGF-β1), tissue inhibitor of metalloproteinase 1 (TIMP-1), and 4q25 single-nucleotide polymorphisms (SNPs) (rs10033464 and rs220073) were measured. Mean plasma levels of both TGF-β1 and TIMP-1 were higher in patients with AF than in the control (all P < .001). Plasma levels of TIMP-1 were higher in patients with recurrence compared with those without recurrence (P = .039). Patients with variant alleles of rs10033464 showed increased recurrence after catheter ablation in patients with paroxysmal AF including after adjustment (P = .027). Patients with TIMP-1 < 107 ng/mL and no variant allele (GG) at rs10033464 had lower recurrence rates compared with other groups in those with paroxysmal AF (logrank; P = .007), whereas there was no significant difference among those patients with persistent forms of AF. Inclusion of biomarkers and genotype improved discrimination of AF recurrence in patients with paroxysmal AF (C-statistic .499 vs .600). The combination of plasma TIMP-1 concentrations less than 107 ng/mL and the absence of a variant allele at rs10033464 was associated with lower recurrence rates in patients with paroxysmal AF. This study suggests that 4q25 SNPs and biomarkers for fibrosis may provide additive value in risk stratification for AF recurrence after catheter ablation.

Predictive Value of Opto-magnetic Imaging Spectroscopy in Discriminating Oral Squamous Cell Carcinoma from Non-tumor Tissue in Surgical Margins

Negative surgical margins status is of extreme importance for better prognosis and lower recurrence rate in patients undergoing surgical treatment for oral squamous cell carcinoma (OSCC). Standard histopathology is time consuming and current optical procedures come with various limitations. We examined the potential of a new imaging technique—opto-magnetic imaging spectroscopy (OMIS) in discriminating tumor (OSCC) from adjacent non-tumor oral cavity tissue. A total of 46 samples from 21 patients were included in this study. Samples were taken from a fresh surgical specimen of primary OSCC. Digital imaging of samples was performed within 60 min of resection using OMIS device. Images were processed through a specifically designed convolution algorithm based on light-matter interaction. As a result a convolution spectrum was generated. Predictive value of spectral data was assessed using correlation tests and Naive Bayes classification model. There was no significant correlation in distribution of characteristic peaks between tumor and non-tumor tissue (P > 0.05). Tumor tissue showed more magnetic activity compared to non-tumor tissue. Naive Bayes classifier with kernel density estimation discriminated tumor from non-tumor tissue with the accuracy of 82.61%, 86.96% sensitivity, 78.26% specificity and the AUC value of 0.917. OMIS seems to be a promising optical method for ex vivo characterization of OSCC and non-tumor tissue. Further investigation is necessary to determine how tissue type and level of pathological transformation impact OMIS results. Ultimately, this could aid surgeons in using this method as an in vivo indicator for surgical resection with safe margins.

7. Good Long Term Outcome With Low Recurrence Rate in Patients With Primary Sclerosing Cholangitis Undergoing Living Donor Liver Transplantation

7. Good Long Term Outcome With Low Recurrence Rate in Patients With Primary Sclerosing Cholangitis Undergoing Living Donor Liver Transplantation

Small Hepatocellular Carcinoma With Low Tumor Marker Expression Benefits More From Anatomical Resection Than Tumors With Aggressive Biology.

We assessed prognostic advantage of anatomical resection (AR) over nonanatomical resection (NAR) for hepatocellular carcinoma (HCC) according to multiplication of α-fetoprotein, des-γ-carboxyprothrombin, and tumor volume (ADV) scores. Superiority of AR over NAR is debated. ADV score is surrogate marker of postresection prognosis for solitary HCC. This study included 1572 patients who underwent curative resection for solitary HCC of 2.0 to 5.0 cm between 2006 and 2014. Preoperative patient profiles were not statistically different between AR and NAR groups. In 1324 naïve patients without preoperative treatment, AR group showed lower recurrence rates (P = 0.003) and higher patient survival rates (P = 0.012) than NAR group. AR group showed lower recurrence rates in patients with ADV ≤5 log (P ≤ 0.046). ADV scores >4 log and >3 log were independent risk factors for tumor recurrence and patient survival in treatment-naïve patients, respectively. In treatment-naïve group with preserved hepatic functional reserve, AR group showed lower recurrence rates in patients with ADV ≤4 log (P = 0.026). Absence of microvascular invasion also showed lower recurrence rates (P = 0.007) in AR group. In 248 patients with preoperative treatment, AR group showed lower recurrence rates (P = 0.001) and higher patient survival rates (P = 0.006). AR group showed lower recurrence rates in patients with ADV ≤4 log (P < 0.001) and higher survival rates in patients with ADV ≤5 log (P ≤ 0.043). Prognostic benefit of AR was evident in patients with ADV score ≤4 log or absence of microvascular invasion. Patients with less aggressive tumor biology benefit more from AR than NAR, thus being reasonably indicated for AR.

Recurrence Rate after Endoscopic vs. Open Approaches for Juvenile Nasopharyngeal Angiofibroma: A Meta-analysis.

Context The effect on recurrence rate between patients with juvenile nasopharyngeal angiofibroma (JNA), treated by an endoscopic versus open approach, has not been well established. Objective A meta-analysis of the available literature concerning recurrence rate in patients who underwent surgery for JNA. Methods A retrospective meta-analysis of studies analyzing recurrence rate after endoscopic or open surgery for patients with JNA was performed using the DerSimonian-Laird random-effects method. English and non-English articles were reviewed using Embase, Medline, and Cochrane databases. Results Among nine studies, including 362 patients from 1981 to 2015, with a mean follow-up of 49.4 months, a total of 89 patients (24.5%) had recurrence. Our analysis revealed a total effect size of -0.16 in favor of endoscopic approach (-0.25 to -0.06, CI [confidence interval] 95%). When analyzing tumor by stage (Radkowski's IA-IIIB n = 299), the endoscopic approach proved to be superior independent of tumor stage (2 vs. 17% for tumors stage IA-IIA, and 26 vs. 32% for tumor stage IIB-IIIB for endoscopic and open approaches respectively; p < 0.05). The endoscopic approach has a statistical significant lower recurrence rate in patients without intracranial compromise when compared with the open approach (13 vs. 28%; p < 0.02). No statistical difference was seen in patients with intracranial compromise ( p = 0.5) Conclusion The use of an endoscopic approach to treat JNA has a significantly lower recurrence rate when compared with open approaches. Independent of disease stage, an endoscopic approach should be the standard of care to surgically treat JNA. For cases with intracranial compromise, either approach can be used for surgical resection.

Bilateral lateral rectus recession versus unilateral recession resection for basic intermittent exotropia: a meta-analysis.

To compare the outcomes between bilateral lateral rectus recession (BLR) and unilateral recession resection (R&R) procedures in the treatment of basic intermittent exotropia. Databases from Medline, Embase, Web of Science and the Cochrane Register of Controlled Trials were searched prior to June 2, 2017. From these searches, three eligible randomized studies and three retrospective cohort trials, which compared conventional BLR versus R&R procedure were identified. Differences observed between these two interventions (BLR versus R&R) were expressed as odds ratio (OR) and 95% confidence intervals (CI). The data on rates of success, recurrence, and overcorrection were pooled and analyzed using a random-effects model. Our findings, as generated from the pooled estimates, suggested that success rates for the R&R procedure were significantly greater than that of BLR (OR, 0.50; 95% CI, 0.31-0.79; P = 0.003) and patients subjected to the BLR procedure were more likely to be recurrent (OR, 2.44; 95% CI, 1.17-5.10; P = 0.02). No statistically significant differences in the combined results for overcorrection rates were present between the BLR and R&R procedures (OR, 0.85; 95% CI, 0.32-2.28; P = 0.75). The overall findings from this meta-analysis indicated that the conventional R&R procedure is associated with higher success rates and lower recurrence rates in patients with basic intermittent exotropia.