Patients In Surgery Group Research Articles

Analysis of Initial Outcomes of Gas-insufflation One-step Single-port Transaxillary (GOSTA) Robotic Thyroidectomy for Thyroid Cancer.

This study compared the initial outcomes of gas-insufflation one-step single-port transaxillary (GOSTA) robotic thyroidectomy with traditional open thyroidectomy for thyroid cancer at a single institution. A retrospective analysis was conducted on 77 patients who underwent thyroidectomy for differentiated thyroid cancer from January to June 2024. Exclusion criteria included benign nodules, Graves' disease, and previous thyroid surgeries. Two surgeons performed the procedures, with one having no prior robotic surgery experience. Of the 77 patients, 48 underwent open thyroidectomy and 29 underwent GOSTA thyroidectomy. The GOSTA group had a significantly lower mean age (40.1 vs. 47.6 years, p=0.002) and a higher proportion of female patients (p=0.040). The open group patients had more harvested lymph nodes than the GOSTA group patients (7.9 vs. 2.4, p<0.001). The GOSTA group patients had longer operation time (156.4 vs. 80.6 min, p<0.001), and had extended hospital stay than the open group patients (5.9 vs. 3.4 days, p<0.001). Complication rates were similar between the groups. GOSTA robotic thyroidectomy provides comparable safety and effectiveness to open thyroidectomy, with improved cosmetic outcomes despite longer operation times and hospital stays. This technique is feasible for surgeons without prior robotic experience, offering a viable alternative for patients prioritizing cosmetic results.

Pulmonary artery banding in infants and young children with end-stage left ventricular dilated cardiomyopathy-Cohort Study.

Dilated cardiomyopathy (DCM) is the most common cardiomyopathy and 40-50% patients may die or need heart transplant in 5 years after diagnosis. Although heart transplantation being the most effective life-saving option of end-stage DCM, scarcity of donors and series of complications prevent many patients from receiving timely treatment. Pulmonary artery banding (PAB) is recently described as an alternative strategy for end-stage DCM, with low left ventricular function (LVEF) but preserved right ventricular function, may potentially restore heart function and delay the need for heart transplantation, but current clinical evidence is still insufficient. On the other hand, the medication treatment of DCM in pediatric patients is mostly based on the experience of adults. It remains unclear whether PAB combing medication treatment could benefit infants and young children patients. The aim of this study was to assess the short-term efficacy of PAB combined with medication therapy in infants and young children with end stage DCM, comparing with medication therapy alone. This is a retrospective analysis of 18 consecutive pediatric patients aged ranging from 1 month to 44 months old who diagnosed with end-stage DCM (LVEF30%) with preserved right ventricular function between 2019 and 2023 in our hospital. All patients had been treated with conventional medications for two months. Then they were divided in two groups: PAB surgery group (6/18), and non-surgery group (12/18). Regardless of whether surgery was performed, both groups continued to receive medication treatment. Recovery of ventricular function was primary endpoints. Secondary endpoints included 180-day mortality and severe heart failure (LVEF≤30%). We found there were no differences in age, weight, height, BMI, renal function, liver function, pulmonary hypertension, tricuspid valve regurgitation, mitral valve regurgitation and genetic abnormalities between those with and without PAB surgery. Comparing with non-surgery group, 5 patients in surgery group regain the normal cardiac ejection fraction (LVEF≥50%) (5/6, 83.3% vs. 4/12, 33.3%, P=0.131). A total of 3 patients had sudden death in non-surgery group, and there was no death in surgery group (P=0.180). 5 patients (5/12, 41.7%) still remain the low heart failure (LVEF≤40%) after 6 months of enrollment only given medical therapy, and none of patients present with LVEF≤40% in PAB surgery group (0/6, 0% vs. 8/12, 67.7%, P=0.034). Pulmonary artery banding is safe and effective in infants and young children with end-stage DCM with preserved right ventricular function. Combined with conventional heart failure medication therapy, it may provide short-term benefits post-operatively, decrease the cardiogenic shock, and act as a bridge to recovery and potentially reduce the need for heart transplantation. Long-term effects remain further observation, and larger randomized controlled trials would be more persuasive in validating its efficacy.

Influence of Single Nucleotide Polymorphisms on CRS Outcomes: A Preliminary Observational Study.

To conduct a preliminary investigation into the relationship between specific SNP variants, type II inflammation, and the effectiveness of dupilumab therapy and surgery in patients with CRS. In this prospective study, 48 subjects were enrolled, comprising 32 CRS patients and 16 healthy controls. The CRS patients were subjected to either dupilumab therapy or endoscopic surgery according to EPOS guidelines. SNP variants were identified using the TaqMan SNP genotyping technique. The identified SNP profiles were compared between the control group and CRS patients, and their potential influence on treatment outcomes was evaluated. Treatment responses were assessed based on symptom scores, such as SS-I, SNOT-22, disease progression using the NPS findings, and SNP profiles at a 6-month follow-up. The primary measures included the Nasal Polyp Score, Smell Identification Test (SIT) score, and SNOT-22 outcomes. Dupilumab therapy and surgery significantly decreased NPS, with the last showing superior results. However, dupilumab therapy resulted in a significantly improved SIT score. Significant differences were observed in SNP profiles, particularly with rs1800629 (TNFA), rs2856838 (IL1a), rs17561 (IL1a), and rs1805011 (IL4R). In particular, the expression of rs2856838 and rs1805011 variants in the dupilumab group was associated with significantly better SIT and SNOT-22 outcomes than non-expressors. Also, the surgery group patients expressing the rs2856838 variant reported significant improvements in SNOT-22 scores. These preliminary findings suggest that SNP genotypes may guide personalized treatment strategies for CRS. Further larger prospective studies are required to confirm these initial observations. 2 Laryngoscope, 2024.

The efficacy of robot-assisted surgery on minor basal ganglia cerebral hemorrhage with neurological dysfunction.

This study aims to compare the outcomes of robot-assisted drainage and conservative treatment in minor basal ganglia hemorrhage (10ml< hemorrhage volume ≤ 30ml) patients with neurological dysfunction, and analyze patients treated with robot-assisted drainage in order to optimize this treatment strategy. In a retrospective study conducted in December 2021 to December 2023, minor basal ganglia cerebral hemorrhage patients with neurological dysfunction were enrolled from the Department of Neurosurgery, Shanghai Ninth People's Hospital. The patients included both the surgical (robot-assisted drainage) and conservative groups. The efficacy of robot-assisted drainage compared with conservative treatment in patients with minor cerebral hemorrhage and neurological dysfunction was evaluated by modified Rankin Scale (mRS) score after 3 months, muscle strength (grade 1 to 5) and cost of hospitalization. Of the patients included, 23 received robot-assisted drainage and 20 received conservative treatment. There were no significant differences in gender, age, history of hypertension and diabetes, muscle strength and mRS score at admission. Female patients accounted for 32.6%, and male patients accounted for 67.4%. About 90% of the patients enrolled had a pre-existing hypertension history. The mRS score after 3 months indicated that prognosis of the patients was significantly better in the surgical treatment group than the conservative treatment group (favorable prognosis 69.57% VS. 35%, P = 0.034) while the patients underwent surgery paid higher hospital bills than patients treated conservatively. Compared with traditional conservative treatment, robot-assisted drainage surgery is more helpful to improve the prognosis of patients with minor basal ganglia hemorrhage (volume ≤ 30mL) accompanied by neurological dysfunction. Robot assisted surgery can safely and effectively remove the hematoma of minor basal ganglia hemorrhage, and there were 69.6% of surgery group patients had a good prognosis in this study.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ±0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

Laparoscopic versus Open Appendectomy in Appendicitis Cases (Retrospective Comparative Study)

Abstract Background Appendectomy is one of the most commonly performed surgeries worldwide. It is commonly done by conventional open method but with progress of laparoscopic surgical procedures, laparoscopic appendectomy is also practiced nowadays. Ever since its initial description by Semm in 1983, laparoscopic appendectomy has struggled to prove its superiority over the open technique. The concept of minimal surgical trauma, resulting in significantly shorter hospital stay, less postoperative pain, faster return to daily activities has made laparoscopic surgery for acute appendicitis very attractive. Objective To compare the intraoperative and post operative outcomes of laparoscopic versus open appendectomies for Appendicitis cases. Patients and Methods This study was done from April 2022 to September 2022 on 60 patients with clinical diagnosis of acute appendicitis admitted in surgical wards of Aldemerdash hospital. The patients were selected by random sampling technique. All the patients were followed every day in post operative period till they were discharged and then later followed for a period of 4 weeks in and out patients department. Results In the study, 8 patients in open group (26.7%) and 4 patients in laparoscopic group (13.3%) have post op fever. In the study, 8 patients in open group (26.7%) and 1 patients in laparoscopic group(3.3%) have post op wound infection. The difference was significant (p &amp;lt; 0.01) In the study, The mean hospital stay score was 1.77 ± 0.728 days in the laparoscopic group and 7.73 ±1.363 days in the open group. The difference was significant (p &amp;lt; 0.0001). In the study, the mean score return to work was 9.6 days in laparoscopic and 17.67 days in the open group. The parameter difference was significant p &amp;lt; 0.0001 In the laparoscopic group, 26 (86.7%) patients were satisfied with cosmetic benefit, 4 (13.3%) patients were equivocally satisfied, 0 patients were unsatisfied. Conclusion We conclude that laparoscopic appendectomy is better than open appendectomy in respect to post operative pain, post operative complications, duration of the hospital stay, return to the work, cosmetic benefit. Duration of time of surgery is higher in laparoscopic compared to open appendectomy.

Long-Term Safety of Level II Oncoplastic Surgery after Neoadjuvant Treatment for Locally Advanced Breast Cancer: A 20-Year Experience.

Background: Oncoplastic surgery (OPS) reliability in the post-neoadjuvant chemotherapy (NACT) setting is still debated due to weak scientific evidences in such scenarios. Methods: Our analysis aims to report results obtained in a retrospective series of 111 patients consecutively treated with level II OPS after NACT at the Multidisciplinary Breast Center of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS between 1998 and 2018. The surgical endpoints were the mean specimen volume, rates of positive margins (PMR), re-excision (RR), conversion to mastectomy (CMR), and complications (CR). The oncological endpoints were overall survival (OS), disease-free survival (DFS), and local recurrence (LR). To evaluate the impact of NACT on surgical and oncological outcomes at 302 months, we conducted a propensity score matching, pairing patients in post-NACT and upfront surgery groups. Results: The mean sample volume was 390,796 mm3. We registered a 3.6% of PMR, 1.8% RR, 0.9% CMR, 5% CR. The 10-year OS and 10-year DFS with a median follow-up of 88 months (6-302) were 79% and 76%, respectively, with an LR recurrence rate of 5%. The post-NACT group received significantly larger excised volumes and lower PMR. NACT did not affect surgical and oncological outcomes. Conclusions: Level II OPS can be considered a reliable alternative to mastectomy even in the post-NACT setting.

Laparoscopic Sleeve Gastrectomy: Suture or not Suture Staple Line

Background The severity of postoperative complications is the main disadvantage of laparoscopic sleeve gastrectomy (LSG). Staple line reinforcement (SLR) is strongly advocated. Recently, oversewing has been proposed as a cost-effective and helpful method for reinforcing the staple line. Aim of the study: To evaluate the benefit of staple lines over sewing in decreasing postoperative complications and their severity. Patients and methods: One hundred laparoscopic surgery group (LSG) patients were randomly assigned to either group (A) without staple line over sewing or (B) with staple line over sewing from January 2022 to January 2023 in a prospective study conducted at three hospitals (Alhussein Medical City, Alkafeel Private Hospital, and Zain Alabdin Private Hospital). We want to learn if laparoscopic sleeve gastrectomy patients benefited more from a staple line than a sewn one. Results: The most frequently reported complication was bleeding, which was reported in two patients in group A and one patient in group B, respectively; vomiting was reported more frequently in group B. The cross-tabulation between complications and comorbidities revealed no significant association between them. The hospital stay was the same in both groups except for patients with non-surgical complications, which need more hospital stay time. In regard to the severity of complications, we found that complicated cases in group A needed more hospital stays and more interventions to control the problem in comparison to those in group B. Conclusion: Laparoscopic sleeve gastrectomy with staple line over sewing is a technique that may decrease early complications and the severity of complications. There was no significant difference between the two groups (with and without staple line over sewing) in regard to the relation between complications on one side and the comorbidity on the other.

Stereotactic Puncture Surgery for the Treatment of Moderate Volume of Thalamus-Internal Capsule Area Hemorrhage: An Analysis of Real-World Data

The efficacy of surgical intervention in ameliorating long-term prognosis for moderate volume of cerebral hemorrhage in the thalamus-internal capsule region remains unsubstantiated by clinical investigations. Consequently, the acquisition of credible evidence is imperative to authenticate the effectiveness of these methodologies. One hundred and three eligible patients with moderate-volume thalamus-internal capsule region cerebral hemorrhage. Twenty-seven pairs of successful matches after using the 1:1 propensity score matching (PSM) method, totaling 54 patients, were analyzed. The short- and long-term treatment outcomes of patients in the stereotactic surgery and conservative treatment groups were compared. The prognosis of the two groups of patients was analyzed by logistic regression analysis and model comparison. The primary outcome of this study was to assess Assessment of daily living(ADL) scores after 6 months of treatment.Based on the analysis of this study,the ADL of the surgical group were significantly higher than those of the conservative treatment group after 6 months of treatment (P< 0.001), and the difference was statistically significant. The amount of residual haematoma was significantly lower in the stereotactic surgery group than in the conservative treatment group at 3 days, 7 days and 2 weeks after the onset of the disease (P< 0.001), and the complication rate was lower than the conservative treatment group (P< 0.05). Univariate logistic regression showed that the risk of severe neurological dysfunction for patients in the surgery group was (OR-0.27, 95% CI: 0.08-0.86, P< 0.05). In multivariate logistic regression analysis, the odds ratio was 0.29 (95% CI: 0.09-0.96, P< 0.05) after adjusting for all covariates. For moderate-volume thalamus-internal capsule region cerebral hemorrhage, stereotactic paracentesis has the advantage of a shorter hospital stay and a lower complication rate than conservative treatment. Moreover, it yields superior outcomes in terms of daily living assessment scores after six months of treatment and enhanced neurological recovery.

Simple coiling of middle meningeal artery embolization for chronic subdural hematoma: An inverse probability of treatment weighting matched cohort study.

Middle meningeal artery embolization (MMAE) for chronic subdural hematoma (CSDH) has gained much attention in recent years. However, unintended embolization may occur when employing liquid embolic agents or particles. We present our clinical experience in simple coiling of MMAE to manage CSDH. Patients underwent either surgical evacuation or MMAE with simple coiling for CSDH were reviewed. Clinical and radiographic outcomes were assessed at admission, 1-month, and 6-month intervals. Two treatment groups were matched with inverse probability of treatment weighting. One hundred twelve patients were included, with 27 patients in MMAE group and 87 patients in surgery group. In MMAE group, significant reductions were observed in hematoma width (admission vs. 1-month, 2.04 [1.44-2.60] cm vs. 0.62 [0.37-0.95] cm, p < 0.001). The adjusted odds ratio (aOR) of surgical rescue rate (0.77 95%CI 0.13-4.47, p = 0.77), hematoma reduction (>50%) (0.21 95%CI 0.04-1.07, p = 0.06), and midline shift improvement rate (3.22, 95%CI 0.84-12.4, p = 0.09) had no substantial disparities between two groups at 1-month follow-up. In addition, no significant difference was noted between two groups in terms of hematoma reduction (>50%) at 6-month follow-up (aOR 1.09 95%CI 0.32-3.70, p = 0.89). No procedure-related complications were found in MMA embolization group. Simple coiling for MMA had comparable outcomes with surgical evacuation for CSDH. Our findings suggest that simple coiling can be an alternative choice for liquid agents or particles in MMA embolization for CSDH with acceptable safety.

Comparative study of morbidity of open cholecystectomy vs laparoscopic cholecystectomy in complicated gall stone disease.

Objective: To evaluate the resist of minimally invasive surgery i.e. laparoscopic cholecystectomy versus open cholecystectomy in cases with complex gallstone diseases. Study Design: Prospective study. Setting: North Surgical Ward, Mayo Hospital Lahore. Period: 11th July 2020 till 10th January 2021. Material &amp; Methods: A total of 372 patient’s fulfilling the criterion was included for study in group-A Laparoscopic cholecystectomy was done. In group B open cholecystectomy was done which includes 86 patients. The entire patient received injection Ketorolac 30 mg i.e. 8 hourly and postoperative injection NeIbufin 6 mg i.v.12hourIy as standard in all patients and Post-operative pain was assessed Visual analogy scale after 24 hours. Results: The mean age of patients in open group was 41.28 ± 13.75 years and in Laparoscopic group was 43.46 ± 13.90 years. In Open group there were 80(43%) male and 106(57%) female cases while in Laparoscopic group there were 65(34.9%) male and 121(65.1%) female cases. The mean hospital stay was statistically shorter in Laparoscopic group (3.80 ± 1.37 days) as compared to Open group (5.12 ± 1.58 days), p-value &lt;0.001. In open group 77(41.4%) cases had post-operative pain and in Laparoscopic group 27(14.5%) cases had post-operative pain. The post-operative pain was statistically higher in open groups, p-value &lt; 0.001. Conclusion: Laparoscopic is an ideal treatment option in terms of less pain and shorter duration of hospital stay as compared to open cholecystectomy for patients with complicated gallstone disease.

The effect of surgical starting time on elective colorectal cancer surgery: A propensity score matching analysis.

The purpose of the current study is to analyze whether surgical starting time affects the short-term outcomes of elective colorectal cancer (CRC) surgery. We retrospectively collected CRC patients who underwent elective surgery from Jan 2008 to Jan 2021 in a single clinical center. The effect of surgical starting time (morning surgery vs afternoon surgery, day surgery vs night surgery) on elective CRC surgery was analyzed using propensity score matching (PSM). A total of 6783 patients were included in the current study. There were 5751 patients in day surgery group and 1032 patients in night surgery group, and there were 2920 patients in morning surgery group and 2831 patients in afternoon surgery group. After 1:1 ratio PSM, there were no significant difference in terms of the baseline information (P > .05). Day surgery group had longer operation time (P = .000) and longer hospital stay (P = .029) than night surgery group after PSM. Morning surgery group had longer operation time than afternoon surgery group before PSM (P = .000) and after PSM (P = .000). Univariate and multivariate analysis of the total of 6783 patients were conducted to find predictors of complications, and found that night surgery was a predictor of major complications (P = .002, OR = 1.763, 95% CI = 1.222-2.543) but not a predictor of overall complications (P = .250, OR = 1.096, 95% CI = 0.938-1.282). Night surgery is a predictor of major complications after elective CRC surgery, therefore, surgeons should be careful when operating at night.

Cytoreductive surgery is feasible in patients with limited regional platinum-resistant recurrent ovarian cancer

IntroductionTo evaluate the efficacy of cytoreductive surgery versus chemotherapy for the treatment of limited regional, platinum-resistant ovarian cancer (PROC).Materials and methodsThe clinical records of all patients with PROC treated in our center between March 2015 and March 2022 were retrospectively reviewed. We compared the oncology outcomes of patients who received cytoreduction or chemotherapy alone at relapse and presented information about postoperative adjuvant chemotherapy.ResultsAmong 52 patients with limited regional recurrence, 40.4% (21/52) underwent cytoreduction because of platinum resistance, and 59.6% (31/52) received chemotherapy alone. No residual disease (R0) was achieved in 20 patients (95.2%). The severe morbidity rate within 30 days after the surgery was 15%. The median follow-up was 70.6 months. Compared with the chemotherapy alone group, the surgery group with R0 had better progression-free survival (PFS) (10.6 vs. 5.1 months; hazard ratio (HR) = 0.421; P = 0.0035) and post-relapse survival (PRS) (32.6 vs. 16.3 months; HR = 0.478; P = 0.047), but there was no difference in overall survival (OS) between the two groups. Laparoscopy is associated with lesser intraoperative blood loss with no differences in survival and postoperative complications compared to the open approach (P = 0.0042). Subgroup survival analysis showed that compared with chemotherapy alone, surgery prolonged PFS in patients regardless of tumor size (greater than or equal to 4 cm or less). Surgery group patients who achieved R0 had an objective response rate (ORR) of 36.8% (7/19), among whom 40% (4/10) received platinum rechallenge chemotherapy and 33.3% (3/9) were administered non-platinum chemotherapy.ConclusionWhen well-selected PROC patients with limited regional recurrence achieved R0, their outcomes were superior to those of patients who received only chemotherapy with an acceptable morbidity rate. Laparoscope technology could be a reliable alternative surgical approach. The reintroduction of platinum agents may be considered following surgery. Further analyses in a larger population are warranted to elucidate the risks and benefits of this surgery and adjuvant chemotherapy strategy.

Long-Term Results and Risk Factors of Treatment for Post-Infarction Ventricular Septal Rupture: A Single-Center Experience

Background: Ventricular septal rupture (VSR) following myocardial infarction (MI) is a rare but lethal complication. We analyzed the long-term results and risk factors for survival in the treatment of VSR. Methods: From January 2012 to December 2021, 115 consecutive patients with post-MI VSR were admitted to our hospital. Depending on different treatment methods patients were divided into following three groups: medical, transcatheter intervention, and surgical repair. During the study, relevant clinical data, operation-related conditions, and follow-up data were analyzed. The Kaplan–Meier method and log-rank test were used to determine the cumulative incidence of mortality. The independent risk factors for patient mortality were evaluated by multivariate logistic regression. Results: The mean follow-up time was 43.4 ± 34.7 months. The overall in-hospital, 30-day, and long-term mortality rates were 24.3%, 38.3%, and 51.3%, respectively. In the medical group, the in-hospital and 30-day mortality rates were 46.7 % (21/45) and 82.2 % (37/45), respectively, with only three patients alive at follow-up. In the transcatheter intervention group, 30-day and long-term mortality rates were 12% and 28%, respectively. In the surgical repair group, 30-day and long-term mortality rates were 8.9% and 22.2%, respectively. Compared with the surgery-group patients, patients with transcatheter intervention had a longer time from VSR to intervention. Logistic regression analysis revealed that age, previous infarction, Killip class, serum creatinine, Troponin T, N-terminal pro-B-type natriuretic peptide, and medical strategy were risk factors for all-cause mortality. Conclusions: The 30-day and long-term outcomes of patients treated with surgical repair and transcatheter intervention were significantly better than medically treated patients.

Analysis of survival benefit from primary tumor resection and individualized prediction of overall survival for lung cancer patients with bone metastasis: Worth it or not?

BackgroundThe clinical management of lung cancer (LC) patients with bone metastasis (BM) is still a significant challenge. This study aimed to explore the role of primary tumor resection (PTR) on survival outcome of LC patients with BM and to develop two web-based nomograms for predicting the overall survival (OS) of LC patients with BM who received PTR and those who did not. MethodsWe enrolled LC patients with BM from the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015. Propensity score matching (PSM) was then conducted to balance the baseline characteristics of covariates between patients in surgery and non-surgery groups. Next, Kaplan–Meier analysis with log-rank test was performed to evaluate the survival benefit of PTR before and after PSM methods and to explore the impact of surgical resection extent on the prognosis of LC patients with BM and clinical outcomes in patients with different metastatic patterns. Cox proportional hazard regression analysis was then applied to determine the independent prognostic factors for OS of patients receiving PTR and did not receiving PTR, respectively. Subsequently, we constructed two individualized nomograms for predicting the 12-, 18- and 24-months OS. Finally, receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA) were generated to evaluate discrimination, accuracy and clinical utility of the nomograms. ResultsA total of 7747 eligible patients were included in this analysis. The survival analysis revealed that PTR was closely associated with better survival outcome among LC patients with BM(P < 0.05), while the survival benefit of PTR was suboptimal in patients presented with multiple metastases(P > 0.05). Besides, lobectomy shows best survival benefit. Two nomograms were then constructed based on independent prognostic factors of patients in the surgery group and the non-surgery group. The ROC curves showed good discrimination of the two nomograms, with the area under curve (AUC) of each time point being higher than 0.7 in both the training set and testing set. The calibration curves also demonstrated satisfactory consistency between actual survival and nomogram-predicted OS of both nomograms. The DCA showed high benefit of nomogram in a clinical context. Moreover, the study population was stratified into three groups based on the scores of the nomogram, and the survival analysis showed that this prognostic stratification was statistically significant (p < 0.05). ConclusionsThis study showed that surgical resection of the primary site strategy can prolong survival of LC patients with BM to some extent, depending on different sites of metastasis and highly selected patients. Furthermore, the web-based nomograms showed significant accuracy in predicting OS for patients with or without surgery, which may provide valuable insights for patients’ counseling and individualized decision-making for clinicians.

Post-operative residual disease and number of cycles of neoadjuvant chemotherapy in advanced epithelial ovarian carcinoma

BackgroundThe optimal number of neoadjuvant chemotherapy cycles in patients with advanced ovarian cancer is still disputed.ObjectiveTo evaluate the impact of the number of neoadjuvant chemotherapy cycles and role of optimal...

Comparison of Laparoscopic Versus Open Resection in Management of Colorectal Carcinoma

Objective: is to compare the impact of laparoscopic and open colorectal surgery in terms of infection, hospital stay and blood loss. Study Design: Randomized controlled trial. Place and duration: Study was conducted at the general surgery department of Nishtar hospital, Multan from January 2020 to January 2021. Methodology: Three hundred and ten patients were enrolled in the study and divided into two groups. One group was treated with laparoscopic technique and the second group treated with open surgical technique. Main variables of study were infection rate, duration of hospital stay and mean blood loss. SPSS version 23 was used for data analysis. Mean and standard deviation for numerical data and frequency and percentages for categorical data were calculated. P value ≤0.05 was considered as significant. Results: In 16.8% patients of laparoscopic group, infection occurred and 20.6% patients in open group. But the difference was statistically insignificant, (p=0.382). The mean hospital stay in laparoscopic group was 11.21±2.53-day and14.78±3.01 days in open group. The difference was statistically significant. (p=0.000). Conclusion: Laparoscopic technique is associated with reduced rate of infection; hospital stay, and blood loss as compared to open surgery of colorectal carcinoma. Laparoscopic surgical method is preferred over open method.

The effect of neoadjuvant treatment on postoperative morbidity in upper rectal cancer

Background. The need of neoadjuvant treatment for upper rectal cancer remains the object of discussion, which makes further study of this topic important.Аim. To estimate the postoperative complications rate depending on the type of neoajuvant treatment.Materials and methods. A retrospective cohort multicenter study, that analyzed data of medical records of patients with upper rectal cancer from the archive of N.N. Blokhin Cancer Research Center of the ministry of Health of Russia, Ryzhikh national medical Research Center of Coloproctology of the ministry of Health of Russia and Stavropol Regional Clinical Oncology Center for 2007–2020. Patients were devided into 3 groups: the group of radiotherapy (5*5 gy), the group of neoadjuvant chemotherapy (4 courses of XELOX before surgery) and the group of surgery. The main endpoint was the study of anastomotic leak rate. Also we estimated the postoperative complications rate III–Iv degree (Clavien– Dindo), the sphincter-preserving surgery rate, the stoma creation rate, the postoperative mortality.Results. we included 110 patients in radiotherapy group, 188 patients in neoadjuvant chemotherapy group, 103 patients in surgery group. Study groups were comparable by sex, ASA status and histological grade. Postoperative grade III– Iv complications (in all cases were associated with anastomotic leak) developed in 8 (6.8 %) patients in neoadjuvant chemotherapy group versus 11 (10.0 %) patients in radiotherapy group (p = 0.379) and 12 (11.7 %) patients in surgery group (p = 0.208). There weren»t any significant differences in this parameter between the radiotherapy and the surgery group (p = 0.698). R0-resection was performed in 117 (99.2 %) patients in neoadjuvant chemotherapy group versus 107 (97.3 %) patients in radiotherapy group (p = 0.280) and 103 patients (100 %) in surgery group (p = 0.349). Radiotherapy and surgery groups didn’t differ significantly in R0-resection rate (p = 0.091). 1 patient (0.84 %) in neoadjuvant chemotherapy died before surgery, in other groups there weren’t any lethal outcomes (p = 0.283). Only the male sex, had a statistically significant effect on the anastomotic leak rate (risk ratio (HR) 2.875; 95 % confidence interval (CI) 1.24–6.63; p = 0.003).Conclusions. A study of these case histories of patients with cancer of the upper ampullary rectum, conducted by us, showed that neoadjuvant treatment didn»t affect the postoperative complications rate.

Efficacy and safety of pembrolizumab plus chemotherapy and sequential surgical resection in initial unresectable stage IIIB NSCLC.

e20595 Background: Neoadjuvant immunochemotherapy has been proved effective in resectable NSCLC, while its role in unresectable stage IIIB NSCLC remains controversial. This study aims to demonstrate the efficacy and safety of neoadjuvant immunochemotherapy sequential surgical resection in initial unresectable stage IIIB NSCLC patients. Methods: This multicenter study retrospectively analyzed 59 patients with initial unresectable stage IIIB NSCLC who received induction pembrolizumab combined with chemotherapy between June 2019 and April 2022. The clinical characteristics, radiological and pathological response and survival outcomes were collected and evaluated. Results: A total of 59 initial unresectable stage IIIB NSCLC patients were identified and divided into the surgery group (n = 23) and non-surgery group (n = 36) with a median follow-up time of 15.0 months. The median PFS/DFS of surgery group was significantly longer than that of non-surgery group (not reached versus 15.5 months, p = 0.0031). The median OS was not reached in both groups, overall survival rate was 100% (23/23) in surgery group and 83.3% (30/36) in non-surgery group. Pathological analysis suggested that 13 of 23 patients (56.5%) achieved major pathological response (MPR) or pathological complete response (pCR), and more squamous cell carcinoma cases were observed in MPR group compared to non-MPR group ( p = 0.034). Of 23 patients in surgery group, all patients had a R0 resection, no surgical-related mortality was recorded, only 3 patients (13.0%) experienced any postoperative complications. Conclusions: Surgical resection after neoadjuvant immunochemotherapy is beneficial in the survival outcome of initial unresectable stage IIIB NSCLC patients, with a high MPR rate and good surgical safety.

Patient Outcomes of Non-Operative Versus Operative Management of Humeral Shaft Fractures: A Randomized Controlled Trial

Objective: To determine the non-surgical versus surgical outcomes in individuals who suffered from humeral shaft fractures. Methods: A randomized controlled trial was undertaken at the Department of Orthopedics Bolan Medical College Hospital Quetta, Pakistan between 09-March-2019 to 08-October-2019. A total number of 248 patients who presented with humeral shaft fractures having age 20-60 years were included in this study. Eligible patients were randomly grouped into two equal sets. Group I: were allotted to patients in whom non-operative management of humeral shaft fractures was done. In group II patients: operative management was done. Surgical outcomes were noted in terms of delayed union and radial nerve palsy. Study outcomes were noted after 1 month of principal procedure. Results: The mean age of individuals included in this study was 45.46±9.64 years. Mean body mass index (BMI) of patients was 25.44±4.63 kg/m2. Mean duration of fracture to surgery was 8.80±8.07 days. There were 169 (68.15%) male patients and 79 (31.85%) female patients. Delayed union was found in 27 (21.80%) patients in non-operative groups versus 19 (15.30%) in patients who underwent operative management (p-value of 0.191). On comparison of frequency of radial nerve palsy between the groups, radial nerve palsy was found in 12 (9.70%) patients in non operative group versus 16 (12.90%) in patients in operative group (0.422). Conclusion: The study revealed that the non-surgical management of humeral shaft fractures gives outcomes that are comparable to operative management. We did not find any evidence of significant difference in the frequency of delayed union and radial nerve palsy between the groups. Keywords: humeral shaft fractures, operative management, non-operative management.