Postoperative Grade Research Articles

Association of body mass index with pathologic agreement of preoperative and postoperative tumor grade in endometrial cancer.

We aim to study association of BMI of EC patients, with the level of agreement between preoperative and postoperative tumor grade. A retrospective study. We included patients with EC diagnosed in an outpatient clinic which had surgical staging as in our division. We categorized patients into BMI categories according to the World Health Organization; (BMI < 18.5kg/m2), (BMI 18.5-24.9kg/m2), (BMI 25-29.9kg/m2), (BMI 30-34.9kg/m2), (BMI 35-39.9kg/m2), and (BMI ≥ 40kg/m2). We further dichotomized the study population for obesity, defined as BMI ≥ 30.0. We analyzed agreement between preoperative and postoperative tumor grade, stratified by patient's BMI. Overall, 623 women met study inclusion criteria, with a median age of 64 [interquartile range (IQR) 57-72]. Among the study cohort, the median BMI was 30.7 [IQR 25.6-38.8], with 330 (53.0%) patients being obese. EC grade 1 was diagnosed preoperatively in 353 (56.7%), grade 3 in 148 (23.8%), and grade 2 in 122 (19.6%). Endometrioid histology was diagnosed in 463 (74.3%), serous in 78 (12.5%), mixed histotype in 51 (8.2%), clear cell in 20 (3.2%) and carcinosarcoma in 11 (1.8%). In 68.7% (n = 428), there was no change in postoperative grade, and in 24.9% (n = 155), there was upgrading of tumor, and in 6.4% (n = 40), there was a tumor downgrade. There were 3 (0.5%) cases in which no tumor was found on final pathology. The rate of no change was higher in preoperative grade 3 (89.9%) vs. grades 1 (63.5%) and grade 2 (58.2%), p < .001). There was no difference in grading agreement when obese patients were compared to non-obese, p = .248. There was no difference in grading agreement when comparing the various BMI categories, with no change proportion ranging between 58.2% in BMI 30.0-34.9 mg/kg2 and 79.7% in BMI 35.0-39.9 mg/kg2, p = .104. ROC analysis of BMI as predictor of no-change yielded an area under the curve of 0.466 (95% confidence interval 0.418-0.515) with a maximal performance at a BMI of 33.8 mg/kg2. The agreement between preoperative and postoperative tumor grade among all patients was kappa = 0.517. The agreement did not differ when compared between obese patients (kappa = 0.456) and non-obese (kappa = 0.575). Our study found no significant association between BMI and the agreement between preoperative and postoperative tumor grading in EC.

Effectiveness of robot-assisted minimally invasive and open freehand transforaminal lumbar interbody fusion in treatment of single-level degenerative lumbar spondylolisthesis and the influence on adjacent segment degeneration

To compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). The clinical data of 116 patients with L 4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L 3, 4 intervertebral disc height (DH), L 3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height ( P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L 3, 4 DH, L 3, 4 DH loss, and L 3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups ( P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group ( P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients ( P>0.05); the change values of L 3, 4 DH and L 3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L 3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant ( P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant ( P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF ( P<0.05). Compared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.

Outcomes of adjuvant radiation treatment following subtotal resection of world health organization grade II meningiomas.

Existing literature on adjuvant radiation after subtotal resection (STR) of WHO II meningiomas is limited by heterogenous patient cohorts, combining adjuvant and salvage radiation, gross total resection (GTR) and STR, primary radiation treatment vs. re-treatment, or grade II and III meningiomas, all of which have different expected outcomes. Tumor control estimates in a large homogenous patient cohort are needed to accurately counsel patients. A retrospective review of patients that had immediate post-operative imaging-confirmed residual WHO grade II meningioma followed by either adjuvant intensity-modulated radiation therapy (IMRT) or stereotactic radiosurgery (SRS) between 1996 and 2020 was conducted. Kaplan-Meier survival analysis and log-rank test was used to assess progression-free survival (PFS). Thirty-nine patients met inclusion criteria (IMRT = 32; SRS = 7). Overall, the 3-, 5-, and 10-year PFS was 81.1%, 61.2%, and 44.6%, respectively. Median follow-up time was 37 months. When comparing IMRT and SRS cohorts, baseline characteristics did not differ significantly between groups, but significantly larger residual tumor volumes were treated with IMRT (22.2 cm3 vs. 6.3 cm3, p = 0.004). PFS was not significantly different between IMRT and SRS at 3 years (81.1% vs. 80.0%) or 5 years (65.5% vs. 40%) (p = 0.19). There was no significant difference in radiation necrosis between groups (IMRT = 3/32 patients vs. SRS = 0/7 patients, p = 0.32). Our homogenous patient cohort displayed acceptable control rates at 3 years using SRS or IMRT as adjuvant therapy. No significant difference in PFS or radiation necrosis was noted between patients treated with adjuvant IMRT versus SRS.

Comparison of the efficacy and safety of mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for the treatment of kidney stones in overweight or obese patients: a systematic review and meta-analysis.

To discuss the differences in the effectiveness and security of kidney stones in overweight or obese patients by mini percutaneous nephrolithotomy (MiniPCNL) and retrograde intrarenal surgery (RIRS). We exhaustively searched numerous databases, including PubMed, Embase, Web of Science, Cochrane Library, and CNKI, covering all records from their initiation date until September 2023. This included controlled trials focusing on the use of MiniPCNL and RIRS in the treatment of kidney stones in overweight or obese patients. The gathered data was then analyzed using the Review Manager 5.4 software. 9 studies including 1122 patients were included. Meta-analysis showed that: The MiniPCNL group had higher overall complications, grade I complications, length of hospital stay(LOS), first stone-free rate (SFR), and final SFR in obese patients, with no significant difference between the two groups in terms of operative time(OT), hemoglobin drop, and grade II complication rate. There were more overall complications, grade I complications, final SFR, and LOS with MiniPCNL in patients with stones > 2cm compared to no significant difference in grade II complications. MiniPCNL performed in the prone position had higher final SFR, less OT, hemoglobin drop, and no statistically significant difference in overall complications or LOS. Sheaths using > 14F had higher overall complication rates, final SFR, and LOS, and no statistical differences in OT and first SFR between the two modalities. In the MiniPCNL subgroup aged ≤ 50 years, there were higher first SFR, final SFR, and shorter OT, and in the MiniPCNL subgroup aged > 50 years, there were more OT, LOS, and hemoglobin drop, with no statistical difference in overall complications between the two groups. Our study showed that MiniPCNL in obese patients had higher initial SFR and final SFR, fewer procedures, but more postoperative complications, LOS, and grade I complications compared with RIRS. Similar results were seen in patients in the prone position, with stones > 2cm and age ≤ 50 years. [ https://www.crd.york.ac.uk/PROSPERO/ ], identifier PROSPERO (CRD42023467284).

Comparison of anterior spinal fusion and posterior cervical foraminotomy for cervical spondylotic radiculopathy in terms of postoperative recovery of upper-limb motor deficits

This study compared postoperative motor recovery between anterior spinal fusion (ASF) and posterior cervical foraminotomy (PCF) in patients with cervical spondylotic radiculopathy (CSR) who had motor deficits. From a database maintained by surgeons across 27 institutions, 227 patients undergoing primary ASF or PCF for CSR without myelopathy were evaluated. Among these, 106 patients with upper-limb motor deficits (manual muscle testing [MMT] grade 0–3) were observed for at least 12 months post-surgery. Data on preoperative and postoperative MMT grades were collected at 3, 6, and 12 months after surgery and at the final follow-up. The recovery of motor function was compared between the ASF and PCF groups using Kaplan–Meier curves and Cox regression analysis. While the overall excellent recovery rates (MMT grade ≥ 2) at the final follow-up were similar between the ASF and PCF group (74 % vs. 86 %, p = 0.15), the PCF group showed significantly faster motor recovery at 3, 6, and 12 months postoperatively, with recovery rates of 43 %, 63 %, and 82 %, respectively, compared to 18 %, 46 %, and 54 % in the ASF group (HR = 1.62, p = 0.031). These findings suggest that PCF may offer a quicker recovery of motor function and could be a more suitable surgical procedure than ASF for patients with CSR and motor deficits.

Trauma Program Value Assessment at an Academic Health Network System Over 12 Years.

Trauma is a leading cause of global death, with 200000 deaths and over 3 million non-fatal injuries/year in the United States. We aim to assess trauma care value for patients who underwent urgent laparotomies (LAP) and thoracotomies (THO) in our Health Network System. Clinical variables (v = 84) from trauma patients (>18 yo) were retrieved retrospectively (Jan-2010 to July-2016) and prospectively (Aug-2016 to Sept-2021) from a Health System warehouse under IRB-approved protocols. Patients were divided according to their Injury Severity Score (ISS) into mild/moderate cases (ISS <15) and severe cases (ISS >15). Value was assessed using quality and cost domains. Quality surrogates included graded postoperative complications (PCs), length of stay (LOS), 30-day readmission (RA), patient satisfaction (PS), and textbook (TB) cases. Total charges (TCs) and reimbursement index (RI) were included as surrogates for cost. Value domains were displayed in scorecards comparing Observed (O) with Expected (E) (using the ACS risk calculator) outcomes. Uni-/multivariate analyses were performed using SPSS. 41,927 trauma evaluations were performed, leading to 16044 admissions, with 528 (3.2%) patients requiring urgent surgical procedures (LAP = 413 and THO = 115). Although the M:F ratio (7:3) was similar in LAP vs THO groups, age and BMI were significantly different (41.8 ± 19.1 vs 51.8 ± 19.9 years, 28.6 ± 9.9 vs 27.4 ± 7Kg/m2, respectively, P < .05). Blunt trauma was involved in 68.8/77.3% of the LAP/THO procedures, respectively (P < .05). Multivariate analyses showed ISS, age, ASA class, and medical center as factors significantly predicting PC (P < .05). Postoperative complication grades from the LAP/THO groups showed above-average outcomes; nonetheless, LOS was higher than the national averages. The Trauma Program holds high value in our Health Network System. Protocols for decreasing LOS are being implemented.

Water vapor thermal therapy (Rezūm System) in patients with large prostates: results from a prospective comparative study.

Rezūm is a novel minimally invasive surgical technique (MIST) useful for BPH patients with medium-sized prostate (30-80 cm3) refractory to medical treatment. The aim of this study was to evaluate the efficacy and safety of Rezūm as a treatment option in large-sized prostates (>80 cm3). We performed a prospective, comparative, single-center study from June 2022 to June 2023, including consecutive patients undergoing surgery with the Rezūm System. Enrolled men were classified into two subgroups based on prostate size: medium prostate (MP) (30-80 cm3) and large prostate (LP) (≥80 cm3). Inclusion criteria included an International Prostate Symptom Score (IPSS) Total score of ≥ 8 points. International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), post-void residual (PVR), and International Index of Erectile Function 5-item version (IIEF-5) were collected at baseline and at three, six, and 12 months post-procedure. Ejaculation presence was assessed at 3 months. Post-operative complications were described using the Clavien-Dindo (CD) classification. The primary outcome was the IPSS-Total score, with intraoperative and postoperative CD grade ≥III complications as secondary outcomes. One hundred and twenty-one patients (PV 78.2±32.1 mL) were included in the study, 51 large prostate (LP) and 70 medium prostate (MP). The IPSS-Total score and Q<inf>max</inf> showed a statistically significant (P<0.0001) improvement at 3, 6, and 12 months respectively. PVR decreased at 3, 6, and 12 months; however, only at 3 months this variation was statistically significant (P<0.0001). At 3-month follow-up, anejaculation was detected in (3; 5.8% and 1; 1.4%) patients in LP and MP group respectively (P=0.86). IIEF-5 significantly improved 3 months after surgery in the LP subgroup (P<0.0001). Rezūm water vapor therapy appears to be effective for treating BPH in larger prostates. Additionally, it demonstrates a low risk of impairing sexual function, indicating a favorable safety profile.

Subchondral curettage cement packing in the distal radius causes wrist joint degeneration: long-term evaluation of distal radius giant-cell bone tumour.

This study investigated wrist joint degeneration after curettage and PMMA treatment for giant cell bone tumours (GCBT) at the distal radius. We performed a retrospective single-centre study, which included 23 patients with GCBT at distal radius treated with curettage and PMMA between 2001 and 2021. The progression of wrist joint degeneration was assessed through radiographic evidence, comparing the postoperative grade with both the preoperative grade and the grade of the contralateral wrist at the latest follow-up. We also analyzed the influence of age, sex, tumour distance of the joint, subchondral bone involvement, tumour size and body mass index. The study included 23 patients with a mean age of 32.1 ± 13.3 years. The average duration of follow-up was 96.4 ± 69 months (range, 24-265 months). The mean tumour-cartilage distance was 1.79 ± 2.4 mm (range, 0-10 mm) and the mean BMI was 23.5 ± 3.8 kg/m2. Degeneration of the wrist joint was evident in 16 patients (69.6%) at the final assessment, however, 10 patients (43.4%) were identified as having a progression of joint degeneration secondary to the surgical procedure among the 16 patients with wrist joint degeneration at the final control view. Age, gender, dominance, tumour-cartilage distance, subchondral bone involvement, tumour size, patient height, weight, and BMI were not associated with secondary joint degeneration. Ten of 23 patients developed wrist joint degeneration over an average follow-up period of 8 years, and no particular factors associated with the degeneration were identified.

Outcomes of Type-1 Tympanoplasty with and without use of Topical Nasal Steroids; a Comparative Study

Objective: To compare the outcome of Type-1 tympanoplasty procedure in patients given intranasal steroids post-operatively versus those not given intranasal steroids after procedure. Study Design: Quasi-Experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi. Pakistan from May 2021 to May 2023. Methodology: A total of 464 patients, 232 of which were given intranasal steroids (Group-A), and 232 who were not given intranasal steroids (Group-B) were made part of this research. Upon inclusion, all pre-operative demographics were documented. Patients in post-operative follow up period were assessed for condition of tympanic membrane and improvement of hearing ability. Results: In current study, post-operatively, in patients who were given intranasal steroids, graft take-up frequency was 227(97.84%) and residual perforation was 5(2.16%) was better than in patients who were not given intranasal steroids, which came to 224(96.55%) and 8(3.45%), respectively (p=0.399). In terms of post-operative WHO grade of hearing impairment distribution (p&lt;0.001) and post-op hearing status (p=0.005) difference between patients who were given intranasal steroids and those not given intranasal steroids was statistically significant. Conclusion: Addition of intranasal steroid spray to the treatment regimen following tympanoplasty is provides better outcomes in terms of higher graft take-up frequency and an improvement in hearing from preoperative levels.

Predictive value of early-stage postoperative albumin-bilirubin grade on the overall survival of hepatocellular carcinoma patients undergoing resection.

The albumin-bilirubin (ALBI) and ΔALBI grades have attracted substantial attention for their ability to predict the overall survival (OS) of patients with hepatocellular carcinoma (HCC). This retrospective study aimed to evaluate the predictive value of the ALBI grade at different time points for the OS of patients with HCC who underwent surgical resection. The clinical data of patients with HCC who underwent radical resection in our hospital were collected and analyzed. The survival rate was analyzed using the Kaplan-Meier method and log-rank test. The risk factors influencing OS were identified via univariate and multivariate Cox regression analyses. A total of 104 patients with HCC were included in this study. The 1-, 3-, and 5-year OS rates of these patients were 91.3%, 64.0%, and 60.2%, respectively. The OS rates were significantly higher in patients with early-stage postoperative ALBI grade 2 than in those with grade 3 (P < 0.001); however, the preoperative ALBI grade, later-stage postoperative ALBI grade, ΔALBI grade (early stage), or ΔALBI grade (later stage) did not affect the OS rate. Furthermore, resection of ≥3 Couinaud liver segments [hazard ratio (HR) = 4.74; 95% confidence interval (CI), 2.32-9.67; P < 0.001], occurrence of postoperative complications (HR = 2.95; 95% CI, 1.38-6.31; P = 0.005), and early-stage postoperative ALBI grade 3 (HR = 2.50; 95% CI, 1.18-5.31; P = 0.02) were identified as independent risk factors for the OS of patients with HCC. Early-stage postoperative ALBI grade can be used to predict the OS of patients with HCC who have undergone radical hepatectomy. Early-stage postoperative ALBI grade 3, resection of ≥3 Couinaud liver segments, and occurrence of postoperative complications are independent risk factors affecting the OS of these patients.

The safety and efficacy of stapler method for transection of the pancreatic parenchyma during pancreatoduodenectomy (STRAP-PD trial): study protocol for a randomized control trial.

Pancreaticoduodenectomy is a highly difficult and invasive type of gastrointestinal surgery. Prevention of postoperative pancreatic fistula is important, and this may be possible by the stapler method. STRAP-PD is a single center randomized controlled trial. We compare a method of transecting the pancreatic parenchyma in pancreaticoduodenectomy using a surgical stapler device with a conventional transecting method using energy devices (e.g., scalpel, ultrasonic coagulator and incision devices). Patients with soft pancreas who are scheduled to undergo pancreaticoduodenectomy are randomized to arm A (conventional method) or arm B (stapler method). We aim to examine the safety and usefulness of dissection by the automatic suture device, with attention to the rate of pancreatic fistula ISGPF grade B or C and to postoperative complications. This is a single-center randomized study, which began in September 2023 at Wakayama Medical University Hospital. Pancreatic parenchymal transection is typically performed either by direct incision using a scalpel or by employing energy devices such as ultrasonic coagulating cutting devices during pancreaticoduodenectomy. In a prospective pilot study, we conducted pancreatic parenchymal transection in 20 consecutive normal pancreatic cases during pancreaticoduodenectomy, observing postoperative pancreatic fistula grade B in one case (5%). Traditional methods involving scalpel incision or the use of ultrasonic coagulating cutting devices have been historically favored but perceived as technically challenging, and they have been reliant upon the surgeon's skill. Notably, relatively high incidences of postoperative pancreatic fistula among patients with soft pancreas have also been observed. Our proposed stapler method may therefore be a useful method responsible for reducing the development of pancreatic fistula. This method would be as part of minimally-invasive surgery for pancreaticoduodenectomy. It uses an endoscopic linear stapler to cut the pancreatic parenchyma, so it is likely to be more convenient than conventional methods and can be used universally. TRIALREGISTRATION: University Hospital Medical Information Network Clinical Trials Registry,UMIN000052089. the Registration Date on 1st September 2023.

Could indirect decompression occur for cord compression by the ligamentum flavum with anterior cervical discectomy and fusion?

Cord compression by the ligamentum flavum (CCLF) has been reported to adversely affect the clinical outcomes of anterior cervical discectomy and fusion (ACDF). While indirect decompression does occur for foraminal stenosis with ACDF, whether ACDF could improve CCLF with the distraction of disc space remains unclear. This study aimed to identify 1) whether indirect decompression occurs for CCLF with ACDF, and 2) risk factors that hinder the improvement of CCLF. This retrospective cohort study included 119 patients who underwent ACDF for the treatment of cervical myelopathy and CCLF was detected on preoperative MRI. Patients who demonstrated improvement in CCLF grade after ACDF were included in the improved group, while those who did not show improvement were classified as the unimproved group. Patient characteristics, cervical sagittal parameters, neck and arm pain visual analog scale score, and Japanese Orthopaedic Association (JOA) score were assessed. A comparison between the improved and unimproved groups was performed. Regression analyses were performed to identify factors associated with CCLF grade improvement. Overall, 58.0% (69/119) of patients showed improvement in CCLF grade after ACDF. CCLF grade did not improve in the remaining 42.0% (50/119) of patients, and 3.4% (4/119) of patients experienced aggravation of CCLF after ACDF. Preoperative spondylolisthesis (OR 0.252, 95% CI 0.090-0.711; p = 0.009) and greater segmental lordosis 3 months postoperatively (OR 0.835, 95% CI 0.731-0.953; p = 0.008) were the factors that hindered the improvement of CCLF after ACDF. Furthermore, patients with higher pre- or postoperative CCLF grades showed significantly less improvement in JOA score 2 years postoperatively. Indirect decompression for CCLF with ACDF is not reliable because 42.0% of patients did not demonstrate improvement in CCLF grade after the operation. Preoperative spondylolisthesis and postoperative increased segmental lordosis were risk factors for failure of CCLF improvement. Both pre- and postoperative higher CCLF grades were associated with poor neurological recovery 2 years postoperatively.

Impact of Glutamine-Enhanced Parenteral Nutrition on Postoperative Outcomes in Colorectal Cancer Patients.

This study investigated the effects of parenteral glutamine (Gln) supplement immunonutrition versus conventional nutritional support on postoperative Clavien-Dindo classification complications and recovery, perioperative nutritional status, and immune, inflammation, and safety indicators in patients with colorectal cancer (CRC). Clinical data were collected for a retrospective cohort study of 178 patients (58 and 120 patients in the observation and control groups, respectively) who underwent radical resection of CRC from January 2019 to December 2021. The incidence of postoperative complications was calculated. Postoperative recovery, nutritional indicators, inflammatory factors indicator, and the safety indicators before operation and at 1, 3, and 7 days after operation were compared. SPSS 29.0 statistical software was used for statistical analysis. The incidence of postoperative overall complications in the control group and the observation group was 22.50% (27/120) and 17.24% (10/58), respectively, and there was no significant difference between the two groups (P=0.42). The incidence of postoperative complications of Clavien-Dindo grade ≥III in the control group and the observation group was 14.17% (17/120) and 3.45% (2/58), respectively, and the difference between the two groups was statistically significant (P=0.03). Secondary outcomes (first exhaust, defecation, and liquid diet intake times) were significantly recovered earlier in the observation group than those in the control group (P<0.05), while the postoperative hospital stay was significantly shorter(P=0.04). The perioperative nutritional status did not significantly differ between the groups before and after surgery(P>0.05), although significant differences were observed in several inflammatory and safety indicators(P<0.05). Unlike conventional nutritional support, postoperative parenteral Gln supplementation reduced the incidence of postoperative Clavien-Dindo complications grade ≥III in patients with CRC while increasing intestinal and immune functions, decreasing inflammation, and reducing the length of hospital stay.

A comparative study on the efficacy of different treatment methods for preventing vocal cord adhesion after laser treatment for glottic cancer

Objective:Comparing the primary tumor control, vocal function recovery, postoperative adhesion rate and degree of adhesion in early glottic cancer involving the anterior commissure treated with CO₂ laser staged and lateral surgery, one-stage surgery combined with laryngeal stent placement, and simple CO₂ laser excision. Methods:This study focuses on 83 patients with T1-2N0M0 stage glottic squamous cell carcinoma involving the anterior commissure who underwent CO₂ laser treatment. The study was divided into three groups: Group A with 15 cases, treated with staged resection surgery; Group B with 18 cases, treated with one-stage surgery combined with the placement of a silicone laryngeal stent; and Group C with 50 cases, treated with simple CO₂ laser excision. The Voice Handicap Index-10（VHI-10）, the GRBAS auditory-perceptual assessment, and the maximum phonation time（MPT） were used to evaluate the vocal function of the patients before and six months after surgery. The degree of vocal cord adhesion was assessed using the Cohen classification of vocal cord adhesion. Statistical analysis was performed to determine the differences in each indicator before and after surgery, and the primary tumor control rates among the three groups. Results:Local recurrence occurred in 1 case each in Groups A and B, and in 4 cases in Group C, with no distant metastasis observed. Postoperative vocal cord adhesion of varying degrees occurred in a total of 77 cases, with an adhesion rate of 73.3%（11/15） in Group A, 88.9%（16/18） in Group B, and 100%（50/50） in Group C. The postoperative vocal cord adhesion rate and degree in Group C were significantly higher than in Groups A and B. The postoperative VHI-10 scores in all three groups were significantly increased compared to preoperative scores（P<0.05）, and when compared between groups postoperatively, Group C was significantly worse than Groups A and B （P<0.05）. The postoperative maximum phonation time（MPT） in Group C was significantly reduced compared to preoperative and was markedly shorter than that of Groups A and B postoperatively（P<0.05）. The postoperative grades of G（Grade） and R（roughness） in Group C were significantly higher than preoperatively, indicating a noticeable deterioration in voice quality, and were also significantly worse than those postoperatively in Groups A and B, with all differences（P<0.05）. Conclusion:For early glottic cancer involving the anterior commissure, choosing staged surgery or one-stage surgery combined with the placement of a silicone anterior commissure laryngeal stent were better than simple laser tumor excision in terms of secondary vocal cord adhesion and voice function preservation.

Enhanced Transconjunctival Lower Blepharoplasty: A Novel Method for Intraorbital Fat Transposition and Stabilization.

The evolution of lower blepharoplasty has shifted from simply removing of orbital septum fat to smoothing of the lid-cheek junction through fat repositioning. This paper adopts a novel technique to transpose and stabilize intraorbital fat during transconjunctival lower blepharoplasty. The tear trough and nasal alar base were filled to correct the pouch while ensuring the blood supply of the fat flap. Between September 2019 and June 2022, 104 patients aged between 22 and 49 who underwent bilateral fat flap transposition-nasal alar base filling lower blepharoplasty were selected. The surgical results were assessed by non-operative plastic surgeons according to the Hirmand grading system. Moreover, a self-satisfaction survey was conducted and patients were followed up for at least 6months to evaluate any complications and surgical outcomes. A high-frequency ultrasound imaging system was used to assess the degree of filling of the tear trough and nasal alar base. All 104 patients were followed up for at least 6months. The postoperative Hirmand grade was 0 for 96 out of 104 (92.3%) patients. In terms of self-satisfaction assessment, there were 92 out of 104 (88.5%) patients reported satisfaction. Dermatologic ultrasound showed no obvious gaps 6months after surgery. Transconjunctival fat flap transposition combined with nasal alar base filling during lower blepharoplasty has been shown to have a positive postoperative effect and high patient satisfaction. This procedure can preserve the blood supply of the fat flap, reduce the rates of fat absorption and denaturation, and improve facial contour, resulting in a satisfactory repairing effect. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Treatment of Capsular Contracture in Previously Irradiated Breasts Implants and Expanders with the Use of Porcine Acellular Dermal Matrices: Outcomes and Complications.

Background: Radiation therapy is a crucial component of breast cancer treatment. However, it is well known to increase the risk of unsatisfactory cosmetic outcomes and higher complication rates. The aim of this study is to provide further insight into the use of acellular dermal matrices (ADMs) for the prevention of capsular contracture. Materials and Methods: This single-center, retrospective study analyzed irradiated patients who underwent post-mastectomy, ADM-assisted implant reconstructions. Of the 60 patients included, 26 underwent expander-to-implant substitution after radiotherapy (Group A), while 34 required implant replacement due to capsular contracture following radiotherapy (Group B). The primary objective was to evaluate the effectiveness of ADMs in reducing reconstructive failures, complications, and capsular contracture after breast irradiation. Results: We recorded a total of 15 complications and four implant losses. Reconstructive failures were attributed to implant exposure in two cases, full-thickness skin necrosis in one case, and severe Baker grade IV contracture in one case. Both Group A and Group B showed a significant decrease in postoperative Baker grades. US follow-up was used to demonstrate ADM integration with host tissues over time. Conclusions: Based on our findings, the use of ADM in selected cases appears to be a viable option for treating and preventing capsular contracture in irradiated breasts. This approach is associated with relatively low complication rates, a low rate of reconstructive failure, and satisfactory cosmetic outcomes and can be applied both in breast reconstructed with implants and with expanders.

Quantifying the Domino Effect of Septoplasty on Eustachian Tube Function and Nasal Resistance in Patients With Chronic Otitis Media: A Cross-Sectional Study.

Background Eustachian tube dysfunction is characterized by insufficient dilation, leading to secondary pathologies in the middle ear. By comparing pre- and post-operative grades of Eustachian tube functionand nasal resistance measurements, this study seeks to determine if septoplasty can improve Eustachian tube function in cases where nasal septal deviation is likely to cause mechanical dysfunction. We also aim to validate the JainBhalerao endoscopic classification of nasal septal deviation by assessing its utility in identifying septal deviations at a higher risk of causing Eustachian tube dysfunction. The ultimate goal is to establish guidelines for aural indications of septoplasty in treating Eustachian tube dysfunction-related middle ear disorders. Material and methods This prospective observational study was carried out from 1stJune 2022 to 31st March 2024 in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital, involving 66 patients diagnosed with chronic otitis media and a deviated nasal septum with Eustachian tube dysfunction. Pre-operative and post-operative improvement in Eustachian tube function and Nasal resistance and their correlation werestudied using dynamic slow-motion video endoscopy and active anterior rhinomanometry, respectively. Statistical analysis included the chi-square test. Results Sixty-six patients diagnosed with chronic otitis media and deviated nasal septum with Eustachian tube dysfunction included in this study had a mean age of 35.6 years with 43 (65.2%) male predominance. Gross luminal narrowing and discrepancy of the volume of both nasal cavities led to higher degrees of Eustachian tube dysfunction due to pressure drop on the affected side, as observed in types 6, 7, and 8 as per Jain Bhalerao classification of deviated nasal septum. Nasal resistance measured using active anterior Rhinomanometry (Rhinodebitometry) showed a positive association of severity of nasal resistance in the types 6, 7, and 8 DNS of the Jain Bhalerao classification of deviated nasal septum. It demonstrated an improvement in the grade of Eustachian tube function and nasal resistance post-septoplasty. Conclusion The deviated nasal septum is one of the causes of Eustachian tube dysfunction and increased nasal resistance. Certain types of DNS are adversely associated with the causation of greater degrees of Eustachian tube dysfunction of mechanical type. Nasal septal deviation correction improved Eustachian dysfunction and nasal resistance after septoplasty.

The Clavien-Dindo Classification for Body-Contouring Surgery Complications: Evaluation of 602 Cases.

Background: Due to the high frequency of postoperative complications after body-contouring surgeries, the need for a unifying postoperative complication grading system that correlates with outcomes is of key importance. Here we therefore consider the application of the Clavien-Dindo classification to evaluate postoperative complications after body-contouring surgeries. Methods: A retrospective study on 602 patients who underwent body-contouring surgery between 2009 and 2015 at our institution was performed. The length of hospital stays, age, sex, follow-up visits, and postoperative complications were evaluated and classified using the Clavien-Dindo classification. Results: We raised a total of 672 body-contouring procedures on 602 patients (563 female, 39 male). According to the Clavien-Dindo System, the severity of postoperative complications following body-contouring procedures was significantly correlated with the duration of hospitalization (mean 5.8 ± 2.7 days) and the number of follow-up visits (mean 4.4 ± 4.7). Conclusions: The Clavien-Dindo classification offers a valid prediction for postoperative hospital stay and the number of follow-up visits after body-reshaping surgery. By becoming a validated and reliable grading system that correlates patients' outcomes after body-contouring procedures, this classification has the potential to significantly improve patients' healthcare and quality of life.

Perioperative toripalimab plus neoadjuvant chemotherapy might improve outcomes in resectable esophageal cancer: an interim analysis of a phase III randomized clinical trial.

In the era of immunotherapy, neoadjuvant immunochemotherapy (NAIC) for the treatment of locally advanced esophageal squamous cell carcinoma (ESCC) is used clinically but lacks of high-level clinical evidence. This study aimed to compare the safety and long-term efficacy of NAIC followed by minimally invasive esophagectomy (MIE) with those of neoadjuvant chemotherapy (NAC) followed by MIE. A prospective, single-center, open-label, randomized phase III clinical trial was conducted at Henan Cancer Hospital, Zhengzhou, China. Patients were randomly assigned to receive either neoadjuvant toripalimab (240 mg) plus paclitaxel (175 mg/m2) + cisplatin (75 mg/m2) (toripalimab group) or paclitaxel + cisplatin alone (chemotherapy group) every 3 weeks for 2 cycles. After surgery, the toripalimab group received toripalimab (240 mg every 3 weeks for up to 6 months). The primary endpoint was event-free survival (EFS). The pathological complete response (pCR) and overall survival (OS) were key secondary endpoints. Adverse events (AEs) and quality of life were also assessed. Between May 15, 2020 and August 13, 2021, 252 ESCC patients ranging from T1N1-3M0 to T2-3N0-3M0 were enrolled for interim analysis, with 127 in the toripalimab group and 125 in the chemotherapy group. The 1-year EFS rate was 77.9% in the toripalimab group compared to 64.3% in the chemotherapy group (hazard ratio [HR] = 0.62; 95% confidence interval [CI] = 0.39 to 1.00; P = 0.05). The 1-year OS rates were 94.1% and 83.0% in the toripalimab and chemotherapy groups, respectively (HR = 0.48; 95% CI = 0.24 to 0.97; P = 0.037). The patients in the toripalimab group had a higher pCR rate (18.6% vs. 4.6%; P = 0.001). The rates of postoperative Clavien-Dindo grade IIIb or higher morbidity were 9.8% in the toripalimab group and 6.8% in the chemotherapy group, with no significant difference observed (P = 0.460). The rates of grade 3 or 4 treatment-related AEs did not differ between the two groups (12.5% versus 12.4%). The interim results of this ongoing trial showed that in resectable ESCC, the addition of perioperative toripalimab to NAC is safe, may improve OS and might change the standard treatment in the future.

452. THE TREATMENT STRATEGY FOR RECURRENT OR UNRESECTABLE ESOPHAGEAL CANCER USING IMMUNE CHECKPOINT INHIBITORS

Abstract Background Cisplatine+5-FU (CF) was the first regimen for patients with recurrent or unresectable esophageal cancer in Japan. Nevertheless, the efficacy of the treatment was limited, and the prognosis of these patients was very poor. Recently, CF + Pembrolizumab (CF+Pmeb), CF + Nivolumab (CF+Nivo), Ipilimumab + Nivolumab (Ipi+Nivo) regimens were covered by the Japanese national health insurance system, and we get the option to use immune checkpoint inhibitor for advanced esophageal cancer. Methods Forty-six patients with recurrent or unresectable esophageal cancer treated with regimens including immune checkpoint inhibitors, were included in this study. We compared best overall response (BOR) among these three regimens. Besides, we also reviewed the validity of conversion surgery. Results Of the 46 patients, 17 and 29 patients were treated for recurrent and unresectable esophageal cancer, respectively. Among the patients with unresectable cancer, 3 patients were diagnosed with CR and 3 patients underwent conversion surgery, whose regimens were CF+Pmeb or CF+Nivo. We could achieve R0 resection in all 3 patients with conversion surgery. Postoperative complications grade 2 or more did not occur in these 3 patients. Recurrence has not been observed yet, though the follow-up periods were short (3 to 5 months). Among the patients with recurrence, 2 patients achieved a CR after treatment with CF+immuno checkpoint inhibitor. Conclusion Regimens with immune checkpoint inhibitors would be the hopeful treatment for advanced esophageal cancer patients. Conversion surgery would also play an important role in improving the prognosis.