Preoperative Therapy Research Articles

Prognostic impact of postoperative complications after neoadjuvant therapy followed by esophagectomy for esophageal cancer: An exploratory analysis of phase III trial JCOG1109.

356 Background: We previously reported that postoperative complications after esophagectomy were significantly associated with poor long-term prognosis in the prospective randomized trial JCOG9907 (Ann Surg, 2017). JCOG1109 evaluated the efficacy and safety of neoadjuvant docetaxel plus cisplatin plus 5-FU (DCF), radiation with cisplatin plus 5-fluorouracil (CF-RT) compared with cisplatin plus 5-fluorouracil (CF) for locally advanced esophageal squamous cell carcinoma, and demonstrated the superiority of DCF compared with CF in improving overall survival (OS). In this exploratory analysis, we investigated the association between postoperative complications and prognosis in JCOG1109, where more intensive preoperative therapies and thoracoscopic esophagectomy (TE) were introduced. Methods: Patients with potentially resectable advanced thoracic esophageal cancer were randomly assigned to CF, DCF, or CF-RT therapies and followed by open esophagectomy (OE) or TE with regional lymphadenectomy in JCOG1109. The impacts of postoperative complications (≥ Grade 2) on long-term prognosis including OS and progression-free survival (PFS) were investigated in each of the three preoperative therapies. Results: Between December 2012 and July 2018, 601 patients were randomized (CF/DCF/CF-RT; 199/202/200). Of 589 eligible patients, 541 patients underwent esophagectomy (183/181/177). Any postoperative complications, pneumonia, anastomotic leakage, recurrent laryngeal nerve paralysis, or infectious complications had no significant impact on OS in each of the three arms. When divided into OE or TE, the impact of any postoperative complications on OS was attenuated by introducing TE in each of three arms; from neoadjuvant CF followed by OE group [hazard ratio (HR) 1.557, 95% confidence interval (CI) 0.881-2.752] to TE group [HR 0.802, 95% CI 0.424-1.515], from neoadjuvant DCF followed by OE group [HR 1.151, 95% CI 0.575-2.306] to TE group [HR 0.703, 95% CI 0.3363-1.471], and from neoadjuvant CF-RT followed by OE group [HR 1.548, 95% CI 0.840-2.852] to TE group [HR 1.186, 95% CI 0.627-2.245]. Conclusions: JCOG1109 showed no association between postoperative complications and long-term prognosis. The prognostic impact of postoperative complications might be attenuated by the introduction of minimally invasive esophagectomy (open to thoracoscopy) even after more intensified preoperative therapy (CF to DCF or CF to CF-RT). Clinical trial information: CRB3180009.

A phase II double window of opportunity trial evaluating the oral TGF-beta receptor I inhibitor vactosertib in patients undergoing standard of care preoperative therapy for locally advanced esophageal adenocarcinoma.

TPS516 Background: Esophageal adenocarcinoma (EAC) is the seventh most common cancer globally and ranks sixth in overall mortality. Despite improvements in pre-operative therapy, EAC has a high recurrence rate, especially among patients whose tumors do not achieve pathologic complete response (pCR), thus there is a critical need to enhance pCR rate and improve long-term outcomes. We recently discovered that a subset of EACs are driven by tumor-intrinsic oncogenic TGFβ signaling and have identified two potential biomarkers to predict response to anti-TGFβ therapy. One of these biomarkers is enriched in poorly differentiated EAC. We hypothesize that TGFβ signaling blockade will exert a tumor-inhibitory effect in patients with EAC and propose a double window-of-opportunity trial to test if TGFβ receptor I inhibitor vactosertib can improve pCR and induce tumor metabolic response in patients undergoing neoadjuvant therapy for localized EAC. Methods: This phase II double window of opportunity study assesses the efficacy and pharmacodynamics of the oral TGFβ Receptor I inhibitor vactosertib in patients with locally advanced esophageal adenocarcinoma (EAC). Patients will be treated with single-agent vactosertib in two windows of opportunity: the first will be prior to initiation of standard of care neoadjuvant therapy and the second after completion of neoadjuvant therapy prior to surgery. Patients will be eligible if they have poorly differentiated EAC and are appropriate for neoadjuvant therapy followed by resection as per standard of care. The primary objectives are improvement in pCR compared to historical controls and metabolic response (decrease in fluorodeoxyglucose uptake by PET CT) in the primary tumor after the first window. Secondary objectives will evaluate biomarkers of response identified in preclinical studies. Pre- and post-first window of opportunity treatment biopsies will be obtained for correlative and exploratory analyses. Clinical trial information: NCT06044311 .

Safety and efficacy of perioperative chemotherapy combined with PD-1 inhibitor versus chemotherapy with D2 gastrectomy plus PAND in gastric cancer with PALD metastasis: A single-center retrospective cohort study.

368 Background: Gastric cancer with para-aortic lymph node (PALD) metastasis is associated with a poor prognosis. When the metastasis is limited to the PALD, preoperative systemic therapy combined with D2 gastrectomy plus para-aortic lymph node dissection (PAND) may enhance survival. The benefit of perioperative chemotherapy combined with immune checkpoint inhibitors for these patients is unknown. Methods: A total of 133 patients with gastric cancer and limited No.16a2/b1 lymph node metastasis underwent perioperative systemic therapy combined with D2 gastrectomy plus PAND. Patients receiving chemotherapy combined with a PD-1 inhibitor were assigned to Group A (n=62), while those receiving chemotherapy alone were assigned to Group B (n=71). Pathological response, safety, efficacy, and survival outcomes were compared between the two groups. Results: Adverse events occurred at comparable rates between the two groups. No treatment-related deaths occurred in either group. In Group A, all patients (100%) achieved R0 resection, compared to 70 patients (98.6%) in Group B. Group A showed significantly better pathological outcomes than Group B, with higher rates of pathological complete response (pCR) (37.1% vs. 4.2%, P < 0.001), and major pathological response (MPR) (58.1% vs. 22.5%, P < 0.001). Group A showed a higher 2-year overall survival (OS) rate compared to Group B (90.3% vs. 62.9%, P = 0.011). The median overall survival (mOS) in Group B was 35.0 months, while follow-up data for Group A are currently insufficient to assess mOS. Conclusions: The addition of a PD-1 inhibitor to chemotherapy significantly improves the pathological response rate and prognosis in gastric cancer patients with PALD. Notably, the combination did not increase adverse events. These findings suggest that combining PD-1 inhibitor with chemotherapy could be a promising strategy for improving outcomes in this patient population, though further prospective studies are necessary to confirm long-term survival benefits. Postoperative outcomes and pathological response. Variable Group A (n=62) % Group A (n=71) % P Value Vascular tumor embolus 0.005 Negative 43 69.4% 32 45.1% Positive 19 30.6% 39 54.9% Nerve infiltration 0.004 Negative 44 71.0% 33 46.5% Positive 18 29.0% 38 53.5% No.16a2/b1 0.057 Negative 53 85.5% 51 71.8% Positive 9 14.5% 20 28.2% Tumor resection 0.970 Distal 26 41.9% 30 42.3% Total 36 58.1% 41 57.7% Serum CEA (U/mL） 0.805 Normal 56 90.3% 65 91.5% >5 6 9.7% 6 8.5% Serum CA125 (U/mL) 0.280 Normal 30 48.4% 41 57.7% >35 32 51.6% 30 42.3% Serum CA199 (U/mL) 0.783 Normal 56 90.3% 65 91.5% >37 6 9.7% 6 8.5% pT-stage <0.001 ≤T2 37 59.7% 19 26.8% ＞T2 25 40.3% 52 73.2% pN-stage 0.001 N0/1 42 67.7% 27 38.0% N2/3 20 32.3% 44 62.0% TRG ＜0.001 0 23 37.1% 3 4.2% 1 13 21.0% 13 18.3% 2 22 35.5% 47 66.2% 3 4 6.5% 8 11.3% pCR 23 37.1% 3 4.2% ＜0.001 MPR 36 58.1% 16 22.5% ＜0.001

Disparities in organ preservation rate for high-risk stage I rectal cancer.

37 Background: Guidelines for the treatment of high-risk stage I rectal cancer is a curative oncologic resection, while recommendations for stage II/III rectal cancer include neoadjuvant therapy with the option for organ preservation. The paradoxical nature of treating less advanced stage cancer with more morbid surgery calls into question the use of organ preservation strategies (OP) for less advanced disease. While sphincter preservation is appealing, benefits from OP require commitment to preoperative therapy, which may require more significant time and financial commitments than a single-stage curative treatment. This study aims to evaluate disparities in social determinants of health regarding receipt of OP compared to major oncologic resection for high-risk stage I rectal cancer. Methods: The National Cancer Database was queried to analyze all patients with high-risk stage 1 rectal cancer between 2004-2021. High-risk stage 1 disease was defined as either T2 or T1 tumors with lymphovascular invasion, or grade 3 or 4 differentiation. Covariates in patients who underwent OP, defined as chemoradiation therapy without oncologic resection or local excision, were compared to those who underwent major oncologic resection. Additional variables included age, sex, race, great circle distance, insurance status, education, facility type, income, rurality, and comorbidity index. Univariate and multivariate analyses were utilized to compare association of covariates to OP. Results: Of the 63,762 patients included, 9,261 (14.5%) underwent OP. Increased rates of OP were seen with increasing age (OR 1.029, p<0.0001), female sex (OR 1.147, p<0.0001), higher education level (OR 1.179, p=0.0034), rurality (OR 1.273, p=0.0003) and lower income (OR 0.757 for income >74K, p <0.0001). Interestingly, OP was more frequently utilized at community cancer centers in comparison to comprehensive cancer centers (OR 0.78, p<0.0001) and academic centers (OR 0.842, p=0.0021). Race, insurance status, distance to treatment, and comorbidity index were not statistically significant predictors of OP. Of note, those who underwent OP had a considerable delay in time to first treatment, with median time to treatment of 36 days in comparison to 13 days for oncologic resection. Conclusions: Socioeconomic and demographic variables are associated with receipt of OP. While plausible that a treatment strategy that requires frequent office visits, travel expenses, and time off from work may preclude OP, lower income and rurality had increased odds of OP. Future aims should be directed to identifying root causes of disparities in treatment and their clinical consequences.

Transarterial infusion chemotherapy and embolization (TAICE) as a pre-operative therapy for patients with locally advanced gastric cancer (LAGC): A prospective, single-arm, pilot study.

436 Background: Interventional therapy is a local intensive therapy for tumor control, often utilized in palliative treatment for solid organ tumors. Yet, its application in tumors of hollow viscera still lacks evidence. Our previous retrospective study revealed transarterial infusion chemotherapy and embolization (TAICE) not only effectively managed tumor-related hemorrhage but also exhibited a notable anti-tumor efficacy in gastric cancer. This prospective study aims to further explore the feasibility and safety of TAICE as a pre-operative therapy for locally advanced gastric cancer (LAGC). Methods: Patients diagnosed with locally advanced adenocarcinoma of stomach and gastrointestinal junction (GEJ) with no distant metastasis (cT3-4N+M0) were enrolled. They were given 4 cycles of pre-operative treatments: 2 cycles of TAICE-SOX (Oxaliplatin [85mg/m 2 transarterial infusion on Day 1] and S-1 [40/50/60mg po bid on Day 1-14]) and 2 cycles of SOX (Oxaliplatin [130mg/m 2 IV on Day 1] and S-1 [same as above]), alternately. Then, they received D2 radical gastrectomy, and 4 cycles of SOX post-operatively. In brief, the TAICE procedure was summarized into 4 steps: 1) Celiac arteriography, 2) Super-selection of tumor feeding artery (TFA), 3) Infusion chemotherapy and embolization of TFA, 4) Celiac re-arteriography to ensure the success of embolization. The primary endpoint was pathological complete response (pCR) rate. Other endpoints included major pathological response (MPR) rate, overall survival (OS), progression-free survival (PFS), treatment-related adverse events (TRAEs). Results: Between December 2020 and June 2023, twenty patients were enrolled and all of them received TAICE. Among them, 18 (90.0%) patients received 2 cycles of TAICE. The pCR and MPR rate were 55.0% and 70.0%, respectively. The 1-year and 3-year OS rate were 100.0% and 82.6%. The 1-year and 3-year PFS rate were 90.0% and 67.3%. There was no difference in OS between the groups of high and low tumor residual rate with the threshold of 50%. Patients achieving low tumor residual rate had significantly longer PFS (NR vs. 12.17 months, p=0.018) than those with high rate after TAICE. Moreover, we divided TFA into two subtypes: dispersive and branching, depending on the vascular pattern presented in the angiography at the first cycle TAICE. Patients with dispersive TFA had higher risk of recurrence after TAICE (NR vs. 15.17 months, p=0.0264). All patients had TRAEs (vomiting, nausea, abdominal pain and fever) of grade 1 or 2 after the first cycle of TAICE. Only one patient experienced nausea of grade 3 after the second cycle of TAICE. The most common TRAEs were vomiting and nausea. Conclusions: TAICE is a promising pre-operative therapy for patients with LAGC for it displaying the satisfactory oncological effectiveness and safety profile. Clinical trial information: NCT05396326 .

Neoadjuvant SHR-1701 (a bifunctional anti-PD-L1/TGF-βRII agent) combined with chemoradiotherapy for resectable locally advanced esophageal squamous cell carcinoma (ESCC): A phase II trial.

410 Background: Neoadjuvant chemotherapy or chemoradiotherapy followed by surgery is the standard of care for resectable locally advanced ESCC. SHR-1701, a new bifunctional fusion protein composed of a monoclonal antibody against PD-L1 fused with the extracellular domain of TGF-β receptor II, may enhance antitumor activity in combination with neoadjuvant standard therapies in ESCC patients (pts). The aim of this phase II trial is to determine the safety and efficacy of neoadjuvant chemoradiotherapy plus SHR-1701 followed by esophagectomy in pts with locally advanced resectable ESCC. Methods: Pts with resectable thoracic ESCC, diagnosed as clinical stage of cT1b-cT2N+M0 or cT3-cT4aNxM0 per AJCC 8th were eligible. Preoperative therapy included SHR-1701 (30 mg/kg every 3 weeks for 2 cycles), albumin paclitaxel (50 mg/m 2 , once a week for 5 weeks), carboplatin (AUC=2, once a week for 5 weeks) and radiotherapy (41.4Gy in 23 fractions). Following esophagectomy, pts received SHR-1701 up to 1 year. The primary endpoint was pathological complete response (pCR) rate in the per-protocol population. Secondary endpoints included R0 resection rate, major pathological response (MPR) rate, disease free survival (DFS) and safety. Results: Between Dec. 2021 and Feb. 2023, 43 pts were screened and 41 met the inclusion criteria, among whom the clinical stage I, II, III, and IVa at baseline were 1 (2.4%), 8 (19.5%), 31 (75.6%), and 1 (2.4%), respectively. All 41 pts received neoadjuvant SHR-1701 combined with chemoradiotherapy. As of Mar. 2024, 30 pts underwent surgery, and all achieved R0 resection. There was no in-hospital and postoperative 30-day mortality. 9 (30.0%) pts achieved pCR in both primary tumor and lymph nodes (ypT0N0), and 12 (40.0%) pts had complete pathological response of the primary tumor with residual disease in lymph nodes alone (ypT0N+). Treatment-related adverse events (TRAEs) occurred in all pts, and most of TRAEs were grade 1-2. Notable toxicity included pneumonitis (31.7%) and anastomotic leak (12.2%). Conclusions: The addition of SHR-1701 to neoadjuvant chemoradiotherapy in ESCC demonstrated promising efficacy with acceptable toxicity, and might be a promising approach for neoadjuvant treatment. Clinical trial information: ChiCTR2000041562.

Evidence-Based Surgical Guidelines for Treating Children With Rhabdomyosarcoma.

Surgery remains the cornerstone of treatment for rhabdomyosarcoma (RMS) in children. However, there is considerable variation in surgical management practices worldwide, highlighting the need for standardized Clinical Practice Guidelines (CPG). The CPG development involved assembling a multidisciplinary group, prioritizing 10 key topic areas, conducting evidence searches, and synthesizing findings. Recommendations were voted on using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) methodology. The panel recommended regional lymph node evaluation for patients with paratesticular RMS who are more than 10years old and extremity RMS. Other suggestions included pretreatment re-excision for incompletely resected RMS, preoperative radiation therapy for unresectable tumors, maintaining a 0.5cm resection margin, and tumor bed marking with surgical clips. The panel also suggests resection of residual metastatic disease following chemotherapy, resection of relapsed disease, and the least invasive approach for managing patients presenting with obstruction. This CPG provides evidence-based surgical management recommendations for RMS that can be adapted to diverse resource settings.

Preoperative hand therapy instructions do not improve short-term outcomes in carpal tunnel and trigger finger surgery.

The impact of preoperative structured instructions by a hand therapist on recovery after carpal tunnel and trigger finger releases was assessed in 87 patients. No significant differences in recovery, satisfaction, or outcomes were found, suggesting limited benefit.

The role of a «short-term» preoperative endocrine therapy for adjuvant therapy guidance in early HR+ HER2-negative breast cancer

In the absence of widespread access to genomic tests there is an urgent need for additional methods that influence the choice of adjuvant therapy in patients with early luminal Her2-negative subtype of breast cancer (BC). The IMPACT and POETIC trials have shown that Ki67 level decrease up to ≤10% after a “short-term” (2–4 weeks) preoperative endocrine therapy (ET) is a favorable prognostic factor. This test allows some patients to avoid adjuvant chemotherapy associated with immediate and delayed adverse events.Aims of the study. To evaluate the impact of “short-term” preoperative endocrine therapy for guidance of further treatment for patients with primary operable luminal Her2-negative breast cancer stages T1–3 N0–1 M0.Results. The study included 123 patients, 76 (60.8%) received tamoxifen and 47 (37.6%) – aromatase inhibitors (AI). Most patients – 69 (55.2%) were >50 years old, premenopausal – 58 (46.4%), menopausal – 67 (53.6%). The average age was 52 years (30–82). With the initial Ki67 level>10% (N= 107), Ki67 decreased in 24 (22.4%) up to ≤10% after “short-term” ET, and remained >10% in 83 (77.6%). According to the PREDICT calculator, the benefit of adjuvant chemotherapy (AChT) was assessed as high in 35 (28.5%) patients, and 10 of them (27.8%) were able to avoid Ch T. In 86 patients with a relatively low estimated AChT benefit (<5% at 10 years) there was no response to “short-term” ET, which led to the AChT prescription in 13 cases (15.1%).Conclusions. “Short-term” course of preoperative endocrine therapy is a simple, accessible and reproducible method for personalizing of adjuvant therapy in patients with luminal HER2-negative breast cancer.

The Landmark Series: The Future of Pancreatic Cancer Clinical Trials.

Pancreatic cancer has a poor prognosis despite ongoing advances in systemic and multimodal therapies. This review analyzes recent progress and future directions in pancreatic cancer clinical trials, emphasizing the evolution from traditional approaches to a more personalized and biologically-driven treatment paradigm. While improvements in overall survival have been achieved through perioperative therapies, gaps remain in our understanding of optimal treatment strategies. Key questions include selection of specific chemotherapeutic agents, duration of preoperative therapy, the role of radiotherapy, and accurate and real-time assessment of response to therapy. Historically, pancreatic cancer clinical trials have been designed based on anatomic criteria, failing to account for the inherent biologic heterogeneity of this disease. The field is now moving towards a precision oncology approach, leveraging genomic and transcriptomic data to identify predictive biomarkers and personalize treatment selection. Novel clinical trial designs, such as platform and basket trials, are accelerating the evaluation of new therapeutic strategies and facilitating efficient patient selection, particularly in the context of new emerging targeted therapies such as KRAS inhibitors. Furthermore, implementation of dynamic response assessment techniques, such as circulating tumor DNA and radiomics, may inform treatment decision-making and improve prediction of long-term outcomes. By integrating these evolving strategies, the emerging clinical trial landscape has the potential to transform the treatment of pancreatic cancer and yield meaningful improvements in patient outcomes.

Analysis of risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive McKeown esophagectomy

Objective: To explore the related risk factors of diaphragmatic hernia after thoraco-laparoscopic minimally invasive Mckeown esophagectomy (MIME). Methods: This is a retrospective controlled study. A retrospective analysis was conducted on the clinical data of patients who underwent MIME at the Department of Thoracic Surgery, Fourth Hospital of Hebei Medical University, from January 2016 to December 2023. A total of 619 patients were included. There were 423 males and 196 females, aged (63.7±7.6) years (range: 37 to 87 years). The diagnosis of diaphragmatic hernia after MIME was made based on clinical symptoms and CT scans. Patients were divided into two groups: the diaphragmatic hernia group (n=16) and the non-diaphragmatic hernia group (n=603). Clinical data, including age, gender, body mass index (BMI), smoking history, tumor location (upper, middle, and lower thoracic esophagus), preoperative neoadjuvant therapy history, and tumor staging, were collected and analyzed. A BMI of 25 kg/m² and age of 65 years were used as cutoff values. The χ² test and Fisher's exact test were used to compare the data between the two groups, and Logistic regression was employed for risk factor analysis. The diaphragmatic hernia group and non-diaphragmatic hernia group were matched in a 1∶3 ratio with a caliper value of 0.02 by propensity score matching. Kaplan-Meier method was used for survival analysis and compared using the log-rank test for between-group differences. Results: The proportion of patients with diaphragmatic hernia after MIME who underwent surgical treatment was 6/16. Statistically significant differences were observed between the diaphragmatic hernia group and the non-diaphragmatic hernia group in terms of age (χ²=16.057, P<0.01), BMI (χ²=16.057, P<0.01), and tumor location (χ²=12.048, P=0.002). Multivariate logistic regression analysis revealed that age ≥65 years (OR=1.236, P=0.023) and BMI<25 kg/m² (OR=0.810, P<0.01) were independent risk factors for the development of diaphragmatic hernia after MIME. Survival analysis showed no significant difference in long-term survival between patients with and without diaphragmatic hernia after MIME (P=0.187), and whether patients with diaphragmatic hernia underwent surgery was not associated with long-term prognosis (P=0.560). Conclusion: Patients with BMI<25 kg/m2 and age ≥65 years are independent risk factors for diaphragmatic hernia after MIME. The occurrence of diaphragmatic hernia is not associated with prognosis, and whether patients with diaphragmatic hernia undergo surgery does not affect the prognosis.

Role of preoperative biliary stents, bile contamination and antibiotic therapy in patients undergoing pancreaticoduodenectomy: A Retrospective Cohort Study

Role of preoperative biliary stents, bile contamination and antibiotic therapy in patients undergoing pancreaticoduodenectomy: A Retrospective Cohort Study

Outcomes After Standardized Burr-Hole Surgery for Chronic Subdural Hematomas: A Population-Based Consecutive Cohort Study of 2655 Patients.

Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. However, current evidence on postoperative outcomes exhibits variability due to small sample sizes, nonstandardized outcome assessment, and variations in surgical techniques. The aim of this study was to overcome these limitations by assessing standardized outcome measures after surgical intervention for CSDH at a high-volume population-based center favoring a uniform burr-hole craniotomy (BHC) approach. Adult patients (≥15 years) who underwent surgical treatment of a CSDH at the Karolinska University Hospital from 2006 to 2022 were retrospectively included. Outcome measures included 6-month ipsilateral hematoma reoperation, postoperative complications categorized by the Landriel-Ibanez grading system, neurological function, and mortality. Predictors of outcomes were assessed using multivariable logistic regression models. In total, 2655 patients were included, with 2407 evacuated using BHC and 248 requiring a minicraniotomy. Reoperation for a hematoma recurrence occurred in 11%. Independent predictors of reoperation were male sex, diabetes, preoperative antithrombotic therapy, midline shift, and bilateral surgery. Postoperative complications occurred in 11% of cases, with 3.9% classified as moderate to severe. A complication leading to death was reported in 22 patients (0.8%). The most common postoperative complications were urinary tract infections (1.5%), subdural empyema (1.4%), and seizures (0.7%). Independent predictors of moderate-to-severe complications were higher preoperative Charlson Comorbidity Index and lower Glasgow Coma Scale score. The 1-year postoperative mortality rate was 12%. This study provided standardized outcome measures in a large cohort of patients treated for CSDH at a center where BHC was consistently used. Most postoperative complications were mild and either did not require intervention or were managed with pharmacological treatment. The identified predictors of CSDH reoperation and moderate-to-severe postoperative complications offer considerations for clinical management and patient care.

Giant Hydatid Cyst Originating From Psoas Muscle Extending to the Iliac Bone: A Case Report.

Hydatid cysts, caused by the Echinococcus granulosus parasite, predominantly affect the liver and lungs, but can also impact other organs such as the kidneys, brain, and muscles. Infection occurs when individuals ingest eggs from contaminated food or water, leading to cyst formation primarily in the liver. While hydatid cysts are commonly found in various endemic regions, muscular involvement is rare, particularly in the psoas muscle. This report presents a case of a muscular hydatid cyst, describes its management, and emphasizes the need for awareness and prompt intervention. A 50-year-old man presented with abdominal and left lower limb pain, along with weakness over several days. He was febrile, and a physical examination revealed pain during leg movement. Routine laboratory tests were normal. Ultrasound and computed tomography scans identified a solid cystic mass in the left lower quadrant, extending to the left lumbar muscle. After 28 days of preoperative albendazole therapy, the patient underwent surgery through a Rocky Davis incision, where a large hydatid cyst containing daughter cysts in the psoas muscle was discovered. The cyst was unroofed, and its contents were evacuated, followed by irrigation with hypertonic saline. Postoperative recovery was uneventful. He also received standard medication therapy with albendazole, and during monthly visits, no complications were observed during the one-year follow-up. This case contributes to the limited literature on muscular hydatid disease and highlights the importance of awareness among healthcare providers to ensure timely diagnosis and management.

Efficacy of Voice Therapy for Vocal Fold Masses: Avoidance of Surgery.

Voice abuse and misuse are the most common causes of benign vocal fold lesions (BVFL). Treatment may include a combination of voice therapy, singing sessions, or surgical resection. Otolaryngologists and speech language pathologists advocate for preoperative, as well as postoperative, voice therapy. To determine the efficacy of voice therapy in avoiding the need for surgery. This study was a retrospective chart review of patients who were seen in the office at Philadelphia Ear, Nose and Throat Associates and were diagnosed with BVFL from January 1, 2010to December 31, 2022. Information gathered from patient charts included past laryngeal medical/surgical history, BVFL pathology or subtype and description, voice intervention (type and dates of intervention), voice therapy outcomes, singing sessions,andvoice surgery and characteristics of preoperative voice therapy, among other information. Data were then analyzed using statistics for relationships and significance. One hundred twenty-seven patients met inclusion criteria for this analysis. Seventy-nine patients were included in the nonsurgical intervention group, while 48 underwent voice therapy (defined as voice therapy or singing sessions) and progressed to surgery. Professional voice users between the two groups were similar, but a higher percentage of singers were present in the surgical group. Sex and lesion type agreed with previous literature for most lesions, with a higher number of polyps in females differing from literature. Patients in the non-surgical group had longer duration and number of voice therapy sessions. Patients undergoing nonsurgical intervention (voice therapy or singing sessions) are less likely to have complete improvement as compared with their surgical counterparts, but the number of patients undergoing voice therapy over surgical options suggests voice therapy is still a valuable option for patients.

Response to letter to the editor: “A striking elevation of CA19-9 after preoperative therapy negates prognostic benefit from radical surgery in resectable or borderline resectable pancreatic cancer”

Response to letter to the editor: “A striking elevation of CA19-9 after preoperative therapy negates prognostic benefit from radical surgery in resectable or borderline resectable pancreatic cancer”

Flow-diverting stents in the management of extracranial carotid artery aneurysms.

This study aims to investigate the indications and therapeutic efficacy of flow-diverting stents (FDSs) in the management of extracranial carotid artery aneurysms (ECAAs) and dissections. A retrospective analysis was conducted on 18 patients treated for ECAAs with an FDS between 2010 and 2024. Patient demographics, aneurysm characteristics, procedural details, and clinical and radiologic follow-up outcomes were extracted from medical records. Procedures were performed under general anesthesia using standard endovascular techniques. Patients received preoperative and postoperative antiplatelet therapy and were fully anticoagulated during the procedure. Follow- up assessments included digital subtraction angiography or computed tomography angiography at 6-12 months and clinical evaluations to monitor symptom resolution and complications. Eighteen patients, with an average age of 46.44 ± 17.54 years, underwent 19 endovascular interventions. Technical success was achieved in all cases. Single stent deployment was used in 15 aneurysms, and telescopic stent deployment in 7. Total occlusion of the aneurysm was achieved in 94.4% of cases. One patient required retreatment due to the separation of two overlapped telescopic stents. All patients were discharged within 2 days post-procedure, with symptomatic patients experiencing the complete resolution of symptoms. No complications or adverse events were reported during the follow-up period. The endovascular treatment of ECAAs with FDSs appears to be a safe and effective alternative, achieving high technical success and positive clinical outcomes. The use of FDSs for treating ECAAs significantly improves patient outcomes with minimal complications.

Long-Term Complications in Patient-Specific Plates for Maxillary Reconstruction.

Virtual surgical planning (VSP) allows for optimal reconstruction of maxillary defects with fibula free flaps. Current data are limited regarding long-term complications of patient-specific plates (PSPs) in this setting. Our objective was to determine long-term complications of PSPs in maxillary reconstruction using fibula free flaps. A retrospective chart review was performed on patients undergoing maxillary reconstruction with a fibula free flap and PSP between January 2010 to July 2022. The primary outcomes were plate-related complications, which were defined as plate exposure, fracture, removal or evidence of loose screws. Secondary outcomes were wound infection, nonunion, or flap failure. A total of 39 patients underwent fibular reconstruction of maxillary defects using PSP. The average age was 56 years, with 56% of patients being female. There were 14 (35.8%) patients with plate-related complications, 10 (25.6%) underwent plate removal, 12 (30.8%) developed exposed hardware, 2 (5.1%) had loose screws, and none had a plate fracture. The average time to plate removal was 2.76 ± 1.94 years. With regard to age, sex, tobacco or alcohol use, diabetes, hypothyroidism, preoperative radiation therapy, number of fibula segments, type of cancer, postoperative radiation therapy, or whether the patient underwent orodental rehabilitation, there were no significant differences between patients who did and did not experience plate complications. VSP allows for patient-specific reconstruction of maxillary defects with a fibula free flap that remains stable in the majority of patients. In the long term, up to 25% of patients may require plate removal, but the reconstruction remains stable. Level 4.

Prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam zones comprehensive specialized hospitals, Northwest Ethiopia

BackgroundBenign prostatic hyperplasia (BPH) is non-cancerous growth of the prostate gland which surrounds the urethra. For men with BPH who are older than 50, a prostatectomy is a common surgical procedure. Open prostatectomy is still more prevalent in regions with limited access to advanced surgical procedures like transurethral resection of the prostate and robotic-assisted laparoscopic prostatectomy. Determining prostatectomy outcomes for BPH and associated factors is essential to optimize patient care and improve awareness of this condition. However, the outcomes of prostatectomy and associated factors are not studied in Ethiopia.ObjectivesTo assess prostatectomy outcomes for patients with benign prostatic hyperplasia and its associated factors in East and West Gojjam Zones, 2021.MethodsA facility-based cross-sectional study was employed among 412 patients with prostatectomy using systematic sampling. Five-year secondary data from 2016 to 2021 data was extracted from patients’ medical records using a structured proforma. The outcomes of prostatectomy for BPH are categorized into good outcomes if significant symptom relief such as reduced urinary frequency, urgency, and nocturia and preserved sexual function using International Prostate Symptom Scores and Sexual Health Inventory for Men. A poor outcome involves minimal symptom improvement, recurrence of symptoms, severe complications like urinary incontinence or retention, and erectile dysfunction. Besides this, logistic regression models were computed to assess the relationship between variables.ResultsAmong 412 patients with prostatectomy, 68 (16.5%; 95% CI 12.9–20.1) had poor outcomes, and 344 (83.5%; 95% CI 79.9–87.1) had good outcomes. In addition, patients who took venous thromboembolism (VTE) prophylaxis were 80% less likely to develop good prostatectomy outcomes than those who did not take prophylaxis (AOR = 0.2; 95% CI 0.07–0.6). Good prostatectomy outcomes were 86% lower in those who did not obtain the proper wound care than in those who did (AOR = 0.14; 95% CI 0.03–0.6). Comparably, patients with hypertension comorbidity were 70% (AOR = 0.3; 95% CI 0.1–0.6) less likely to have good prostatectomy outcomes. On the other hand, patients who underwent transurethral resection of the prostate (TURP) had twice the odds of a good prostatectomy outcome compared to those who underwent transvesical prostatectomy (TVP) (AOR = 2; 95% CI 1.5–5.4). Moreover, patients who received preoperative oral medical therapy for benign prostatic hyperplasia (BPH) were twice as likely to experience poor prostatectomy outcomes compared to those who did not take preoperative medical therapy (AOR = 2; 95% CI 1.2–8.7). Similarly, patients with a prostate volume of 100–200 cm3 were five times more likely to develop poor prostatectomy outcomes compared to those with a prostate volume of 30–60 cm3 (AOR = 5; 95% CI 2.3–10).ConclusionsA total of 16.5% of the participants experienced poor outcomes following prostatectomy. The factors associated with these outcomes included venous thromboembolism prophylaxis intake, appropriate wound care, hypertension as a comorbidity, surgical modality, preoperative oral medication therapy for BPH, and prostate volume.

THE EFFECT OF PREOPERATIVE FLUID REGIMEN ON CARDIAC PERFORMANCE IN BARIATRIC SURGERY

Objective: We must strive to minimize the intraoperative and postoperative risks for patients who will undergo surgery. In the treatment of obesity, which is becoming an increasingly pressing issue, bariatric surgery has become a recommended option for suitable patients. This study aimed to minimize potential complications in obese patients by considering the frequency of cardiac problems and using preoperative fluid therapy. Material and Methods: The study included 31 obese patients with a Body Mass Index of 30 or above, aged 18-50, who were in the American Society of Anesthesiologists Physical Status Classifications 1-2 group and were scheduled to undergo laparoscopic sleeve gastrectomy. Patients were randomly divided into two groups. The first group did not receive fluid therapy during the preoperative period. In the second group, intravenous crystalloid fluid was administered at a rate of 10 ml/kg/hour over 3 hours in the preoperative period, based on their ideal weight. Cardiac output, stroke volume variation, and stroke volume index measurements were taken at specific times intraoperatively in patients from both groups. These parameters were compared between the groups. Results: Among the cardiac parameters measured with the FloTrac™ sensor, only the stroke volume variation values measured after extubation showed a difference between the groups. There was no statistically significant difference between the groups for the other values. Conclusion: The cardiac output, stroke volume variation, and stroke volume index values measured at various times during the surgery are similar between patients who received preoperative fluid therapy and those who did not. There is a need for more comprehensive studies that involve different fluid therapy models and more patients in this area.