Primary Surgery Research Articles

Evaluating the Efficacy and Safety of Perirectal Sclerotherapy with 50% Dextrose Injection as a Primary Surgical Procedure for Rectal Prolapse in Pediatric Patients: A Clinical Trial

Background: Rectal prolapse is a condition where the rectum protrudes through the anus. This study aimed to evaluate the effectiveness of perirectal sclerotherapy using a 50% dextrose injection as a primary surgical procedure for rectal prolapse in children under 14 years of age. Objectives: The purpose of the study was to evaluate the efficacy, safety, and advantages of perirectal sclerotherapy using a 50% dextrose injection as a primary surgical procedure for rectal prolapse in pediatric patients. Methods: This clinical trial involved 40 patients diagnosed with rectal prolapse, who were treated with perirectal sclerosant (dextrose 50%) injection. All patients had grade III or grade IV rectal prolapse. Three injections of 50% dextrose were administered into the area around the anus and the submucosa, 2 - 3 cm above the dentate line, while the patient was in the lithotomy position. Injections were given at the 3, 6, and 9 o'clock positions around the anus (1 cc/kg at the 6 o'clock position and 0.5 cc/kg at the 3 and 9 o'clock positions). The patients were followed up for recurrence and complications at three-month and six-month intervals, respectively. Results: The patients had an average age of 5.62 years, with the majority being male (77.5%). The average time between symptom onset and sclerotherapy administration was 6.60 ± 1.73 months. Five patients experienced edema around the anus and injection site on the first day of observation. At the second examination (one week later), only one patient had cellulitis. At the three-month visit, eight patients exhibited symptoms of rectal mucus discharge, which were considered mid-term complications. In the final examination at six months, four patients experienced prolapse recurrences. Conclusions: Based on the findings, it can be concluded that perirectal sclerotherapy using a 50% dextrose injection is an effective primary surgical procedure for rectal prolapse in children under 14 years of age. The treatment is simple, inexpensive, and associated with minimal risk of complications and short recovery times compared to open surgery.

Comparison of Outcome of Septoplasty with and without Intranasal Splintage in Patients Admitted to a Tertiary Care Hospital, Peshawar

Objective: To compare outcome of septoplasty with and without intranasal splints in patients admitted in Khyber Teaching Hospital, Peshawar Methodology: A Randomized controlled trial was done at department of ENT, Khyber Teaching Hospital, Peshawar from 21-01-2020 to 21-07-2020. Patients with diagnosis of symptomatic DNS, aged between 15 to 30 years, both genders and undergoing septoplasty for symptomatic Deviated Nasal Septum for primary surgery were included. Patients were randomly allocated into two groups using a coin toss method. Patients in group A were subjected to intranasal splintage packing while patients of group B were not be subjected to intranasal splintage. Patients in both groups was assessed on the first postoperative day, for degree of pain. Follow-up visits were scheduled after first and third weeks following the surgery. All the data was entered and analyzed in SPSS Version 23.0. Results: The mean age of the whole sample was 22.7 ± 4.9 years. Average age in the group A was 22.3 ± 4.9 years compared to 23.3 ± 5.0 years (p = 0.271). 60% in group A were males compared to 61.7% in group B (p = 0.852). On follow-up, out of an overall sample of 120, mild, moderate, and severe pain and bleeding were recorded in 35%, 45%, and 20% (pain) and 35%, 30%, and 35% (bleeding), respectively. In group A, 30% had mild pain compared to 40% in B group (p = 0.467), 50% in A group had mild bleeding compared to 20% in B group (p = 0.002), 30% in A group developed crusting compared to 20% in the B group (p = 0.206), and 20% in the A group had synechiae compared to 10% in the B group (p = 0.125). Conclusion: The outcome of septoplasty with splints not observed significantly differ from septoplasty without splints, except in the case of postoperative bleeding.

Intraoperative evaluation of sentinel lymph nodes in patients with breast cancer treated with systemic neoadjuvant therapy

AimsTouch preparation (TP) and frozen section (FS) are the two methods routinely used in the intraoperative evaluation (IOE) of sentinel lymph nodes (SLNs) to detect metastases in patients with breast...

Survival among 148 patients with an incidentally detected appendiceal tumours at surgery for acute appendicitis: a population-based cohort follow-up study.

To investigate the long-term prognosis of appendiceal tumours incidentally detected at appendicectomy for suspicion of benign appendicitis. A retrospective register-based single centre cohort study was carried out, using data from the local acute appendicectomy quality register of cases operated on at the Department of Surgery, South General Hospital, Stockholm, Sweden. The local colorectal cancer register was also used to identify appendix tumours. The study period was between January 2004 and January 2023. Survival was calculated according to the Kaplan-Meier method. A total of 11,888 patients were registered in the acute acute appendicectomy register, 54% males and 46% females, median age 32 (Q1 = 21, Q3 = 47) (with 33.7% were 41 years or older). From the appendicectomy and colorectal registers 148 (1.2% of the total cohort) appendiceal tumours were found; 60% in females and 40% in males, median age 56 (Q1 = 43, Q3 = 70) (with 78.4% being 41 years or older). Tumours found were: Low grade Appendiceal Mucinous Neoplasms (LAMN, N = 64); Neuroendocrine Tumours (NET N = 24); adenocarcinomas or other form of carcinomas (N = 57); and adenomas (N = 3). The overall 5-year survival in patients operated for LAMN was 96.8%, for NET 93.3% and for adenocarcinoma 69.7%. The overall 5-year survival for all tumour patients was 85.7%. For the younger patients (< 51 years) with LAMN and NET, almost all survived to the end of follow-up. Survival of patients in the carcinoma group was statistically significantly lower than for the LAMN and NET groups, especially in females 51 years or older. In the group of tumour patients undergoing surgery (n = 146), primary surgery was laparoscopic in 47% and open in 52%. Two patients did not undergo surgery due to widespread disease. In 64% of cases operation was acute, whereas it was delayed and/or planned in 34%. Most procedures were laparoscopic appendicectomy 36%, followed by open appendicectomy 30%, right-sided hemicolectomy 14.6% (open 11.6% and laparoscopic 3%, acute operation 5.5%), ileocaecal resection 5% (acute operation 3.4%), and staging laparoscopy 7%. In 38% of the operated patients the tumour was discovered incidentally at histopathology examination. Two patients had CRS and HIPEC as the initial operation. Forthy-three per cent of the 146 tumour patients operated underwent a second procedure: CRS and HIPEC in 23.3% and right-sided hemicolectomy in 13.6% (laparoscopic 8.2% open 5.4%). Survival was high for patients with incidentally detected appendiceal LAMN or NET, but not so for carcinoma. Survival was lower in the carcinoma group older than 50 years, especially those sick and females.

Low meniscus reoperation rates following meniscus repair during anterior cruciate ligament reconstruction in Turkey: an in-depth national analysis of 8-years

BackgroundConcomitant knee injuries, such as meniscal tears, are observed in up to 80% of cases and can have a detrimental impact on outcomes following anterior cruciate ligament reconstruction (ACLR). Over recent decades, there has been a growing recognition of the importance of preserving meniscal tissue. Consequently, the prevalence of meniscal-preserving procedures has been on the rise.PurposeThe objective of this study was to examine the prevalence of concurrent meniscal procedures, assess the success rate, and identify factors associated with the failure of meniscal repair in patients undergoing ACLR.MethodsAll patients who underwent ACLR due to anterior cruciate ligament (ACL) injury between January 2015 and December 2022 were extracted from the Republic of Türkiye National health system using operation-specific procedure codes. Patients with multiple ligament injuries, revision ACL patients, and patients with missing data were excluded from the study. The treatment methods were grouped into the subsets of meniscectomy, meniscal repair, transplantation, and meniscectomy + repair. The distribution of ACLR and meniscus treatment methods according to years, age and sex groups, hospital characteristics, and geographical regions was examined. A secondary analysis was performed to assess the effect of patient demographics and hospital healthcare level on revision meniscal procedures in the ACLR + concomitant meniscal repair group.ResultsA total of 91,700 patients who underwent ACLR between 2015 and 2022 were included in the study. A concomitant meniscal procedure was noted in 19,951(21.8%) patients (16,130 repair,3543 meniscectomy). In the 8 years studied, meniscus repair rates increased from 76.3%to87.9%, while meniscectomy rates decreased from 23.7%to12.1% (p < 0.001). The revision meniscus surgery rate following ACLR + meniscal repair was 3.7%at a mean follow-up of 50 ± 26 months. The interval between primary and revision surgery was 20.5 ± 21.2 months. The meniscectomy rates were higher in community hospitals, while private hospitals showed the lowest revision meniscus surgery rates. Younger age was associated with increased meniscus repair failure rates.ConclusionThe propensity towards using repair techniques to treat meniscal tears during concurrent ACLR has significantly increased in Turkey. Age and the healthcare level of the treating hospital affect the success of meniscal repair.

Recurrent tethered cord: outcome and follow-up of 20 de-thetering for symptomatic spina bifida: choort study.

The objective of this study was to evaluate the prevalence of tethered cord among patients in the postoperative period of open and occult spina bifida. To identify warning signs for its early diagnosis, as well as outcomes after the new surgical approach. Retrospective study of patients followed at the Pediatric Neurosurgery Department of the Federal University of São Paulo with spinal dysraphism. Signs and symptoms indicating reoperation were collected, and postoperative results were classified as improved, unchanged, or worsened. 222 medical records of patients diagnosed with spinal dysraphism were evaluated. Symptomatic Tethered Cord Syndrome (STCS) was identified in 30 patients (13.51%), with clinical manifestations related to orthopedic deformities (66.7%), neurological deficits (56.7%), urological dysfunction (50%), and intestinal dysfunction (40%). 20 cases underwent surgery for tethered cord release. The mean age at the time of surgery was 7.7 ± 4.9years, with 13 female patients (65%). In the postoperative evaluation, improvement in low back pain (90.9%), urological pattern, and urinary tract infection episodes (45.4%) were particularly noteworthy. 3 patients (33.3%) with constipation showed improvement, and one worsened (11.1%). Improvement in ambulation was seen in two cases (16.7%). Low back pain was the first symptom to improve after surgery, with an average time of 1.3months, followed by changes in the urological pattern at 15.6months. Improvement in constipation was observed in the first month in 2 cases (66.7%), positive changes in ambulation were observed around 7months after surgery, and only one case showed improvement in clubfoot correction. The prevalence of tethered cord recurrence after primary correction surgery for open or occult neural tube closure defects was similar to that found in the literature. The results were encouraging, with good postoperative evolution of patients, especially in the improvement of low back pain and urological symptoms.

Future of sentinel node biopsy in ovarian cancer.

The rationale on the use of sentinel lymph node (SLN) biopsy in the surgical staging of apparent early-stage ovarian cancer (OC) is supported by the fact that diagnostic and prognostic role of systematic staging lymphadenectomy has been determined but its therapeutic significance is still matter of controversy. Moreover, SLN biopsy represents an option to decrease intra- and postoperative morbidity. The present review aims to provide an overview on the current and future role of SLN in OC. Most recent evidence shows that the overall mean per patient SLN detection rate in case of indocyanine green (ICG) alone was 58.6% compared with 95% in case of ICG + technetium, and with 52.9% in case of technetium alone or in combination with blue dye ( P < 0.001). Site of injection has been reported to be in both ovarian ligaments in majority of studies (utero-ovarian ligament and infundibulo-pelvic ligament), before or after ovarian mass removal, at time of primary or re-staging surgery and by minimally invasive or open approach. Cervical injection has been recently proposed to replace utero-ovarian injection. SLN detection rate in patients with confirmed ovarian malignancy varied across different studies ranging between 9.1% and 91.3% for the injection in the utero-ovarian ligament and migration to pelvic lymph nodes and between 27.3% and 100% for the injection in the infundibulo-pelvic ligament and migration to para-aortic lymph nodes. No intra- or postoperative complication could be attributed directly to SLN biopsy. The sensitivity and the accuracy of SLN in detecting lymphatic metastasis ranged between 73.3-100% and 96-100%, respectively. In up to 40% of positive SLNs, largest metastatic deposit was classified as micro-metastasis or isolated tumor cells, which would have been missed without ultrastaging protocol. SLN biopsy represents a promising tool to assess lymph node status in apparent early-stage OC. The type and volume of injected tracer need to be considered as appear to affect SLN detection rate. Ultrastaging protocol is essential to detect low volume metastasis. Sensitivity and accuracy of SLN biopsy are encouraging, providing tracer injection in both uterine and ovarian ligaments.

A Decalogue on Enhanced Recovery After Breast Augmentation Surgery (ERABAS).

Medical and technical advances have changed the state of postoperative surgical patient care, allowing for better and faster recovery. Since its publication, predictable 24-hour recovery in breast augmentation surgery has been controversial and has generated discussion. In this study, we present a novel, easy, and reproducible protocol for Enhanced Recovery After Breast Augmentation Surgery (ERABAS), along with a summary of the ten points to follow. We conducted a retrospective study of all primary breast augmentation surgeries performed between 2010 and 2020 by a private activity. All surgeries were performed by the same surgeon according to the same protocol, and all implants were obtained from the same company. Data were evaluated using two binary logistic regression models, taking as variables responses to recovery time and postoperative pain and as predictor or explanatory variables to the factors age, smoking, size, and location of the implant. In total, 2906 patients were included in this study. Of these, 2770 patients (95%) immediately returned to normal life within the first 24h, 129 achievednormal life in four days, and only seven needed a week to recover. In these seven patients, the main acute complications were hemorrhage and acute hematoma. The implants were always round; textured implants were used in 88.8% of patients, while smooth implants were used in 11.2%. A subfascial pocket was used in 934 patients, and a dual-plane pocket was performed for 1972 patients. The only factor that showed a significant effect on recovery time was the location of the implant (p < 0.05), with the dual-plane pocket being the intervention associated with a later recovery, specifically a probability of recovery after 24 hour, 2.86 times greater than subfascial. The ERABAS protocol allowed rapid return to daily activities with low complication rates. Further prospective comparative multicenter studies are required to confirm these results. 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.

High Demand for Psychological Support in Patients Who Have Periprosthetic Hip and Knee Joint Infections: An Analysis of 13,976 Patients

BackgroundThere is only sparse knowledge on the psychological burden of patients who have periprosthetic joint infections. The aim of our study was to assess the need for psychological support following total joint arthroplasty of the hip and knee. A special focus was set on patients who had aseptic and septic complications. MethodsA total of 13,976 patients who underwent total hip (n = 6,926) or total knee arthroplasty (n = 7,050) between January 1, 2012 and December 31, 2019 at a single institution were retrospectively evaluated for the postoperative need for a psychological consultation. Data were collected on age, sex, type of surgery, and indications for revision procedures. The need for a psychological consultation was assessed during the daily postoperative visits, which were further coordinated by 2 institutional psychologists. ResultsThe average age was 68 years (range, 12 to 100), and there were 63.5% women. The overall rate of psychological consultations was 1.7%. Patients who had a septic indication for revision surgery had an 18.7-fold higher rate of postoperative psychological consultations compared to patients following primary surgery and a 5.4-fold higher rate compared to patients who had an aseptic indication. In detail, this rate was 1.0% in the primary subgroup, compared to 7.7% following revision arthroplasty (P < .001). In the revision subgroup, the rate was 17.9% for septic and 3.3% for aseptic revision arthroplasty cases (P < .001). Postoperative psychological consultations were twice as frequent in women (2.1%) compared to men (1.0%), P < .001. ConclusionsThe present study raises awareness of the markedly high psychological burden in revision arthroplasty cases, in the view of the high estimated number of unknown cases. There is a significant correlation between periprosthetic joint infectionsand the postoperative need for a psychological consultation, with women being at an even higher risk. Health care providers should aim at offering psychological support for patients who have a septic complication, with affected patients being at risk for psychological stress. Level of EvidenceIV.

Long-Term Postoperative Outcomes Following Cionni Ring and In-the-Bag Intraocular Lens Implantation in Eyes With Subluxated Lenses

Evaluate long-term outcomes following Cionni modified capsule tension ring (MCTR) and in-the-bag intraocular lens (IOL) implantation in subluxated lenses. Retrospective case series. Forty-one eyes of 31 patients from Raghudeep Eye Hospital, India, with subluxated lenses who had completed a minimum of 5 years' postoperative follow-up were included. Lens extraction, capsular bag fixation with MCTR using 9-0 polypropylene suture, and in-the-bag IOL implantation were performed in all eyes. Corrected distance visual acuity (CDVA), IOL centration, posterior capsule opacification, glaucoma, and retinal complications were documented at final follow-up. The mean age of the cohort was 20.48 ± 16.46 (SD) years. Twenty-four eyes (58%) were below 15 years of age at the time of surgery. Marfan syndrome accounted for 37% cases. Mean follow-up was 9.89 ± 3.81 (SD) years. Thirty-two eyes (74%) had a CDVA of ≥0.3 logMAR at final follow-up. IOL decentration was noted in 7 eyes (17%), requiring a secondary surgery. The mean duration from primary surgery to resurgery was 8.79 years. Seventeen eyes (41%) required a laser capsulotomy, 88% of which were pediatric eyes. Retinal detachment occurred in 4 eyes (10%), 3 of which had Marfan syndrome. Capsular bag fixation with an MCTR using 9-0 polypropylene and in-the-bag IOL implantation had good long-term visual outcomes with an acceptable rate of serious postoperative complications in eyes with subluxated lenses. This approach allows preservation of the natural compartments of the eye and placement of an IOL in its most physiological position. However, considering a 17% rate of IOL decentration requiring surgical intervention, long-term stability with nonbiodegradable suture materials such as polytetrafluoroethylene as well as decentration rates following sutured or sutureless scleral fixation should be compared.

Predictive factors for adnexal involvement in endometrial cancer FIGO stage IIIA

ObjectiveUnderstanding ovarian involvement incidence and risk factors in women with endometrial cancer may inform the decision of ovary preservation.MethodsOur retrospective study included all consecutive fully surgically staged patients with endometrial...

The impact of Paclitaxel-based hyperthermic intraperitoneal chemotherapy in advanced high-grade serous ovarian cancer patients - interim analysis of safety and immediate efficacy of a randomized control trial (C-HOC trial)

ObjectiveThis study evaluates the potential superiority of combining paclitaxel-based hyperthermic intraperitoneal chemotherapy (HIPEC) with sequential intravenous neoadjuvant chemotherapy over intravenous neoadjuvant chemotherapy alone in Chinese patients with Federation of Gynecology and Obstetrics (FIGO) stage IIIC, IVA and IVB high-grade serous ovarian/fallopian tube carcinoma (HGSOC). This interim analysis focuses on the safety and immediate efficacy of both regimens to determine the feasibility of the planned trial (C-HOC Trial).MethodsIn a single-center, open-label, randomized control trial, FIGO stage IIIC, IVA, and IVB HGSOC patients (FAGOTTI score ≥ 8 during laparoscopic exploration) unsuitable for optimal cytoreduction in primary debulking surgery (PDS) were randomized 2:1 during laparoscopic exploration. The Experiment Group (HIPEC Group) received one cycle of intraperitoneal neoadjuvant laparoscopic hyperthermic intraperitoneal chemotherapy (paclitaxel) followed by three cycles of intravenous chemotherapy (paclitaxel plus carboplatin), while the Control Group received only three cycles of intravenous chemotherapy. Both groups subsequently underwent interval debulking surgery (IDS). The adverse effects of chemotherapy, postoperative complications, and pathological chemotherapy response scores (CRS) after IDS were compared.ResultsAmong 65 enrolled patients, 39 HIPEC Group and 21 Control Group patients underwent IDS. Grade 3–4 chemotherapy-related adverse effects were primarily hematological with no significant differences between the two groups. The HIPEC Group exhibited a higher proportion of CRS 3 (20.5% vs. 4.8%; P = 0.000). R0 resection rates in IDS were 69.2% (HIPEC Group) and 66.7% (Control Group). R2 resection occurred in 2.6% (HIPEC Group) and 14.3% (Control Group) cases. No reoperations or postoperative deaths were reported, and complications were managed conservatively.ConclusionsCombining HIPEC with IV NACT in treating ovarian cancer demonstrated safety and feasibility, with no increased chemotherapy-related adverse effects or postoperative complications. HIPEC improved tumor response to neoadjuvant chemotherapy, potentially enhancing progression-free survival (PFS). However, the final overall survival results are pending, determining if HIPEC combined with IV NACT is superior to IV NACT alone.

Association of fracture type with enophthalmos and intraorbital volume correction in orbital fractures: A computed tomographic study.

To determine the influence of different types of orbital fractures on the radiographic post-treatment outcomes. The investigation was a retrospective cohort study involving CT data of all patients who underwent delayed primary or secondary surgery for orbital/zygomatico-orbital trauma between 2019 and 2021. The sample was divided into three groups 1, 2, and 3: isolated floor, floor and medial wall, and combined orbit and zygomatic complex fractures. The type of orbital fracture was the exposure, while the outcome measures were reduction in enophthalmos and intraorbital volume and linear relationship between the two variables. Data were analyzed for variance between groups and association. Statistical significance was set at < 0.05. Forty-four patients (3 females and 41 males) with a mean age of 28.6 years were included in the study. Reductions in enophthalmos (P < 0.001) and intraorbital volume (P = 0.003) demonstrated significant variance between the groups. For every cubic centimeter of reduction in volume, the reduction in enophthalmos was 0.78 mm (P < 0.001) in isolated floor fractures, 0.60 mm (P = 0.013) in combined fractures involving the floor and medial walls, and 0.24 mm (P = 0.456) in combined fractures of the orbit and zygoma. Correction of enophthalmos strongly depends on the type of orbital fracture. There exists a significant linear relationship between enophthalmos and intraorbital volume in fractures involving the internal orbit.

The Role of Secondary Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy in Recurrent Ovarian Peritoneal Carcinomatosis.

Ovarian cancer maintains the highest mortality rate among gynecological malignancies. Unfortunately, two-thirds of cases are diagnosed at an advanced stage with the presence of peritoneal carcinomatosis. In this study, we aimed to present the 7-year results of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in cases where peritoneal carcinomatosis developed during the medical oncological treatment and follow-up after primary high-grade serous ovarian cancer debulking surgeries. Data from 63 patients collected prospectively in our clinic were retrospectively evaluated. Postoperative Clavien-Dindo grade 3-4 complications occurred in 12 cases (19%) and 14 cases (22.2%), respectively. CD grade 3a complications developed in four cases (6.3%), which were treated with percutaneous drainage catheters, while CD grade 3b complications occurred in eight cases (12.7%), and these cases underwent reoperation. Five cases (7.9%) experienced mortality within the first 30 days. The mean survival time was determined as 44.99 months (36.33-53.65), while the median survival time was 56 months. In selected patients requiring redo surgery due to recurrent ovarian cancer, secondary cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are associated with longer overall survival and should be considered in the treatment of advanced-stage disease. Further large-scale randomized controlled trials are needed in this regard.

The Contemporary Role of Salvage Radical Prostatectomy in the Management of Recurrent Prostate Cancer: An Up-to-Date Review.

Prostate cancer is the second most common cancer among men, with many treatment modalities available for patients, such as radical prostatectomy, external beam radiotherapy, brachytherapy, high-intensity focused ultrasound, cryotherapy, electroporation and other whole-gland or focal ablative novel techniques. Unfortunately, up to 60% of men with prostate cancer experience recurrence at 5 to 10 years. Salvage radical prostatectomy can be offered as an option in the setting of recurrence after a primary non-surgical treatment. However, the complexity of salvage radical prostatectomy is considered to be greater than that of primary surgery, making it the least popular treatment of choice. With the wide use of robotic platforms in urologic oncologic surgery, salvage radical prostatectomy has attracted attention again because, compared to past data, modern series involving salvage Robot-Assisted Radical Prostatectomy have shown promising results. In this narrative literature review, we comprehensively examined data on salvage radical prostatectomy. We investigated the correlation between the different types of primary prostate cancer therapy and the following salvage radical prostatectomy. Furthermore, we explored the concept of a robotic approach and its beneficial effect in salvage surgery. Lastly, we emphasized several promising avenues for future research in this field.

Preoperative Nonselective Chest Computed Tomography Prior to Primary Cardiac Surgery Results in Meaningful Change to Surgical Management: Systematic Review and Pooled Prevalence Meta-Analysis

Routine screening chest computed tomography (CT) prior to primary cardiac surgery is advocated by some surgeons due to the purported benefits of identifying significant aortic calcification that impacts ongoing management, such as performing anaortic off-pump surgery or adjusting cannulation strategy. Additionally, axial imaging can identify incidental findings that may require concomitant or staged procedures such as ascending aortic dilatation or pulmonary lesions. The objective of this study was to quantify the impact that nonselective chest CT prior to primary cardiac surgery had on subsequent management. A systematic review and pooled prevalence meta-analyses were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Included studies performed non-selective chest CT prior to primary cardiac surgery. A total of eight studies, including 2,250 patients were included. The rate of mortality and stroke was low (1% and 2%, respectively). Calcification of the ascending aorta was identified in 15% of patients (95% confidence interval [CI] 5.0-26.0). A significant change to the surgical plan such as cannulation strategy, off-pump surgery, cancellation, or an additional procedure was required in 7% (95% CI 2.0-12.0). Clinically relevant incidental findings requiring in-patient management or follow-up were identified in 10% (95% CI 6.0-14.0). Nonselective CT chest prior to primary cardiac surgery identifies clinically relevant findings that result in a modification of the surgical plan in a significant population of patients to address the risk of stroke associated with aortic calcification as well as the identification of important incidental findings such as pulmonary lesions.

Using a machine learning algorithm and clinical data to predict the risk factors of disease recurrence after adjuvant treatment of advanced-stage oral cavity cancer

ABSTRACT Objectives: Head-and-neck cancer is a major cancer in Taiwan. Most patients are in the advanced stage at initial diagnosis. In addition to primary surgery, adjuvant therapy, including chemotherapy and radiotherapy, is also necessary to treat these patients. We used a machine learning tool to determine the factors that may be associated with and predict treatment outcome. Materials and Methods: We retrospectively reviewed 187 patients diagnosed with advanced-stage head-and-neck cancer who received surgery and adjuvant radiotherapy with or without chemotherapy. We used eXtreme Gradient Boosting (XGBoost) – a gradient tree-based model – to analyze data. The features were extracted from the entries we recorded from the electronic health-care system and paper medical record. The patient data were categorized into training and testing datasets, with labeling according to their recurrence status within the 5-year follow-up. The primary endpoint was to predict whether the patients had recurrent disease. The risk factors were identified by analyzing the feature importance in the model. For comparison, we also used regression to perform the variate analysis to identify the risk factors. Results: The accuracy, sensitivity, and positive predictive value of the model were 57.89%, 57.14%, and 44.44%, respectively. Pathological lymph node status was the most important feature, followed by whether the patient was receiving chemotherapy. Fraction size, early termination, and interruption were the important factors related to radiotherapy and might affect treatment outcome. The area under the curve of the receiver operating characteristic curve was 0.58. The risk factors identified by XGBoost were consistent with those found by regression. Conclusion: We found that several factors were associated with treatment outcome in advanced-stage head-and-neck cancer. In future, we hope to collect the data according to the features introduced in this study and to construct a stronger model to explain and predict outcomes.

Association between the Worst Pattern of Tumor Invasion and Epithelial-mesenchymal Transition and their Prognostic Impact on Early-stage Oral Tongue Squamous Cell Carcinoma.

We aimed to determine the association between the worst pattern of tumor invasion (WPOI) and epithelial-mesenchymal transition (EMT) in early-stage oral tongue squamous cell carcinoma (OTSCC) with no adverse features and their impact on 2-year disease-free survival (DFS) and overall survival (OS) rates. This prospective observational study included treatment-naive 50 patients who underwent primary surgery for OTSCC (pT1T2N0M0; AJCC 8th edition, with no adverse features) from June 1, 2020, to March 31, 2021 (minimum follow-up period, 2 years). WPOI (low- or high-invasive) and EMT (E-cadherin, N-cadherin, and vimentin expression at the tumor invasive front) were assessed. High invasive WPOI was seen in 66% and low invasive in 34%. 80% of the patients had EMT. No statistically significant association was found between WPOI and EMT. The OS and DFS at 2 years were 90% and 80% respectively. WPOI had statistically significant impact on 2-year DFS (100% for low & 69.7% for high, p-value 0.014). EMT did not significantly affect DFS or OS rates. In early stage OTSCC with no adverse features, WPOI can be a promising predictor for disease recurrence. However, this should be validated for modifying treatment guidelines.

Malignant phyllodes: 10 year review of management through a sarcoma service

BackgroundPhyllodes tumours of the breast are rare, and their treatment is still subject to discussion. They are classified as benign, borderline, or malignant based on histopathological characteristics of the stroma. This study demonstrates 10 years’ experience in diagnosis and management of malignant phyllodes. MethodsAll patients referred for discussion at our sarcoma multidisciplinary team meeting from 2003 to 2013 with a diagnosis of malignant phyllodes were identified. Patient demographics, biopsy details, excision extent, final pathology, reconstruction, adjuvant treatment, recurrence and overall survival were assessed. ResultsThirty patients were identified over the 10 year period. Eight (26.7 %) had their diagnosis upgraded to malignant phyllodes on completion excision, compared to initial biopsy. Nine (30 %) had breast surgery elsewhere as definitive treatment before referral to our service. Four of these (44.4 %) required more extensive excision and three developed metastases (33.3 %) and died. Twenty-one patients had primary surgery through our service and three (14.3 %) died from disease. Overall, 13 patients had radical mastectomy, 92.3 % with adequate margins (>1 cm histologically) and no local recurrence, 9 simple mastectomy 22.2 % with adequate margins and 1 local recurrence and 8 wide local excision with 37.5 % adequate margins and 1 local recurrence. ConclusionFor malignant phyllodes patients, the best chance to reduce recurrence and improve survival is adequate excision and radical mastectomy should be considered. For borderline lesions, consideration should be given for referral to a specialist centre and we recommend delayed reconstruction, because of the chance of histological upgrade to malignancy.

A retrospective study on the impact of radiotherapy on the survival outcomes of small cell lung cancer patients based on the SEER database

Small cell lung cancer (SCLC) patients exhibit significant heterogeneity in tumor burden, physical condition, and responses to initial treatment. This diversity in treatment responses can result in varying treatment outcomes. The primary objective of this study was to explore the patient demographics associated with improved survival outcomes through radiotherapy. Based on the SEER database, we identified 42,824 SCLC patients enrolled between 2004 and 2015. These patients were stratified into radiotherapy (n = 20,360) and non-radiotherapy groups (n = 22,464). We controlled for confounding factors using propensity score matching (PSM) analysis. Subsequently, Kaplan–Meier (KM) analysis was employed to evaluate the impact of radiotherapy on patients’ overall survival (OS) and cancer-specific survival (CSS). Cancer-specific mortality was further analyzed using competitive risk models. Cox analysis was also conducted to examine additional variables potentially affecting the survival of SCLC patients. We identified a total of 42,824 eligible patients, and following PSM, 13,329 patients were successfully matched in both the radiotherapy and non-radiotherapy groups. The KM analysis showed that the median OS was 9 months in the radiotherapy group and 6 months in the non-radiotherapy group. The median CSS was 10 months in the radiotherapy group and 7 months in the non-radiotherapy group. The 5-year OS and 10-year OS rates were 6.2% versus 1.6% in the radiotherapy group and 2.6% versus 0.8% in the non-radiotherapy group (P < 0.001). Competitive risk analysis showed that cancer-specific mortality was significantly higher in the non-radiotherapy group than in the radiotherapy group (P < 0.001). Multivariate Cox analysis showed that the radiotherapy group (relative non-radiotherapy group) showed a significant positive effect on survival outcomes (OS: HR 0.658 95% CI [0.642, 0.675] P < 0.001; CSS: HR 0.662 95% CI [0.645, 0.679], P < 0.001). In addition, age, gender, race, primary tumor site, T stage, N stage, M stage, chemotherapy, and surgery were also considered as important predictors of SCLC outcome. The results of the subgroup analysis showed that the radiotherapy group showed a significant survival advantage regardless of age, sex, race, primary tumor site, M stage, chemotherapy, and surgery (P < 0.001). Radiotherapy may improve both OS and CSS in SCLC patients. Patients with SCLC may benefit from radiotherapy regardless of age, sex, race, primary tumor site, M stage, chemotherapy, and surgery.