Reduce Recurrence Rates Research Articles

Comparison of the effects of contrast-enhanced ultrasound and conventional ultrasound-guided radiofrequency ablation on benign thyroid nodules.

To compare the effect of contrast-enhanced ultrasound (CEUS) and conventional ultrasound-guided radiofrequency ablation (RFA) on benign thyroid nodules (BTNs). In this retrospective observational study, the data of 72 patients with BTNs who received RFA treatment in The Fourth Affiliated Hospital of Zhejiang University School of Medicine from January 2020 to December 2021 were retrospectively reviewed and selected. The records showed that 34 patients received RFA under the guidance of conventional ultrasound (conventional ultrasound group) and 38 patients received RFA under the guidance of CEUS (CEUS group). The effect of treatment, complications and recurrence of the two groups were compared and analyzed. There was a smaller volume of thyroid nodules in the two groups immediately post-operation. The incidence of complications was lower in the CEUS group (5.26%) compared to the conventional ultrasound group (23.53%) (P<0.05). The recurrence rate at 6-months (0.00% vs 11.76%) and 12- months (2.63% vs 20.59%) post-operation was lower in the CEUS group compared to the conventional ultrasound group (P<0.05). Compared with conventional ultrasound, CEUS-guided RFA is effective in treating BTNs, with smaller postoperative nodule volume, reduced occurrence of surgical complications, and reduced recurrence rate of thyroid nodules.

Abstract 12 Evaluating the Properties of the Donor to Determine the Quality of Cord Blood

Abstract Introduction Cord blood is a valuable source of hematopoietic stem cells (HSCs) that offer advantages over other sources, but the volume and the absolute number of stem cells in cord blood are limited. Objectives The study aimed to analyze the influence of the factors relating to mothers, babies, and collection on the quality of cord blood units before cryopreservation in Vinmec Tissue Bank, Vietnam. This provides a thorough insight into available predictors that can inform the potential recipients. Methods This study, conducted at Vinmec Tissue Bank in Vietnam between January 2019 and December 2021, collected, processed, and analyzed 2,668 cord blood samples. The study evaluated the impact of donor and collection factors, including maternal age, delivery mode, gestational age, infant weight, gender, blood group, geography, season, collection volume, viability, TNC, and CD34+ cell components on cord blood characteristics. Results Results showed that maternal age, gestational age, delivery mode, and infant weight significantly affected TNC and CD34+ cells, while infant gender only has a significant impact on TNC. Additionally, the collection features such as cord blood volume, geography, the season of delivery, and waiting time associated with cord blood outcomes. Discussion In virtue of its superior matching probability, lower incidence of GVHD, and reduced recurrence rates, cord blood is considered a favorable option for HSC transplantation. However, the limited number of HSCs available from cord blood for bigger patients can be addressed through global cooperation. The possibility of using multiple cord blood units for hematologic cancers has been made feasible through inter-unit HLA matching 29,30. As global cooperation between cord blood banks expands, there is a growing opportunity to find matching samples for recipients. Our large-scale analysis of cord blood throughout Vietnam has highlighted the significance of baby weight and volume in determining cord blood quality. This report represents the first-ever study in Asia to investigate the impact of geography and demography on cord blood. Further evaluation is necessary for a comprehensive understanding of these factors, which would enable more appropriate counseling for patients. Figure 1. Elements that impact the quality of hematopoietic stem cells in cord blood.

Influence of lymphadenectomy on survival and recurrence in patients with early-stage epithelial ovarian cancer: a meta-analysis

BackgroundThis meta-analysis aimed to evaluate the effectiveness of lymphadenectomy on survival and recurrence in patients with early-stage epithelial ovarian cancer (eEOC).MethodsRelevant studies were searched from four online databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) or risk ratios (RRs) with 95% CIs were used to evaluate the effects of lymphadenectomy on overall survival (OS), progression-free survival (PFS), and recurrence rates. A subgroup analysis was performed to explore the sources of heterogeneity, followed by sensitivity and publication bias assessments.ResultsFourteen articles involving 22,178 subjects were included. Meta-analysis revealed that lymphadenectomy was significantly associated with improved OS (HR = 0.72; 95% CI:0.61, 0.84; P < 0.001), improved PFS (HR = 0.74; 95% CI: 0.67, 0.80; P < 0.001), and reduced recurrence rates (RR = 0.72; 95% CI: 0.60, 0.85; P < 0.001). Subgroup analysis showed that factors including area, histology, and source of the control group were significantly related to improved OS and PFS in patients with eEOC. Sensitivity analysis showed that the combined results were stable and reliable, and no significant publication bias was observed.ConclusionsPatients with eEOC can benefit from lymphadenectomy, with improved survival outcomes (OS and PFS) and a lower recurrence rate.

Construction and Intervention Effectiveness Analysis of a Combined Cough and Asthma Pharmacy Outpatient Service Model for Children's Asthma

To explore the service model and application effectiveness of cough and asthma pharmacy combined outpatient service for chronic respiratory diseases, researchers collected 107 cases of childhood asthma from July 2021 to December 2022, and divided them into two groups based on their age, receiving routine pharmaceutical services and personalized pharmaceutical services. Children under 5 years old received TRACK scores, while children over 5 years old received C-ACT scores to evaluate their asthma control, and statistical analysis was conducted. After providing pharmaceutical services, the TRACK score and C-ACT score of the experimental group were significantly higher than those of the control group, and the differences were statistically significant. The joint medical clinic established by clinical pharmacist cough and asthma pharmacy and pediatric asthma standardization clinic can significantly improve the treatment effect of pediatric asthma, and reduce recurrence rate and treatment costs.

Barrigel Spacer Injection Technique

The combination of intensity modulated radiation therapy (IMRT) and image guidance technique (IGRT) has enhanced the sparing of normal tissue during definitive radiotherapy (RT) for organ-confined prostate cancer, allowing for dose escalation and reduced recurrence rates and toxicities associated with treatment. However, challenges arise as the close proximity of the posterior prostate to the anterior rectal wall often results in high rectal doses that IGRT alone cannot remedy. To address this issue, biodegradable inflatable balloons, polyethylene-glycol (PEG) based hydrogel, and more recently hyaluronic acid (HA), have been employed to improve rectal dose volume histograms by displacing the anterior rectal wall away from the prostate gland. Unlike other spacing products, HA is a sculptable gel that offers benefits including easy customization to the patient's anatomy without the need for hydrodissection and the ability to visualize the spacer throughout the implant procedure. As the HA gel placement can be both assessed and modified during the brief procedure, consistent quality placement is more readily achieved. Meticulous procedural technique is thus necessary to create a significant, symmetrical radioprotective space from prostate base to apex, leading to improved rectal dosimetry. This technical report outlines the specific technique for HA spacer placement which was employed to obtain the excellent patient outcomes recently reported in the Barrigel® IDE trial. These outcomes include a reduction in the volume of rectal tissue receiving the prescribed radiation dose and a significant reduction in the risk of grade 2+ GI toxicities following RT. Consistent spacing was observed throughout the treatment and no unexpected adverse device effects or HA spacer-related adverse events were reported. Overall, HA spacer is easy to use, safe, and allows for sculptable, customized spacing.

Comparison of the efficacy and safety of different surgical procedures for patients with hemorrhoids: a network meta-analysis.

This study used a network meta-analysis to evaluate the efficacy and safety of different surgical approaches in patients with hemorrhoids. PubMed, Embase, Web of science, and Cochrane Library were searched for randomized controlled trials on patients with hemorrhoids treated by different surgical procedures. The search was conducted until January15, 2023. Two investigators independently screened the resulting literature, extracted information, evaluated the risk of bias of the included studies, and performed a network meta-analysis. A total of 23 randomized controlled studies were included and involved 3573 patients and 10 interventions, namely L(Ligasure), M-M(Milligan-Morgan), F(Ferguson), H(Harmonic), OH(open Harmonic), CH(closed Harmonic), PPH(procedure for prolapse and hemorrhoids), TST(tissue selecting technique), T-S(TST STARE+; tissue selection therapy stapled transanal rectal resection plus), and STARR (stapled transanal rectal resection). Network meta-analysis results showed that L has the shortest mean operating time and STARR has the longest mean operating time, F and H have the longest length of hospitalization and T-S has the shortest length of hospitalization, PPH has the most intraoperative blood loss and L has the least intraoperative blood loss, TST has the shortest time to first defecation and M-M has the longest time to first defecation, STARR had the least recurrence and PPH had the most recurrence, PPH had the least anal stenosis and L had the most anal stenosis, and F had the least postoperative pain after 24h and PPH had the most postoperative pain after 24h. Current evidence suggests that L is best at reducing mean operative time and intraoperative bleeding, T-S is best at reducing mean length of stay, TST has the shortest time to first defecation, STARR is best at reducing recurrence rates, PPH is best at reducing postoperative anal stricture, and F is best at reducing postoperative pain after 24h.

Is robotic ventral mesh rectopexy for pelvic floor disorders better than laparoscopic approach at the beginning of the experience? A retrospective single-center study.

To compare perioperative results of laparoscopic and robotic ventral mesh rectopexy for pelvic floor disorders at the beginning of the surgical experience. Between 2017 and 2022, the first 30 laparoscopic ventral mesh rectopexies and the first 30 robotic ventral mesh rectopexies at the beginning of the experience of 2 surgeons were retrospectively analyzed. Perioperative (demographic characteristics, surgical indication, conversion rate, operative time), and postoperative (complications, length of stay, unplanned reintervention) data were compared between groups. Demographic characteristics were similar between groups. Conversion rate was lower (0 vs 17%, p = 0.05), but the operative time was significantly longer (182 [146-290] vs 150 [75-240] minutes, p < 0.0001) during robotic procedure when compared with laparoscopic approach. In terms of learning curve, the number of procedures to obtain the same operative time between the 2 approaches was 15. Postoperative results were similar between groups, in terms of pain (visual analogic scale = 2 [0-8] vs 4 [0-9], p = 0.07), morbidity (17 vs 3%, p = 0.2), and unplanned reintervention (1 vs 0%, p = 0.99). Mean length of stay was significantly reduced after robotic approach when compared with laparoscopic approach (3 [2-10] vs 5 [2-11] days, p < 0.01). Functional results were better after robotic than laparoscopic ventral mesh rectopexy, with higher satisfaction rate (93 vs 75%, p = 0.05), and reduced recurrence rate (0 vs 14%, p = 0.048). Despite longer operative time at the beginning of the learning curve, robotic ventral mesh rectopexy was associated with similar or better perioperative results than laparoscopic ventral mesh rectopexy.

Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes.

Ovarian endometriomas have a negative impact on a patient's reproductive potential and are likely to cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-Müllerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a postoperative reduction in AMH is to be anticipated, despite there being evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian-tissue-sparing effect, and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post sclerotherapy, and both were significantly reduced. AMH levels may be useful in predicting the chances of conception postoperatively. None of the aforementioned approaches has a clearly demonstrated superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve the probability of pregnancy. Evidence on its value before medically assisted reproduction (MAR) is conflicting; however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualization of care, combined with optimal surgical technique, is highly recommended.

Conjunctival autograft with fibrin glue in primary pterygium Demographic profile, visual, refractive and surgical outcome

: To compare the pre and post-operative visual, refractive and surgical outcome. It was a prospective interventional study of 56 primary pterygium patients with 12 months follow up. All patients underwent surgery with pterygium excision and conjunctival autograft fixation with fibrin glue without any fixating suture and adjuvant. Pre and post- operative visual acuity, spherical equivalent was compared and surgical outcome were evaluated. All patients were followed up to 12 months. The mean age was 42.43 ±13.38 years with male predominance. Seventy five percent (n=42) patients with normal vision (6/5 to 6/12, according to WHO) became 96% (n=54), 4 week post-operatively. Preoperatively, 42.8% (n=24) patients had spherical equivalent up to 1 D followed by 25% (n=14) Plano, 17.9% (n=10) up to 2 D, 5.4% (n=3) up to 3 D, 3.6% (n=2) had more than 3D which post operatively became 57.1% (n=32) up to 1D, 26.8% (n=15) Plano, 12.5% (n=7) up to 2D and there was no patients more than 2D with pre and post-operative comparison, p value of 0.000. There were no recurrence in 12 months follow up. Fibrin glue is very much effective in reducing recurrence rate and minimizes the complication with a very good visual outcome within 4 week postoperatively if surgery done carefully.

Effect of Metformin Use on Survival and Recurrence Rate of Gastric Cancer After Gastrectomy in Diabetic Patients: A Systematic Review and Meta-analysis of Observational Studies.

Gastric cancer (GC) is one of the most common worldwide cancers and causes of death. Various studies have investigated the effect of metformin on overall survival (OS), cancer-specific survival (CSS), recurrence-free survival (RFS), and recurrence rate in diabetic patients after gastrectomy, and their results have been contradictory. This meta-analysis aimed to evaluate the effect of metformin use compared to sulfonylurea compounds with OS, CSS, RFS, and recurrence rate after gastrectomy in diabetic patients. We reviewed the Scopus, Google Scholar, PubMed, Web of Science, and Embassy databases until September 2022 based on appropriate MESH terms. All observational studies that evaluated the effect of metformin on survival in diabetic patients who underwent surgery for GC were included. The hazard ratio (HR) with a 95% confidence interval was used to estimate the effect size. The Egger test was used to evaluate publication bias. Overall, nine studies, including 245,387 GC patients who underwent surgery, were included. The use of metformin significantly increased the OS rate (HR: 0.81, 95% CI: 0.78, 0.86, P: 0.001, I2: 4.5%), CSS rate (HR: 0.72, 95% CI: 0.63, 0.81, P: 0.011, I2 = 0%), and RFS rate (HR: 719, 95% CI: 0.524, 0.986, P: 0.001) and decreased the recurrence rate after gastrectomy (HR: 0.83, 95% CI: 0.77, 0.87, P: 0.001, I2: 0%). The use of metformin was significantly associated with a greater increase in OS and CSS rate and a greater decrease in recurrence rate in the Asian population than in the Western population. The use of metformin in diabetic patients with GC can be associated with improved OS, CSS, RFS, and reduced recurrence rate after gastrectomy, especially in the Asian population.

Effect of hyperthermic intraperitoneal chemotherapy on survival and recurrence rates in advanced gastric cancer: a systematic review and meta-analysis.

Around 5-20% of patients who undergo surgery for advanced gastric cancer (AGC), which invades into the muscularis propria or beyond, have peritoneal carcinomatosis. The peritoneal recurrence rate is 10-54%, which is associated with a poor prognosis. The role of hyperthermic intraperitoneal chemotherapy (HIPEC) in AGC with and without peritoneal carcinomatosis is not clearly defined. The authors conducted a meta-analysis, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, of the clinical trials and high-quality nonrandomized studies evaluating the role of HIPEC in AGC over the last 10 years. The studies were searched in PubMed, EMBASE, MEDLINE, and Cochrane databases between January 2011 to December 2021. Clinical data including overall survival, recurrence free survival, overall recurrence rate, peritoneal recurrence rate, and complications analyzed using RevMan 5.4. Six randomized controlled trials and 10 nonrandomized studies, comprising a total of 1700 patients were included. HIPEC was associated with significantly improved OS at 3 [odd ratio (OR) 1.89, 95% CI: 1.17-3.05] and 5 years (OR 1.87, 95% CI: 1.29-2.71). HIPEC was associated with reduced overall recurrence (OR 0.49, 95% CI: 0.31-0.80) and peritoneal recurrence (OR 0.22, 95% CI: 0.11-0.47). HIPEC was not associated with increased complications. The occurrence of postoperative renal dysfunction was significantly higher in the HIPEC group (OR 3.94, 95% CI: 1.85-8.38). The role of HIPEC in AGC has evolved over the past decade. HIPEC may improve survival rates and reduce recurrence rates in patients with AGC, without significant increase in complications and with a favorable impact on 3 and 5-year survival.

Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta-analysis.

Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. The objective of this meta-analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA). We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager. Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42-0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49-0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41-0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44-1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13-32.37, p < .0001). Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.

Efficacy and safety of Chinese patent medicine paiteling in condyloma acuminatum: A systematic review and meta-analysis

Ethnopharmacological relevanceCondyloma acuminatum (CA) is a common sexually transmitted disease. Previous studies using randomized controlled trials (RCTs) have revealed that Paiteling (PTL), a Chinese patent medicine formula, can effectively relieve CA symptoms. However, the evidence needs to be more cohesive and there is a need for a clear summary of the existing RCTs to assess the overall efficacy and safety profile of PTL. Aims of the studyThis study aimed to conduct a comprehensive review and meta-analysis of RCTs, to examine the efficacy of PTL and physical therapies in CA. Material and methodsA literature search was conducted in multiple databases, including PubMed, MEDLINE, Cochrane Library, etc. up to December 1, 2022. Revman 5.4 and Stata 15.0 was used for data statistics and sensitivity analyses. Results31 trials with a total of 2868 patients were included in this review. The results showed that PTL plus physical therapies were significantly more effective than physical therapies used alone (RR = 1.60, 95% CI [1.38, 1.86]; P < 0.00001). Subgroup analysis showed that the type of physical therapies, gender, and wart location might be the primary sources of heterogeneity. Additionally, PTL can reduce recurrence rates (RR = 0.27, 95% CI [0.19, 0.39]; P < 0.00001), improve the negative conversion rate of HPV (RR = 1.15, 95% CI [1.02, 1.30]; P = 0.02), and improve immune function. No severe adverse reactions or physical injuries were observed, making it a better choice for women planning to become pregnant. ConclusionCompared with physical therapies, PTL can effectively eliminate CA symptoms and reduce the recurrence rates with safety ensured. However, due to the heterogeneity and methodological shortcomings, large sample sizes and high-quality rigorous RTCs are still needed to strengthen this clinical evidence.

Surgical Management of Crohn’s Disease: An Overview

Crohn's Disease (CD) is a chronic inflammatory condition of the digestive tract resulting in symptoms such as abdominal pain, weight loss, and fatigue, requiring a multifaceted approach to management. While not curative, the surgical management of CD forms a vital part of the therapeutic strategy for complications. This article overviews various surgical methods for treating CD, their indications, and potential complications. CD predominantly emerges in developed countries, with known risk factors including genetic predisposition, environmental triggers, and diet. The clinical presentation involves varied symptoms based on the inflammation's location within the gastrointestinal tract. Diagnosis necessitates a comprehensive approach, including medical history, physical examination, and diagnostic tests. Surgical intervention may be necessary due to severe complications like intestinal obstruction, abscesses, strictures, fistulas, and perforation. Common reasons for surgery include medically resistant disease and malignancy. However, postoperative recurrence is frequent, necessitating repeated surgery in 26% of cases. This narrative review paper examines three major surgical interventions in detail. Fistulotomy, primarily used for simple fistulas, can offer symptomatic relief in well-selected CD cases but may risk complications and high recurrence rates. Stricturoplasty, useful for widening narrow bowels, preserves intestinal length and function and can serve as an effective alternative to resection. Lastly, the intestinal resection and colectomy procedures are explored, focusing on their indications and complications. Future research should focus on optimizing surgical approaches to reduce recurrence rates and improve patient outcomes.

Systemic Neoadjuvant and Adjuvant Therapies in the Management of Hepatocellular Carcinoma—A Narrative Review

The burden of hepatocellular carcinoma (HCC) continues to pose a significant global health problem. Several systemic therapies have recently been shown to improve survival for patients with unresectable disease. However, evidence to support the use of neoadjuvant or adjuvant systemic therapies in patients with resectable disease is limited, despite the high risk of recurrence. Neoadjuvant and adjuvant systemic therapies are being investigated for their potential to reduce recurrence after resection and improve overall survival. Our review identified various early-phase clinical trials showing impressive preliminary signals of pathologic complete response in resectable disease, and others suggesting that neoadjuvant therapies—particularly when combined with adjuvant strategies—may convert unresectable disease to resectable disease and cause significant tumor necrosis, potentially decreasing recurrence rates. The role of adjuvant therapies alone may also play a part in the management of these patients, particularly in reducing recurrence rates. Heterogeneity in trial design, therapies used, patient selection, and a scarcity of randomized phase III trials necessitate the cautious implementation of these treatment strategies. Future research is required to identify predictive biomarkers, optimize the timing and type of therapeutic combinations, and minimize treatment-related adverse effects, thereby personalizing and enhancing treatment strategies for patients with resectable and borderline resectable HCC.

Topical pharmacotherapy for the management of ocular surface squamous neoplasia

Abstract Ocular surface squamous neoplasia (OSSN) encompasses a spectrum of dysplastic and neoplastic conditions affecting the conjunctiva and cornea, ranging from intraepithelial neoplasia to invasive squamous cell carcinoma. Traditional management of OSSN has primarily involved surgical excision, often supplemented by cryotherapy. However, the emergence of topical pharmacotherapies has significantly transformed the treatment landscape, offering noninvasive alternatives that may reduce recurrence rates and preserve ocular surface integrity. This review provides a comprehensive analysis of the current topical pharmacotherapeutic agents used in OSSN, including interferon alpha-2b, 5-fluorouracil, and mitomycin C. We evaluate the mechanisms of action, clinical efficacy, dosing regimens, and adverse effect profiles of these agents. In addition, the review discusses the selection criteria for topical versus surgical management, the role of adjuvant therapy, and the latest advancements in drug delivery systems. By synthesizing recent clinical trials and case studies, this article aims to guide clinicians in optimizing treatment strategies for OSSN, highlighting the potential of topical pharmacotherapy to improve patient outcomes while minimizing treatment-related morbidity.

A New Approach: Determination of the Safe Surgical Margin in Pterygium Surgery.

In this retrospective study, we aimed to determine the safe surgical limit for excision of pterygium tissue. Therefore, we aimed to prevent excessive or incomplete normal conjunctival tissue excision during surgery in the coming years. Autografted pterygium surgery was performed between January 2015 and April 2016, and the excised pterygium tissue was examined histopathologically. The files of 44 patients, who had not previously undergone any ocular surgery, who did not have an inflammatory disease and who continued to be checked for at least 1 year, were retrospectively examined. The distance (P-DSEM) from the excised pterygium tissue to the surgical excision margin was measured by a pathologist. Postoperative recurrence rates were evaluated according to this value. In this way, the clean surgical margin was determined. The mean age of the participants was 44.77 ± 12.70, and the mean follow-up time was 55.61 ± 16.38 months. Recurrence developed in 5 out of 44 patients (11.4%). The average recurrence duration was 51 ± 13.87 days. Distance to the average surgical margin was 3.88 ± 0.91 mm. The surgical distances of 5 patients with recurrence were 2, 2.5, 2, 3, and 3 mm, respectively. It was determined that recurrence was less as the distance (P-DSEM) from the tissue to the surgical excision margin increased (p = 0.001). We found that the recurrence rate in pterygium surgery was linked to the clean surgical margin. When planning pterygium surgery, we believe that determining the amount of tissue to be excised before surgery will reduce recurrence rates.

Late outcomes of parastomal hernia repair

AIM: to assess late results of parastomal hernia repair using Sugarbaker’s technique modifications.PATIENTS AND METHODS: prospective non-randomised study included 60 patients with parastomal hernia, which underwent surgery in 2013-2019. Patients were divided in two groups. The control group included 30 patients with “classic” Sugabacker method, the main group included 30 patients with Sugarbaker’s procedure added by suture of abdominal wall defect. Both groups were homogenous by age, gender, hernia size, type of primal disease and preoperative quality of life (EQ-5D-5L). The efficacy of the treatment was estimated by recurrence rate and quality of life 1 and 2 years after surgery.RESULTS: the recurrence rate in the main group was significantly lower after 1 and 2 years (3 vs 13; p = 0.01). Quality of life in the main group was significantly higher after the first year of follow-up (the median of the weighted coefficient 0.92 vs 0.89; p = 0.04) and this trend has preserved 2 years after surgery.CONCLUSION: suture of abdominal wall defect in Sugarbaker’s procedure for parastomal hernia reduces recurrence rate significantly and provides better quality of life.

Camrelizumab in combination with apatinib as a perioperative treatment for patients with hepatocellular carcinoma at high risk of recurrence: A prospective, single-arm, phase 2 study.

4120 Background: Hepatocellular carcinoma (HCC) is one of the most common malignancies worldwide, and a rising cause of cancer-related mortality. To date, the optimal perioperative treatment strategy for HCC patients remains unclear. It is urgent to develop novel and reliable therapeutic interventions to reduce the risk of recurrence and improve survival in patients with locally advanced HCC. Methods: This prospective, exploratory, single-arm, phase 2 study enrolled patients with primary resectable HCC who had not received prior systemic therapy. Before surgery, patients received combination treatment with four cycles of camrelizumab (200 mg, Q2W) plus apatinib (250 mg, QD). Each cycle was two weeks. The feasibility of hepatic resection was assessed by radiographic imaging. After 4-8 weeks of surgery, patients continued combination therapy (camrelizumab [200 mg, Q2W] and apatinib [250 mg, QD]) for one year. Primary endpoint was major pathological response (MPR). Secondary endpoints were pathologic complete response rate (pCR), objective response rate (ORR), disease-free survival (DFS), and safety. Exploratory endpoint was microvascular invasion (MVI). This study is registered on Clinical Trials.gov, number NCT04701060. Results: Between Jan 12, 2021, and Aug 17, 2022, 31 patients with a median age of 54 years were enrolled. Among these, 21 patients (67.7%) had hepatitis B virus infection. Before surgical incision, two patients withdrew informed consent. Therefore, ORR based on RECIST 1.1 and mRECIST were 13.8% (4/29) and 48.3% (14/29), respectively. 26 patients underwent hepatic resection, R0 resection rate was 100%, 10 (38.5%) patients achieved MPR, and pCR rate was 7.7%. The reasons for patients not undergoing surgery were disease progression and serious adverse events (AEs). Among patients with MVI, M0 was found in 57.7% (15/26) patients, MI was found in 34.6% (9/26) patients, and M2 was found in 7.7% (2/26) patients. 1-year DFS rate was 77.4%, and median DFS was not reached. The most common AEs included increased aspartate aminotransferase (74.2%), increased alanine aminotransferase (70.1%), decreased platelet count (61.3%), anemia (58.1%), and decreased lymphocyte count (51.6%). Grade 4 AEs occurred in 7 of 31 patients, and there were no treatment-related deaths. Conclusions: Camrelizumab plus apatinib as a perioperative treatment is effective and tolerable in patients with HCC at high risk of recurrence. Preoperative neoadjuvant therapy has reduced the rate of MVI. Because of the short follow-up period, whether perioperative treatment can effectively reduce recurrence rates and improve long-term survival still needs further investigation. Clinical trial information: NCT04701060 .

Clinical research of the value of high-risk CTV setting on intensity-modulated radiotherapy for stage IIB-IVA cervical cancer

BackgroundThis study aims to evaluate the clinical efficacy and side effects of setting up a high-risk clinical target volume (CTV-hr) alongside simultaneous integrated boost intensity-modulated radiotherapy (IMRT-SIB) in patients diagnosed with stage IIB-IVA cervical cancer.MethodsThis study retrospectively analysed patients with stage IIB-IVA cervical cancer who received radical radiotherapy at the Affiliated Hospital of Qingdao University between November 2014 and September 2019. The patients were divided into experimental and control groups based on whether CTV-hr was set. All patients received a combined treatment of radiotherapy and chemotherapy. The dosage for paclitaxel was 135 mg/m2, while for cisplatin it was 75 mg/m2 or for carboplatin it was AUC 4–6, given in a cycle of 21 days. Radiotherapy (RT) included external beam radiation therapy (EBRT) and intracavitary brachytherapy (ICBT). In the control group, positive lymph nodes (GTV-n) were treated at a dose of 58–62 Gy/26–28 fractions(f), while clinical target volumes (CTV) were treated with a dose of 46–48 Gy/26-28f. The experimental group received a simultaneous integrated boost (SIB) to CTV-hr at a dose of 54–56 Gy/26-28f, with the same CTV and GTV-n as the control group. Both groups were combined with brachytherapy with a total dose (EQD2, the equivalent dose in 2 Gy/f) of 80-90 Gy. The study measured objective remission rate (ORR), 3-year progression-free survival (PFS) rate, 3-year overall survival (OS) rate, recurrence rate, and side effects as endpoints.ResultsThe study enrolled 217 patients, with 119 in the experimental group and 98 in the control group. Results showed that the experimental group had a higher 3-year OS rate (87.4% vs. 71.4%, p = 0.001) and 3-year PFS rate (72.3% vs. 51.0%, p = 0.000) compared to the control group. Additionally, the experimental group had significantly lower rates of overall recurrence (26.1% vs. 50.0%, p = 0.003), in-field recurrence (15.1% vs. 36.7%, p = 0.000), and out-field recurrence(13.4% vs. 35.7%, p = 0.000) compared to the control group. All observed differences were found to be statistically significant. However, the experimental and control groups had no statistically significant difference in ORR and radiological side effects, such as radiation cystitis and enteritis (p > 0.05).ConclusionsSetting CTV-hr and performing IMRT-SIB on patients with stage IIB-IVA cervical cancer effectively increased the 3-year OS rate, 3-year PFS rate and reduced recurrence rate, with no significant differences in side effects.