Surgical Treatment Of Patients Research Articles

The concentration of serum neopterin in patients with surgical treatment of spondyloarthrosis complicated byfacet syndrome

Objective. To study the concentration of serum neopterin in patients before and after surgical treatment of pain syndrome caused by the formation of facet syndrome associated with spondyloarthrosis.
 Materials and methods. The study involved 52 patients (32 men and 20 women) hospitalized to the neurosurgical department of the City Clinical Hospital No. 4. The main group consisted of 26 patients with spondyloarthrosis complicated by chronic pain associated with facet syndrome. The comparison group (n=26) consisted of patients with pain syndrome in radiculopathy. The control group (comparable in gender and age) consisted of 10 people who underwent periodic examination. The concentration of neopterin in blood serum was determined by solid-phase enzyme immunoassay (ELISA) using the Neopterin ELISA kit (cat. No. 59321; lot ENO230) ("IBL", Germany).
 Results. Statistically significant differences in the level of serum neopterin concentration (p = 0.0016) were revealed between the studied groups. The highest concentration of neopterin was noted in the comparison group, where it was 10.31 ± 2.02 nmol/l, exceeding the results of the control group (p=0.02256) and the main group (p=0.04996). Three months after surgical treatment of patients in the main group, the median content of serum neopterin decreased by 1.161 times (p = 0.049029).
 Conclusion. Further studies to clarify the influence of pain on metabolic processes and neopterin in particular are required.

Retroperitoneal synovial sarcoma

Synovial sarcoma of the retroperitoneum is a rare and aggressive tumor. In some cases, differential diagnosis between retroperitoneal sarcoma and adrenocortical cancer is difficult due to the similar clinical and intrascopic manifestations of these neoplasms. The final diagnosis is established based on the results of histological, immunohistochemical and genetic studies. The most important step in the treatment of synovial sarcoma is complete removal of the tumor. However, despite the radical nature of the intervention, the incidence of local relapse and metastasis remains high.
 AIM: to conduct a retrospective analysis of the parameters of operated patients with synovial sarcoma of the retroperitoneum.
 This study is aimed at studying the results of examination and surgical treatment of patients with synovial sarcoma of the retroperitoneal space who were hospitalized in the E.E. Eichwald Clinic surgical department of the North-Western State Medical University named after. I.I. Mechnikov.
 The patients were assessed for hormonal status using an immunoassay to determine the levels of adrenocorticotropic hormone, cortisol, aldosterone, renin, normetanephrine and metanephrine in the blood, and a dexamethasone suppression test has been performed at a dose of 1 mg. High-performance liquid chromatography has determined 6 glucocorticoids in the blood serum: cortisol, cortisone, corticosterone, 11-deoxycorticosterone, 11-dehydrocorticosterone, 11-deoxycortisol. The urine steroid profile was studied in all the patients using gas chromatography-mass spectrometry. All the patients underwent computed tomography of the abdominal organs and retroperitoneal space with contrast, morphological and immunohistochemical examination of the removed material. The material was fixed in 10% neutral buffered formalin. The pieces were then subjected to standard wiring followed by embedding in paraffin. Sections 2–3 microns thick were prepared from the resulting blocks and stained with hematoxylin and eosin. Immunohistochemical studies were performed on paraffin sections. A panel of monoclonal antibodies was used: protein S-100 (poly), pancytokeratin (AE1/AE3), EMA, cytokeratin-8, -18, chromogranin A, synaptophysin, α-inhibin, SOX-10, CD99, TLE-1, bcl- 2, GATA-3. Postoperative outcomes and follow-up were assessed according to the information in the medical records and data obtained from a telephone conversation with each patient. Statistical processing of the results has not been out due to rare cases of the disease.

Modifiable factors of development and recurrence of adenomatous colorectal polyps (literature review)

Relevance. Adenomatous colorectal polyps are associated with a high risk of developing a malignant tumor. They are considered precancerous conditions and can lead to the development of colorectal cancer. To date, colorectal cancer ranks third in the world in frequency of occurrence among all malignant neoplasms.Objective. Improving the results of diagnosis and surgical treatment of patients with colorectal adenomatous neoplasms by identifying development factors and identifying risk groups for this nosology.Materials and methods. Analysis of literary data.Results. Among the factors leading to the development of colorectal polyps, it is worth noting a genetic predisposition, so by immunoblotting, PCR sequencing of the entire exome in cases of patients with familial dentate polyposis, rare variants of the germ line in the WNK2 gene were identified. Functional studies have shown that variants of the WINK2 germ line affect protein function in the context of the MAPK pathway, a molecular trait of this disease. Also, in the course of many domestic and foreign randomized clinical trials, the following modifiable factors for the development of adenomatous colorectal polyps were identified.Conclusion. The study revealed the factors of development and recurrence of colorectal neoplasms and identified risk groups for this nosology. The study revealed low compliance of patients with respect to changes in certain living conditions (the use of ethyl alcohol and products containing it, tobacco smoking, both active and passive, the fight against obesity and inactivity), which leads to recurrence and increases the risks of malignancy of colorectal polyps.

Surgery versus Endoscopy for the Management of Painful Chronic Pancreatitis: A Systematic Review and Meta-Analysis of Randomized Trials

Background: Debate exists regarding the optimal treatment for painful chronic pancreatitis (CP). This meta-analysis aims to determine the outcomes of surgical intervention as compared to endoscopy in patients with painful CP. Methods: A systematic review and meta-analysis including studies from PubMed, Embase, Web of Science, and Cochrane Databases (1995 onwards) was done by two independent reviewers using PRISMA guidelines. Primary outcome was pain relief. Results: Among 8,479 studies, three were randomized trials, comprising a total of 199 patients. Compared with endoscopy, surgery was associated with a lower Izbicki score, both at medium term (mean difference (MD) 21.46, 95% confidence interval (CI) 13.48–29.43, p < 0.00001) and long term (MD: 17.80, 95% CI: 8.36–27.23, p = 0.0002). A higher proportion of surgical patients had some sort of pain relief compared with those who had endoscopy, both at medium term (72% vs. 46%, RR: 1.51, 95% CI: 1.19–1.90, p = 0.0006) and long term (73% vs. 47%, RR: 1.50, 95% CI: 1.19–1.89, p = 0.0007). Complete pain relief was more common in the surgical group compared to the endoscopy group, both at medium term (33% vs. 17%, RR: 1.97, 95% CI: 1.16–3.36, p = 0.01) and long term (35% vs. 18%, RR: 1.92, 95% CI: 1.15–3.20, p = 0.01). The pooled crossover rate from endoscopy to surgery was 22% (22/99). Conclusions: Surgical treatment in patients with painful CP leads to better pain control, requiring fewer interventions as compared to endoscopic treatment.

Development of a Machine Learning Algorithm to Correlate Lumbar Disc Height on X-rays with Disc Bulging or Herniation.

Lumbar disc bulging or herniation (LDBH) is one of the major causes of spinal stenosis and related nerve compression, and its severity is the major determinant for spine surgery. MRI of the spine is the most important diagnostic tool for evaluating the need for surgical intervention in patients with LDBH. However, MRI utilization is limited by its low accessibility. Spinal X-rays can rapidly provide information on the bony structure of the patient. Our study aimed to identify the factors associated with LDBH, including disc height, and establish a clinical diagnostic tool to support its diagnosis based on lumbar X-ray findings. In this study, a total of 458 patients were used for analysis and 13 clinical and imaging variables were collected. Five machine-learning (ML) methods, including LASSO regression, MARS, decision tree, random forest, and extreme gradient boosting, were applied and integrated to identify important variables for predicting LDBH from lumbar spine X-rays. The results showed L4-5 posterior disc height, age, and L1-2 anterior disc height to be the top predictors, and a decision tree algorithm was constructed to support clinical decision-making. Our study highlights the potential of ML-based decision tools for surgeons and emphasizes the importance of L1-2 disc height in relation to LDBH. Future research will expand on these findings to develop a more comprehensive decision-supporting model.

Clinical characteristics and assessment of the frequency of complications after surgical treatment of patients with free and strangulated hernias using synthetic implants

Objective. To give a clinical assessment and conduct a comparative analysis of the frequency of postoperative complications in patients with free and strangulated hernias of various localizations after tension-free hernioplasty using synthetic implants.Materials and methods. A retrospective analysis of 965 medical records of inpatient patients who underwent tension-free hernioplasty for hernias of various localizations in the period from 2018 to 2022 was carried out. The results of the study were processed using applied statistics using MS Excel and a software package for statistical analysis “Statistica v. 10.0”. Statistically significant differences were considered at p &lt; 0.05.Results. The study revealed that in the postoperative period after tension-free hernioplasty in patients with strangulated hernias, the complication rate was 15.8%. At the same time, the frequency of complications was higher after “onlay” hernioplasty in patients with strangulated hernias than in patients with free hernias. The frequency of postoperative complications in patients with impaired postoperative ventral hernias is 8.3 times higher than in patients with free postoperative ventral hernias. In the postoperative period, complications such as seroma and infiltration of the postoperative wound were detected in 10.5 and 5.2% of cases in patients with strangulated hernias. The duration of inpatient treatment for patients with complications after hernioplasty is 2.6 times longer compared to patients without complications (p &lt; 0,05).Conclusion. In the postoperative period, in patients with strangulated hernias, the incidence of complications was observed in 15.8% of cases, and in patients with free and irreducible hernias in 1.5% of cases. Clinically, such postoperative complications as seromas, infiltrates of the postoperative wound, ligature fistulas, scrotal hematoma, orchitis, abscess of the postoperative wound were identified.

Mucosal melanoma of the head and neck: a retrospective analysis of 34 cases in Japan

Purpose Mucosal melanoma of the head and neck (MMHN) is a rare condition. This study aimed to investigate oncological outcomes of surgical intervention in patients with MMHN. Materials and methods The study included 34 patients with MMHN who underwent surgical resection as initial treatment at 10 institutions in Japan between July 2005 and June 2015. Results: The 5-year overall survival (OS), local control rate (LCR), disease-free survival (DFS), and disease-specific survival (DSS) rates were 48.7%, 53.4%, 32.4%, and 55.1%, respectively. Based on multivariate analysis, no independent prognostic factors for the 5-year OS and DSS were found. Based on univariate analysis, the 5-year LCR was worse in patients with lesions in the nasal cavity and paranasal sinuses than in the oral cavity and pharynx. However, no differences in oncological outcomes were identified in relation to primary sites, and postoperative radiotherapy (PORT) and adjuvant systemic therapy did not contribute to improvements in the 5-year OS. Conclusions No independent prognostic factors for the 5-year OS or DSS were identified. Regional or distant recurrences are often identified, regardless of local control with surgical resection. Difficult control of MMHN with conventional therapeutic strategies, such as surgical intervention, PORT, and systemic therapy, has been suggested.

Surgical treatment of patients with borderline resectable and locally advanced pancreatic cancer

Surgical treatment of patients with borderline resectable and locally advanced pancreatic cancer

Efficacy and safety of surgical treatment of patients with pathological tortuosity of the internal carotid artery

Of the study is to improve the results of surgical treatment in patients with pathological tortuosity of the internal carotid artery. The study included 119 patients (41 (34%) men and 78 (66%) women) with PI ICA aged 34 to 71 years (average age 53.2±7.5 years) divided into 2 groups. 64 patients (54%) of group I underwent BSA resection with lower mouth and 55 patients (46%) of group II underwent BSA prosthetics. Depending on the degree of neurological disorders, patients were distributed according to the classification of A.V. Pokrovsky. In the early postoperative period, TIA was noted in one patient, and transient lesions of the cranial nerves were observed in 5 patients. During 5 years of follow-up, none of the patients developed TIA, IS or other vascular events. In the early surgical period, there were no significant differences in effectiveness between the groups of patients. In the long-term period (5 years after surgery), a higher frequency of asymptomatic patients was noted in group I. Resection and replacement of a pathologically tortuous internal carotid artery (ICA) is a safe and effective surgical treatment. A multicenter randomized trial should be conducted to compare the effectiveness of surgical treatment of PI ICA with a conservative approach to effectively treat patients.

Algorithm for choosing of surgical treatment in patients with reducible postoperative median abdominal hernias

Algorithm for choosing of surgical treatment in patients with reducible postoperative median abdominal hernias

Comparison of Surgical Results of Modified Stoppa and Ilioinguinal Approach in Patients with Acetabular Fractures Involving Quadrilateral Surface Fractures.

The aim of this study was to evaluate the results of surgical treatment in patients with acetabular fractures with a fractured quadrilateral surface treated using two different approaches. The study included 106 patients who were operated on with ilioinguinal (group A) or modified Stoppa (group B) technique for acetabular fracture with a fractured quadrilateral surface between 2011 and 2020 in our clinic. The quality of reduction was evaluated according to Matta criteria and postoperative pelvic (anteroposterior, external oblique, iliac oblique) radiographs. Evaluation of hip function was recorded using the Merle d'aubigne and Postel Score and Harris Hip Score. Among the patients included in the study, there were 45 patients in group A and 61 patients in group B. When the group data were compared, it was seen that the modified Stoppa approach was superior in terms of intraoperative reduction quality, radiological data, Harris hip score, Merle d'aubigne and PostelScore. (Respectively p=0.40, p=0.49, p=0.040, p=0.028). : Modified Stoppa approach has successful clinical and radiological outcomes and better reduction quality and hip scores than ilioinguinal approaches in acetabular fractures involving quadrilateral plates.

Incidence and Risk Factors of Acute Ischemic Cholecystitis after Transarterial Chemoembolization: Correlation with Cone Beam CT Findings.

Acute cholecystitis is a complication of transarterial chemoembolization (TACE) that occasionally requires surgical intervention. We aimed to analyze the incidence and risk factors of cholecystitis requiring surgical intervention in patients with embolic material uptake on cone beam CT (CBCT) performed immediately after various TACE procedures. After a retrospective review of 2633 TACE procedures performed over a 6-year period, 120 patients with embolic material retention in the gallbladder wall on CBCT immediately after TACE were selected. We analyzed the incidence of and risk factors for acute cholecystitis. The overall incidence of acute cholecystitis requiring surgical intervention was 0.45% (12 of 2633 TACE procedures); however, it was present in 10% (12 of 120) of procedures that showed high-density embolic material retention in the gallbladder wall on CBCT performed immediately after TACE. Acute cholecystitis requiring surgical intervention occurred in eight patients (66.7%) who underwent direct cystic arterial embolization. Surgical intervention was performed 15 days (mean) after TACE. Most unintended chemolipiodol deposits in the gallbladder wall resolved without intervention or surgery. However, superselective direct cystic arterial chemoembolization was associated with a high incidence of acute cholecystitis requiring surgery, and patients who undergo this procedure should be closely monitored.

Staging corneal neovascularization to guide treatment

To describe the diagnostic technique to assess corneal neovascular (CoNV) complexes and identify feeder vessels in ocular surface pathologies. To illustrate the role of corneal angiography in clinical assessment and surgical treatment of patients with complex corneal neovascularization. To compare corneal angiography with non‐invasive diagnostic tests such as OCT angiography and slit lamp camera. A case series of patients with CoNV is presented whose management was guided by indocyanine green (ICG) and fluorescein corneal angiography. Corneal angiography is a useful diagnostic tool to guide medical and surgical management of CoNV by enabling the localization of vessel depth and topography.

Surgical treatment and prognostic factors in perihilar tumors

To study the results of surgical treatment in patients with perihilar tumors. We analyzed 98 patients with perihilar tumors who underwent surgery. We prefer percutaneous transhepatic biliary drainage (n=58) for jaundice. Retrograde interventions were performed in 18 cases (20.5%), complications grade III-IV were more common (p=0.037) in the last group. Postoperative mortality was 12%. Complications developed in 81 patients (82.7%), grade ≥3 - in 39 (39.8%) cases. Portal vein resection (n=26) increased the incidence of complications grade ≥III (p=0.035) and portal vein thrombosis (p=0.0001). Chemotherapy after surgery was performed in 47 patients (48.0%), photodynamic therapy - in 7 (7.1%) patients. A 5-year overall survival was 28.1%, the median survival - 29 months. R2 resection and/or M1 stage (n=12) significantly worsened the prognosis and overall survival (16.5 vs. 31 months, p=0.0055). Lymph node (LN) lesion, microscopic status (R0 vs. R1) of resection margin, technique of decompression and isolated resection of extrahepatic bile ducts did not affect the prognosis, and we combined appropriate patients (n=72) for analysis. SI resection and excision of ≥6 lymph nodes were independent positive factors for disease-free survival (p=0.042 and p=0.007, respectively). Blood transfusion and high preoperative neutrophil-lymphocyte index (NLI ≥2.15) worsened overall (p=0.009 and p=0.002, respectively) and disease-free survival (p=0.002 and 0.007, respectively). The absence of adjuvant therapy worsened disease-free survival alone (p=0.024). SI liver resection, adequate lymph node dissection and adjuvant therapy should be used for perihilar tumors. Isolated resection of extrahepatic bile ducts is permissible in some cases. Blood transfusion and NLI ≥2.15 are independent negative prognostic factors.

Osteonecrosis of the jaw: surgical treatment results before and during the COVID-19 pandemic in one of the reference hospitals in Poland.

The COVID-19 pandemic has had a huge impact not only on everyday life but, above all, on the functioning of medical entities. During its duration, there were problems with access to health care, including maxillofacial surgery departments. The aim of the study is to analyze how the pandemic affected the surgical results of the treatment of osteonecrosis of the jaws at the Clinic of Maxillofacial Surgery in Poznań which delivers services in maxillofacial surgery for almost 4.5 million inhabitants in Poland. We conducted a retrospective analysis of patients' medical records before and during the pandemic restrictions. The data was obtained by entering the appropriate passwords and ICD-10 diagnoses (e.g., M87) in the hospital's IT system. The obtained information was subjected to statistical analysis. The number of patients before and during the pandemic did not differ significantly. During the COVID-19 pandemic, the waiting time of patients after admission to the hospital for surgery and the total time of hospitalization were shortened. The number of complications was similar in both groups. However, the waiting time for a follow-up visit was longer during restriction time. The COVID-19 pandemic had an impact on the course of surgical treatment in patients with osteonecrosis of the jaws. The outcomes of the medical procedure remained consistent with the ones observed before the implementation of restrictions. This is likely due to the urgency of the illness. Despite the pandemic, a critical condition called osteonecrosis of the jaw was treated promptly.

Uniportal thoracoscopic mediastinal lymphadenectomy using appropriate surgical steps.

Although lymphadenectomies play an important role in the surgical treatment of patients with non-small cell lung cancer (NSCLC), the quality of lymphadenectomies via a uniportal approach has only been evaluated in a few studies. We describe the surgical steps for a mediastinal lymphadenectomy via uniportal video-assisted thoracoscopic surgery (uVATS) and compare the quality of mediastinal lymphadenectomies using uVATS versus multiportal video-assisted thoracoscopic surgery (mVATS). Between April 2017 and January 2023, we analyzed data from 304 patients with NSCLC who underwent (bi-)lobectomy with nodal dissection (ND)2a-1 or greater lymphadenectomy via uVATS or mVATS. We compared patient characteristics and perioperative results, including the number of harvested lymph nodes (LNs), between the two approaches. In addition, the factors associated with N-upstage were identified. No significant differences in the total number of harvested LNs were detected between the two approaches. Significantly more LN#2R/4R zone LNs were harvested in the uVATS group compared with the number harvested in the mVATS group [uVATS group: 8.5, interquartile range (IQR), 5-12.3; mVATS group: 7, IQR, 5-9, P=0.0177], while no significant differences in total nodes or nodes harvested in other zones were detected. Multivariable analysis revealed that pathologic invasion size [odds ratio: 1.0200, 95% confidence interval (CI): 1.0100-1.0400, P=0.0050], but not approach (uVATS, odds ratio: 0.6240, 95% CI: 0.3160-1.2300, P=0.1750), significantly contributed to N factor upstages. The use of appropriate surgical steps enabled us to achieve similar quality lymphadenectomies via mVATS or uVATS.

Predicting early complications in patients with spinal gunshot wounds: A multicenter study

IntroductionThere is a wide variation in the clinical presentation of spinal gunshot wounds ranging from isolated minor stable fractures to extremely severe injuries with catastrophic neurological damage. Research questionwe aim to analyze the risk factors for early complications and impact of surgical treatment in patients with spinal gunshot wounds. Material and methodsThis is a multicentre retrospective case-control study to compare patients with spinal gunshot wounds who had early complications with those who did not. The following matching criteria were used: sex (1:1), injury level (1:1) and age (±5 years). Univariate and multivariate analyses were performed using logistic regression. ResultsResults: Among 387 patients, 36.9 % registered early complications, being persistent pain (n = 32; 15 %), sepsis/septic shock (n = 28; 13 %), pneumonia (n = 27; 13 %) and neurogenic bladder (n = 27; 12 %) the most frequently reported. After case-control matched analysis, we obtained 133 patients who suffered early complications (cases) and 133 patients who did not as control group, not differing significantly in sex (p = 1000), age (p = 0,535) and injury level (p = 1000), while the 35 % of complications group required surgical treatment versus 15 % of the non-complication group (p < 0.001). On multivariable analysis, significant predictors of complications were surgical treatment for spinal injury (OR = 3.50, 95 % CI = 1.68–7.30), dirty wound (3.32, 1.50–7.34), GCS ≤8 (3.56, 1.17–10.79), hemodynamic instability (2.29, 1.07–4.88), and multiple bullets (1.97, 1.05–3.67). Discussion and conclusionSpinal gunshot wounds are associated with a high risk of early complications, especially when spinal surgery is required, and among patients with dirty wound, low level of consciousness, hemodynamic instability, and multiple bullets.

CLINICAL ASSESSMENT OF MANAGEMENT WHEN CHOOSING A METHOD OF PROVIDING CARE TO PATIENTS WITH OPEN-ANGLE GLAUCOMA

Introduction: glaucoma is an essential international social and medical problem, as it leads to irreversible blindness in patients worldwide. Organization of treatment and prevention of complications using the most effective methods is the most important task of ophthalmologists at the present stage of the fight against glaucoma.&#x0D; The purpose of the study: to evaluate the management of assistance under the monitoring program «STOP! Glaucoma» to patients with suspected glaucoma, open-angle glaucoma, and more advanced stages of glaucoma. To compare the effectiveness of therapeutic and surgical methods of glaucoma treatment.&#x0D; Materials and methods: To detect and prevent the progression of glaucoma in patients, the LLC «VISIOBUD» Clinic developed and implemented the monitoring program «Stop! Glaucoma». The main task of program was to analyze the dynamics of glaucomatous changes in the optic nerve and, based on this, to determine whether glaucoma compensation is complete and whether the patient does not need a more radical treatment method to preserve visual functions. The following methods of empirical research were used: systematic approach - to determine the research elements between which there are relationships of objects and their properties; observation - to identify signs and external manifestations of facts; comparison – to determine similarities and differences and identify regularities; measurement; monitoring.&#x0D; Results: In the course of the study, the dynamics of changes in intraocular pressure in patients who follow the annual monitoring program «Stop! Glaucoma» in the clinic of LLC «VISIOBUD». 4 groups of patients (116 patients – 156 eyes) were under observation. Installed that in 75% of cases, patients need surgical treatment of glaucoma to preserve their visual functions. Surgical treatment of patients with open-angle glaucoma effectively preserves vision in 89% of cases.&#x0D; Conclusions: Timely detection, monitoring, and treatment of initial signs of open-angle glaucoma and symptoms of its progression affects the preservation and prolongation of visual functions in patients. In the long term, surgical treatment of glaucoma is more cost-effective, as the need to use expensive hypotensive drops is significantly reduced (by 2.5 times).

Changes In Serum Creatine Kinase In Patient After Total Hip Arthroplasty

Background : Some studies reported that measuring serum creatine kinase (CK) level is an objective method with which to determine the relative invasiveness of surgery. The purpose of this study was to evaluate the change in postoperative serum CK levels as a measure of whether the direct anterior approach (DAA) is less invasive than the posterior approach (PA) regarding postoperative rehabilitation.&#x0D; Objective : This article presents a literature review regarding changes in serum creatine kinase in patients after total hip arthroplasty.&#x0D; Method : Descriptive research with a qualitative approach, systematic literature review study. Researchgate, Google Scholar and ScienceDirect searches reviewed changes in serum creatine kinase in patients after total hip arthroplasty. A total of 5 studies conducted between 2019-2023 were included in this review.&#x0D; Results : A total of 42,890 titles were identified and found 5 studies that met the requirements/criteria which discussed changes in serum creatine kinase in patients after total hip arthroplasty.&#x0D; Conclusions : We analyzed biochemical markers of muscle damage in patients treated with total hip arthroplasty with minimally invasive and standard posterolateral approach to providing objective evidence of the local soft-tissue injury at the time of arthroplasty. The objective measurement of muscle damage marker provides an unbiased way of determining the immediate effects of surgical intervention in patients treated with total hip arthroplasty.

Long-term outcomes and early recurrence after resection for metachronous pulmonary metastases from colorectal cancer.

Properly selecting patients for aggressive curative resection for pulmonary metastases (PMs) from colorectal cancer (CRC) is desirable. We purposed to clarify prognostic factors and risk factors for early recurrence after metachronous PM resection. Clinical data of 151 patients who underwent R0 resection for metachronous PMs from CRC at two institutions between 2008 and 2021 were reviewed. Seventy-six patients (50.3%) were male, and the median age was 71 (42-91) years. The numbers of colon/rectal cancers were 76/75, with pStage I/II/III/IV/unknown in 15/34/86/13/3. The duration from primary surgery to PM was 19.7 (1.0-106.4) months. The follow-up period was 41.9 (0.3-156.2) months. The 1-, 3-, and 5-year recurrence-free survival (RFS) rates were 75.1%, 53.7%, and 51.1%, and the 1-, 3-, and 5-year overall survival (OS) rates were 97.7%, 87.5%, and 68.2%. On multivariate analysis, lymph node metastasis of the primary lesion (HR 1.683, 95%CI 1.003-2.824, p = 0.049) was an independent predictor of poor RFS, and history of resection for extrapulmonary metastasis (e-PM) (HR 2.328, 95%CI 1.139-4.761, p = 0.021) was an independent predictor of poor OS. Patients who experienced early recurrence (< 6months) after PM resection showed poorer OS than others (3-year OS 50.8% vs. 90.2%, p = 0.002). On multivariate analysis, e-PM was an independent predictor of early recurrence after PM resection (OR 3.989, 95%CI 1.002-15.885, p = 0.049). Since a history of e-PM was a predictor of early recurrence and poor OS after R0 resection for PM, surgical treatment of patients with a history of e-PM should be considered carefully.