Surgical Therapy Research Articles

[Open surgical treatment for carotid stenoses].

Globally, stroke is considered the second most common cause of death. According to the German Federal Statistical Office, 33.6% of mortality was due to cardiovascular diseases, making them the most prevalent cause of death. Specifically, cerebral infarctions were recorded as the cause in over 16,000cases. These figures underscore the significant role that cerebrovascular diseases play in Germany's mortality statistics. Notably, about 80% of strokes are ischemic. Moreover, one-fifth of all strokes result from extracranial carotid stenosis. The increase in stroke risk with advancing age, especially among men, is particularly striking. This trend highlights the growing importance of efficient stroke prevention and treatment in an aging society. Open surgical therapy, as acrucial treatment method, is increasingly important, especially as an emergency intervention. Its role in modern medicine emphasizes the urgency of prioritizing this life-saving procedure in healthcare and making it widely available.

Management of patients with diffuse intrinsic pontine glioma in Australia and New Zealand: Australian and New Zealand Children's Haematology/Oncology Group position statement.

The main mission of the Australian and New Zealand Children's Haematology and Oncology Group (ANZCHOG) is to develop and facilitate local access to the world's leading evidence-based clinical trials for all paediatric cancers, including brain tumours, as soon as practically possible. Diffuse intrinsic pontine gliomas (DIPGs) - a subset of a larger group of tumours now termed diffuse midline glioma, H3K27-altered (DMG) - are paediatric brain cancers with less than 10% survival at two years. In the absence of any proven curative therapies, significant recent advancements have been made in pre-clinical and clinical research, leading many to seek integration of novel therapies early into standard practice. Despite these innovative therapeutic approaches, DIPG remains an incurable disease for which novel surgical, imaging, diagnostic, radiation and systemic therapy approaches are needed. All patients with DIPG should be discussed in multidisciplinary neuro-oncology meetings (including pathologists, neuroradiologists, radiation oncologists, neurosurgeons, medical oncologists) at diagnosis and at relapse or progression. Radiation therapy to the involved field remains the local and international standard of care treatment. Proton therapy does not yield a superior survival outcome compared with photon therapy and patients should undergo radiation therapy with the available modality (photon or proton) at their treatment centre. Patients may receive concurrent chemotherapy or radiation-sensitising agents as part of a clinical trial. Biopsy should be offered to facilitate consideration of experimental therapies and eligibility for clinical trial participation. After radiation therapy, each patient should be managed individually with either observation or considered for enrolment on a clinical trial, if eligible, after full discussion with the family. Re-irradiation can be considered for progressive disease. Every child diagnosed with DIPG should be offered enrolment on a clinical trial where available. Access to investigational drugs without biological rationale outside the clinical trial setting is not supported. In case of potentially actionable target identification with molecular profiling and absence of a suitable clinical trial, rational targeted therapies can be considered through compassionate access programs.

Single Institution Experience in the Management of Locally Advanced (pT4) Differentiated Thyroid Carcinomas.

Locally infiltrating (T4) differentiated thyroid carcinomas (DTC) represent a challenge. Surgical strategy and adjuvant therapy should be planned balancing morbidity and oncologic outcome. A series of patients with T4 DTC who underwent multidisciplinary evaluation and treatment is reported. The main study endpoints were the oncologic outcome, complication rates, and risk factors for tumor recurrence. All DTC cases operated between 2009 and 2021 were reviewed and T4 DTC cases were identified. En bloc resection of inferior laryngeal nerve (ILN), tracheal, and/or internal jugular vein (IJV) was performed in cases of massive infiltration. In cases of pharyngoesophageal junction (PEJ) invasion, the shaving technique was always applied. Among 4775 DTC cases, 60 were T4. ILN infiltration was documented in 45 cases (en bloc resection in 9), tracheal infiltration in 14 (tracheal resection in 2), PEJ invasion in 11 (R0 resection in 7 cases and < 1 cm residual tissue in 4 cases), IJV resection in 6, and laryngeal in 2. In total, 11 postoperative ILN palsy, 23 transient hypoparathyroidisms, and 2 hematomas requiring reoperation were registered. Final histology showed 7 pN0, 22 pN1a, and 31 pN1b tumors. Aggressive variants were observed in 47 patients. All but 1 patient underwent radioiodine treatment, 12 underwent adjuvant external beam radiation therapy (EBRT), and 2 underwent chemotherapy. At a median follow-up of 58 months, no tumor-related death was registered, and seven patients required reoperation for recurrence. Tracheal invasion was the only significant factor negatively impacting recurrence (p = 0.045). A multidisciplinary approach is essential for the management of T4 DTC. Individualized and balanced surgical strategy and adjuvant treatments, in particular EBRT, ensure control of locally advanced disease with acceptable morbidity.

Advances in preclinical surgical therapy of cardiovascular diseases.

Cardiovascular disease is the most common cause of death worldwide, resulting in millions of deaths annually. Currently, there are still some deficiencies in the treatment of cardiovascular diseases. Innovative surgical treatments are currently being developed and tested in response to this situation. Large animal models, which are similar to humans in terms of anatomy, physiology, and genetics, play a crucial role in connecting basic research and clinical applications. This article reviews recent preclinical studies and the latest clinical advancements in cardiovascular disease based on large animal models, with a focus on targeted delivery, neural regulation, cardiac remodeling, and hemodynamic regulation. It provides new perspectives and ideas for clinical translation and offers new methods for clinical treatment.

Abstract PO4-09-10: A successful method for treatment of an uninsured underprivileged breast cancer population

Abstract Background Improvements in breast cancer treatment and care have resulted in improved outcomes and decreased mortality. These improvements, however, come with great expense. Despite efforts from health care systems, a significant proportion of the population remains uninsured. The uninsured population is often underprivileged, undereducated and more likely to come from racial/ethnic minority groups. This combination of factors results in a delay in diagnosis, presentation at later stage, and decreased access and compliance with treatment. The goal of the current study is to describe a method for treating an uninsured, underprivileged breast cancer population and the resulting outcomes. Methods Retrospective review was performed of all breast cancer patients seen at Maricopa Medical Center, the safety net hospital in Phoenix, AZ. All breast cancer patients seen from January 1, 2000 to December 31, 2020 were included. Baseline data for every patient was compiled prospectively, supplemented by retrospective chart review. The data included sociodemographic information, health literacy assessment, and diagnostic tests. Health literacy was assessed using the Newest Vital Sign (NVS). Breast cancer treatment, follow up, and mortality were documented. Beginning on July 1, 2006 a new process was implemented to facilitate care of uninsured patients. More details will be included in the poster presentation. Briefly, however, core needle biopsies were performed in the Breast Clinic by the Breast surgeon or Physician assistant during the initial consultation. Rather than requiring full payment of the planned operation upfront, instead a down payment was made with a plan for payment in installments of the remainder of the cost. For chemotherapy and targeted therapy, a process was implemented to apply for discounted medications for appropriate regimens. There are no radiation therapy facilities at Maricopa Medical Center. An agreement was therefore made with a Radiation oncology group in Phoenix to provide discounted radiation therapy. The treatment was paid through treatment grants as well as fundraising activities by the Health Foundation of the hospital. In 2011, the Breast surgeon underwent training for genetic counseling at City of Hope Medical Center to provide genetic counseling for these patients. Results A total of 1,797 patients were included. Among them, 661 patients were seen before the process (BP) was started, while 1,136 patients were seen after the new process (NP) was implemented. Overall, the mean age of the patients was 52 years with most patients being Hispanic (56%). On average the patients had 10 yrs of education and 18% had adequate health literacy. The majority of patients were not employed (70%) and completely uninsured (56%) or underinsured (31%). Only 18% of patients underwent screening mammography and as a result 67% of patients presented at stage II or later. Despite the barriers mentioned above, the NP group underwent a higher percentage of breast conservation procedures (75% versus 47%, p &amp;lt; 0.001). A higher percentage of the NP group received adjuvant therapy: Chemotherapy (91% vs 70%, p &amp;lt; 0.001), Radiation therapy (91% versus 70%, p &amp;lt; 0.001), and initiated endocrine therapy (87% versus 67%, p &amp;lt; 0.001). At a mean follow up of 8 years, these improvements in adjuvant therapy resulted in a lower incidence of both ipsilateral breast tumor recurrence and chest wall recurrence (2% vs 16%, p &amp;lt; 0.001 and 5% versus 8%, p = 0.21, respectively) and improvement in overall survival (90% vs 81%, p &amp;lt; 0.001). Conclusions Despite treatment of a population with many barriers to breast cancer management, implementation of a treatment process improved access to diagnosis and surgical therapy as well as recommended adjuvant therapy. These improvements resulted in lower local recurrence rates and improved survival in an uninsured population. Citation Format: Ian Komenaka, Trevin Reyes, Jacqueline Gilbert, Chiu-Hsieh Hsu, Waqas Arslan, Gilbert Ramos, John Dover, Herbert Hitchon, Jesse Nodora, Elena Martinez. A successful method for treatment of an uninsured underprivileged breast cancer population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-09-10.

Abstract PO5-05-12: Loco-regional Treatment in De Novo Bone Only Metastatic Breast Cancer; Prospective, Multi-Institutional Real-World Data, BOMETIN, Protocol MF14-1a

Abstract Introduction: The impact of loco-regional treatment (LRT) on survival in de novo bone-only metastatic breast cancer (BC) is controversial. The aim of this study is to assess the effect of LRT on survival utilizing international, prospectively acquired data in this cohort of patients. Materials and Methods: Patients with de novo metastatic BC with bone-only metastases were divided into two groups: those receiving systemic therapy only (ST) and those undergoing LRT. Patients who received LRT were divided into two groups: those who received ST after LRT (LRT+ST arm) and those who received ST prior to LRT (ST+LRT arm). Solitary or multiple bone metastases were classified, and factors associated with disease progression were analyzed. Results: There were a total of 744 patients with de novo bone-only metastatic BC treated at each of the participating institutions between 2014 and 2022, with 372 (50%) participants in each arm. Median follow-up was 48 months (32-66, 25-75%). Patients in the LRT group were significantly younger than the ST group [50 (42, 60) vs 55 (44, 66), p=0.0001]. There were no significant differences in grade, Her2 neu and triple negative status, receipt of hormonal therapy and intervention to metastatic sites. During follow-up, 58% (n=217) of patients in ST arm and 32% (n=120) of patients in LRT arm died (p&amp;lt; 0.001). Local progression was observed in 20% of the patients in the ST arm whereas it was 9% in the LRT arm (p=0.0001). Systemic progression occurred more in ST arm; 66% (n=244) compared to 41% (n=152) of patients in LRT group (p&amp;lt; 0.001). The Hazard of death was 64% lower in LRT group than in ST group (HR: 0.36, 95% CI: 0.29-0.45), p&amp;lt;0.0001). The burden of metastatic disease was significantly different between groups with the solitary bone metastasis rate higher in LRT group than the ST only group (50% vs 24%, p&amp;lt; 0.001). However, the LRT group had better overall survival for both solitary (HR: 0.38, 95% Cl: 0.26-0.55) and multiple (HR: 0.38, 95% Cl: 0.29-0.51) bone metastases patients. Within the LRT group, survival rates were similar whether the breast surgery was performed before or after ST.Multivariate Cox analysis showed that LRT and ER/PR positivity significantly decrease the hazard of death (p&amp;lt; 0.05). Conclusion: Analysis of this large multi-institutional patient cohort provides further evidence that LRT improves overall survival and lowers loco-regional recurrence in patients with de novo bone-only metastatic BC. In breast cancer patients with bone-only metastases at presentation, the decision for LRT should be made through a multidisciplinary approach with consideration of surgical therapy at the primary tumor. Citation Format: Atilla Soran, Serdar Ozbas, Lutfi Dogan, Didem Can Trabulus, Jamila El-Azrhi, Kazim Senol, Berk Goktepe, Shruti Zaveri, Salyna Meas, Umut Demirci, Hasan Karanlik, Aykut Soyder, Ahmet Dağ, Ahmet Bilici, Mutlu Dogan, Mehmet Ali Nahit Sendur, Hande Koksal, Mehmet Ali Gulcelik, Neslihan Cabıoğlu, Levent Yeniay, N. Zafer Utkan, Nuri Karadurmus, Gul Daglar, Turgay Simsek, Birol Yildiz, Cihan Uras, Mustafa Tukenmez, Cihangir Ozaslan, Niyazi Karaman, Arda Isik, Berkay Demirors, Efe Sezgin, Vahit Ozmen, Anthony Lucci. Loco-regional Treatment in De Novo Bone Only Metastatic Breast Cancer; Prospective, Multi-Institutional Real-World Data, BOMETIN, Protocol MF14-1a [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-05-12.

Abstract PO2-22-08: Nipple areolar complex changes after breast-conserving surgical therapy and periareolar mastopexy: a three-dimensional Surface Analysis

Abstract Objectives: The position and configuration of the nipple-areolar complex (NAC) have a high impact on satisfaction (objective and subjective) after breast-conserving therapy (BCT). The aim of this study is to objectively measure the changes in the NAC after breast conservation surgery by the use of the 3D whole body scanner and compare its results with the outcome reported by the patients. This will support further patients and help physicians to tailor their technique prior to breast-conserving surgery. Methods: In a unicentric pilot project 6 months after BET with periareolar mastopexy and adjuvant radiation between 2019 and 2022, 38 women were studied. The mean age was 56.3 ±11.6 and BMI was 24.6 ± 4.5 kg/m². Objective 3D parameters were collected using the Vectra Whole Body Surface Imaging System (WB360) based on breast and NAC dimensions. In addition, the patients received the BCT module and the mastopexy module items about satisfaction with the NAC from the BREAST Q questionnaire. Results: In a group of 38 women, BCT with periareolar mastopexy and irradiation showed a small but significant change in NAC position and shape (see Table 1). This small change is matched by the high satisfaction with the nipple and areola surveyed in the BREAST-Q questionnaire. More than 66% of the women were rather satisfied or very satisfied. The BREAST-Q results from the Items about satisfaction with the nipple and areola are shown in Table 2. However, 34% of participants reported being somewhat dissatisfied to very dissatisfied with the symmetry of placement. This could be due to a significant cumulative small change in nipple-sternal notch distance and nipple-midline distance. No significant difference was found when measuring the nipple-inframammary fold distance (p=0.649). The absolute difference was of 0.13 ± 1.22 mm. The change in breast diameter was of 0.55 ± 1.54 mm (relative 2,75 ± 7.95%). There was also no significance (p=0.042). This indicates that after BCT, the nipple-inframammary fold distance and breast diameter did not change significantly. Breast volume decreases insignificantly by 49.2 ± 136.1 cc (relative 12,96 ± 33.51) on the operated side (p=0.009). In particular, a difference in vertical diameter of the NAC of -4,79 mm (14,27%) was observed between the non-operated and the operated breast (p=0.005 by Wilcoxon-test). The BREAST-Q BCT Module consists of 8 domains. The higher the score, the higher the satisfaction with the questioned item. In our sample of 38 women, satisfaction with the surgeon(s) was highest (BREAST-Q score of 83,97 ± 19,12). The mean Q score for satisfaction with "psychosocial well-being" is 67,47 ± 22,03. For the item "sexual well-being", only 35 women answered sufficient questions and the mean Q score was 54,42 ± 16,43. “Satisfaction with breast” had a Q-score of 61,03 ± 19,36. The questions about "physical well-being" had a mean of 70,11 ± 16,69. The Q-score for “satisfaction with medical team”, “with office staff”, and “with information” can be seen in Table 3. Conclusions: In a nutshell, the conclusion of this study is that the Vectra XT 3D-Imaging is a useful tool to assess the cosmetic outcome in terms of NAC position and shape. Hence, it is a helpful tool to support the planning of the surgery and may have a positive impact on the outcome. Postoperatively, there was only a slight change in the NAC dimension and position compared with intraoperative planning. The 3D Surface Analysis is most useful in assessing the quality of reconstruction after BCT and additionally the NAC is therefore an important factor for patient satisfaction. Results of a multicenter study are pending. Table 1: Descriptive statistic and Wilcoxon-test Results from the measures from the Breast and from NAC Dimension and Position (n=38) The 3D Measures from the Breast and from NAC Dimension and Position Table 2: Results from the BREAST-Q mastopexy modul about satisfaction with the nipples (n=38) Satisfaction with the nipples Table 3: Results from the BREAST-Q BCT Modul after BCT and periareolar mastopexy und adjuvant radiation (n=38) BREAST-Q Scores Citation Format: Therese Peter, Konstantin Koban, Denis Ehrl, Pamina Geiger, Nadia Harbeck, Steffen Kahlert, Carolin Luczak, Johannes Schmid, Rachel Wuerstlein, Friederike Hagemann. Nipple areolar complex changes after breast-conserving surgical therapy and periareolar mastopexy: a three-dimensional Surface Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-22-08.

Prostate Cancer: Localized: Surgical Therapy I (MP37)

Prostate Cancer: Localized: Surgical Therapy I (MP37)

Stone Disease: Surgical Therapy (including ESWL) I (MP04)

Stone Disease: Surgical Therapy (including ESWL) I (MP04)

Kidney Cancer: Localized: Surgical Therapy I (PD11)

Kidney Cancer: Localized: Surgical Therapy I (PD11)

Stone Disease: Surgical Therapy (including ESWL) II (PD10)

Stone Disease: Surgical Therapy (including ESWL) II (PD10)

Intracranial Neuromodulation for Neurologic Recovery

Neurologic insults (traumatic brain injuries, strokes, and spinal cord injuries) profoundly influence motor, cognitive, and psychological functions. Current medical and surgical therapies are often insufficient to address the functional deficits from these injuries. Intracranial neuromodulation, specifically deep brain stimulation (DBS) and motor cortex stimulation (MCS), has been studied to improve these deficits. Preclinical results demonstrate that DBS and MCS effectively potentiate the sequalae of neurologic insult. Clinical evidence is limited, but existing reports and clinical trials show the promising therapeutic potential of intracranial neuromodulation. Further study of intracranial neuromodulation treatment is warranted, with greater attention to confounding variables and methodology.

Stone Disease: Surgical Therapy (Including ESWL) V (MP78)

Stone Disease: Surgical Therapy (Including ESWL) V (MP78)

Stone Disease: Surgical Therapy (Including ESWL) III (MP29)

Stone Disease: Surgical Therapy (Including ESWL) III (MP29)

Stone Disease: Surgical Therapy (Including ESWL) IV (PD47)

Stone Disease: Surgical Therapy (Including ESWL) IV (PD47)

Kidney Cancer: Localized: Surgical Therapy V (MP67)

Kidney Cancer: Localized: Surgical Therapy V (MP67)

Sexual Function/Dysfunction: Surgical Therapy I (PD46)

Sexual Function/Dysfunction: Surgical Therapy I (PD46)

Gender, Race and Socioeconomic Disparities on Initiation of Surgical Device-Aided Therapies (DATs) Among Medicare Beneficiaries with advanced Parkinson’s Disease (aPD)

Gender, Race and Socioeconomic Disparities on Initiation of Surgical Device-Aided Therapies (DATs) Among Medicare Beneficiaries with advanced Parkinson’s Disease (aPD)

TRI- Immunophasic Therapy: A Future Landscape

The chronic, multifactorial inflammatory disease known as periodontitis is linked to dysbiotic plaque biofilms and is defined by the gradual breakdown of the structure that supports teeth. Its main characteristics are gingival bleeding, periodontal pocketing, radiographically measured alveolar bone loss, and clinical attachment loss (CAL), which indicate a decrease of periodontal tissue support. Owing to its high prevalence, periodontitis is a major public health concern since it can lead to tooth loss and impairment, negatively affect one's look and ability to chew food, exacerbate social inequality, and diminish one's quality of life. Improvements have been made in the diagnosis and treatment of periodontal infections using a variety of contemporary methods that are currently accessible.Controlling the etiological causes and bacteria, reducing inflammation, and replenishing the lost alveolar support are the main goals of periodontal therapy. The main components of periodontal treatment is the surgical and non-surgical therapy. Dissatisfaction with the conventional therapy for protecting oral microbiota and replacing lost alveolar bone support may prompt medical professionals and researchers to investigate the novel and cutting-edge Bone One Session Treatment (BOST). It is an aerobic therapy that supports the alveolar bone and eradicates periodontal disease in the deepest pocket without requiring an intrusive operation. This review paper provides a novel approach, emphasis, and assessment of the important pathway for treating periodontal disease using the Bone One Session Treatment.

Sexual Function/Dysfunction: Surgical Therapy II (MP76)

Sexual Function/Dysfunction: Surgical Therapy II (MP76)