Type Of Surgery In Patients Research Articles

The Impact of Preoperative Cytology on Type of Surgery in Patients with NIFTP

The Impact of Preoperative Cytology on Type of Surgery in Patients with NIFTP

Outcomes of orbital decompression for thyroid eye disease over a 10-year period at a tertiary eye care referral center

Background: Orbital decompression is frequently indicated to treat exophthalmos and compressive optic neuropathy, among other indications for thyroid eye disease (TED). This study aimed to evaluate the outcomes of orbital decompression and compare the results by urgency and type of surgery in patients with TED.
 Methods: In this cross-sectional study, we recruited patients with TED who had undergone emergency or elective orbital decompression surgery at a tertiary eye care referral center in Tehran, Iran, between 2010 and 2020. Ophthalmic examination findings, demographic and clinical profiles, and types and outcomes of surgical interventions were reviewed and analyzed.
 Results: Fifty-one orbits of 35 patients with a mean (standard deviation [SD]) age of 36.2 (12.0) years and male-to-female ratio of 23 (66%)/12 (34%) were included. The mean (SD) duration from the diagnosis to the surgery was 41.0 (39.0) months. The surgical method was fat decompression in 1 (2%) orbit; fat and inferior wall decompressions in 2 (4%) orbits; fat, inferior, and medial wall (two-wall) decompressions in 43 (84%) orbits; and fat, inferior, medial, and lateral wall (three-wall) decompressions in five (10%) orbits. Three-wall decompression surgery resulted in significantly lower exophthalmometry readings than those associated with two-wall surgery at all postoperative follow-ups (P < 0.05). Ten (20%) orbits required emergency decompression because of sight-threatening conditions and revealed comparable exophthalmometry readings with electively decompressed orbits at the 1-year visit (P > 0.05). Thirty-seven (73%) orbits required other surgeries within the 1-year follow-up. The mean (SD) exophthalmometry readings before and 1-year after surgery were 26.3 (4.0) and 18.3 (2.7) mm, respectively, with a significant decrease and significant 5.5 (3.3)-mm change from baseline in decompressed orbits (both P < 0.001). Diplopia was reported in 29% (n = 10) of patients less than 2 months postoperatively.
 Conclusions: Emergency or elective orbital decompression significantly reduced exophthalmos in patients with TED within 1 year postoperatively. Three-wall orbital decompression produced the more immediate impact, while two-wall orbital decompression showed the higher effect at a later timepoint. The most common complication was diplopia, while other serious complications occurred infrequently. Further prospective comparative studies involving more participants and longer postoperative follow-up periods are required to verify these preliminary findings.

Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis

BackgroundDuring the COVID-19 pandemic, a great number of patients required Mechanical Ventilation (MV). Tracheostomy is the preferred procedure when difficult weaning is presented. Surgical techniques available for performing tracheostomy are open and percutaneous, with contradictory reports on the right choice. This paper aims to describe the clinical results after performing a tracheostomy in patients with COVID-19, regarding both surgical techniques.MethodsAn observational, analytical study of a retrospective cohort was designed. All patients admitted to the Hospital Universitario Mayor Méderi, between March 2020 and April 2021 who presented COVID-19 requiring MV and who underwent tracheostomy were reviewed. Open versus percutaneous tracheostomy groups were compared and the primary outcome evaluated was in-hospital mortality.ResultsA total of 113 patients were included in the final analysis. The median age was 66.0 (IQR: 57.2 – 72.0) years old and 77 (68.14%) were male. Open tracheostomy was performed in 64.6% (n = 73) of the patients and percutaneous tracheostomy in 35.4% (n = 40) with an in-hospital mortality of 65.7% (n = 48) and 25% (n = 10), respectively (p < 0.001). In a multivariate analysis, open tracheostomy technique [OR 9.45 (95% CI 3.20–27.92)], older age [OR 1.05 (95% CI 1.01–1.09)] and APACHE II score [OR 1.10 (95% CI 1.02–1.19)] were identified as independent risk factors for in-hospital mortality. Late tracheostomy (after 14 days) [OR 0.31 (95% CI 0.09–1.02)] and tracheostomy day PaO2/FiO2 [OR 1.10 (95% CI 1.02–1.19)] were not associated to in-hospital mortality.ConclusionsPercutaneous tracheostomy was independently associated with lower in-hospital mortality and should be considered the first option to perform this type of surgery in patients with COVID-19 in extended MV or difficulty weaning.

ILEOSTOMY AND RISK OF ACUTE KIDNEY INJURY IN PATIENTS WITH CROHN'S DISEASE

Chron’s disease is an inflammatory disorder that can involve any part of GI tract but most commonly involves the small intestine. Many of the patients with Cohn’s disease end up requiring surgery, and the 10-year risk of requiring surgery is estimated to be around 50%. The most common type of surgery in patients with Crohn’s disease is ileocecal resection. More than 40,000 ileostomies are formed annually in the United States. Up to 15% of patients who receive ileostomy experience a de novo or community-onset AKI within 90 days. Oral rehydration with iso-osmolar fluids is the mainstay of outpatient management. Both hypotonic fluids, and hypertonic fluids can cause a net flow of fluid into the bowel lumen increasing the ostomy output. We aimed to study the risk of AKI within 30 days in CD patients after an ileostomy procedure.

Abstract P2-01-06: Real-world outcome and cost analysis of the addition of pertuzumab to neoadjuvant therapy in localized HER2 positive breast cancer: a single center experience

Abstract BACKGROUND: Breast cancer is the most common cancer in woman and can be classified based on the expression of hormonal receptor as well as the human epidermal growth factor receptor 2 (HER2). HER2 amplification is associated with an aggressive clinical course and higher recurrence rates following curative intend surgery. For non-metastatic T2 or node-positive HER2-positive disease neoadjuvant treatment is favored. The National Comprehensive Cancer Network (NCCN) guidelines have endorsed the use of dual HER2 blockage with trastuzumab and pertuzumab combined with chemotherapy in the neoadjuvant setting. However, pertuzumab isn’t frequently reimbursed in public health care systems for this indication. Patients who don’t achieve a pathological complete response (pCR) at surgery are eligible for adjuvant T-DM1, adding significant side effects on patients and cost on the healthcare system. METHODS: We conducted a retrospective analysis of patients receiving anti-HER2 therapy in the neoadjuvant setting at the Jewish General hospital between 2015 and 2021. After 2019, pertuzumab was routinely added to standard neoadjuvant therapy enabling us to compare patients treated with or without dual-HER2 blockade. Our primary endpoint is the percentage of pCR at surgery. Secondary objectives are to estimate and compare the cost of anti-HER2 targeted therapy in the perioperative setting and side effect burden on patients. Statistical analyses were done using fisher exact test with statistical significance defined p value &amp;lt; 0.05 in a one-sided test. Drug cost was calculated using publicly available resources. RESULTS: We identified 83 patient who underwent neoadjuvant chemotherapy for HER2 amplified breast cancer. 44 patients received only trastuzumab has anti-HER2 therapy and 39 patients were treated with dual HER2 blockade containing pertuzumab. The addition of pertuzumab was associated with improved the pCR rate (67% vs. 27%; p = 0.0016). The increased pCR rate was observed in hormone-receptor positive and negative tumors. We also described a non-statistically significant trend in reduction in the requirement for axillary dissection with the use of pertuzumab (28% vs. 39%; P=0.2208). The increased in pCR rate with pertuzumab reduced the number of patients eligible for adjuvant T-DM1. If all patients with residual disease had received adjuvant T-DM1, the cost of neoadjuvant pertuzumab would be neutral, with a mean anti-HER2 drug cost of 65 150 CA$ in the pertuzumab-trastuzumab group and 66 116 CA$ in the trastuzumab group. CONCLUSION: Our real-world analysis confirmed that neoadjuvant chemotherapy with dual HER2-blockade was well tolerated and associated with increased the pCR rate compared to regimens containing trastuzumab only. This measure is neutral on drug cost by reducing the amount of patients eligible for adjuvant T-DM1. Further research is warranted to estimate the overall health-care utilization costs of neoadjuvant pertuzumab-trastuzumab in settings where adjuvant T-DM1 is available. Table 3: Pathologic complete response (pCR) and type of surgery in patients who received dual HER2 blockade with neoadjuvant pertuzumab-trastuzumab plus chemotherapy and in patients receiving trastuzumab only with chemotherapy at Jewish General Hospital between 2015 and 2021. ** p &amp;lt; 0,01, ns non-statistically significant Citation Format: Francois Panet, Matt Young, Stephanie Wong, Alice Dragomir, April A. N. Rose, Lawrence Panasci. Real-world outcome and cost analysis of the addition of pertuzumab to neoadjuvant therapy in localized HER2 positive breast cancer: a single center experience [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-01-06.

ILEOSTOMY AND RISK OF ACUTE KIDNEY INJURY IN PATIENTS WITH CROHN'S DISEASE

Abstract BACKGROUND Chron's disease is an inflammatory disorder that can involve any part of GI tract but most commonly involves the small intestine. Many of the patients with Cohn’s disease end up requiring surgery, and the 10-year risk of requiring surgery is estimated to be around 50%. The most common type of surgery in patients with Crohn’s disease is ileocecal resection. More than 40,000 ileostomies are formed annually in the United States. Up to 15% of patients who receive ileostomy experience a de novo or community-onset AKI within 90 days. Oral rehydration with iso-osmolar fluids is the mainstay of outpatient management. Both hypotonic fluids, and hypertonic fluids can cause a net flow of fluid into the bowel lumen increasing the ostomy output. We aimed to study the risk of AKI within 30 days in CD patients after an ileostomy procedure. METHODS We collected data from the Healthcare Cost and Utilization Project- (HCUP) Nationwide Readmission Database- 2016- 2018. CD patients were identified and those who received an ileostomy procedure were identified using ICD-10 and PCS-10 codes respectively. Median and IQR were used to describe Continuous variables, and proportions were used with categorical variables. Comparison between groups was performed by Mann Whitney test for continuous variables and the Chi-Square test for Categorical variables. RESULTS We identified 214,622 index hospitalizations with CD, 3,789 of whom received an ileostomy procedure. Of those who received ileostomy, 2.1% were readmitted within 30 days for a primary diagnosis of AKI while 2.9% had 30-day readmission with a secondary diagnosis of AKI. CD patients admitted for AKI after ileostomy had a median length of stay of 14 days (IQR: 8-24). CD patients who received ileostomy had a higher rate of 30-day admission for AKI (2.1% vs. 0.3%, P &amp;lt;0.001) and a higher rate of 30-day readmission with a secondary diagnosis of AKI (2.9% vs. 1.5%, P &amp;lt;0.001) compared to CD patients who didn’t receive ileostomy during the index hospitalization. CD patients who received an ileostomy procedure and were readmitted for AKI within 30 days had an average cost of hospitalization of $140,544 (IQR: $85,072 - $242,059). CD patients admitted for AKI within 30 days after an ileostomy were older (59, IQR: 48-69 vs. 47, IQR: 33-61, P &amp;lt;0.001) compared to those who didn’t have a 30day readmission for AKI respectively. CONCLUSION In a nationwide cohort of patients hospitalized with Crohn’s disease, patients who received ileostomy had a significant risk of AKI within 30-days. The development of AKI was associated with significant morbidity, hospital readmission, and elevated costs of hospitalization. Further studies are needed to investigate novel measures to decrease the risk of AKI in this patient population.

ДИФФЕРЕНЦИАЛЬНЫЙ ПОДХОД В ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ТРУБНОЙ БЕРЕМЕННОСТИ

Ectopic pregnancy is still actual problem in gynecology nowadays due to its unpredictability and is serious threat for women’s life because in the case of interrupt it’s accompanied massive bleeding. Without contemporary treatment the death is potential. Nowadays there is no common treatment approach for patients with ectopic pregnancy. According to the literature frequency of treatment tactic is dependent of country. The purpose of the work is to assess the validity of the choice of the type of surgery for patients with ectopic pregnancy. The article presents the results of clinical observation of patients with a confirmed diagnosis of tubal pregnancy. The study included 103 case histories of patients whose age corresponded to the reproductive age period, according to WHO criteria (15-49 years) and ranged from 23 to 42 years. Based on the volume of surgical intervention, 5 observation groups were formed. The gynecological anamnesis, complaints of patients when contacting the emergency department, laboratory and instrumental diagnostics performed in dynamics, the choice of treatment tactics (organ-preserving or radical surgery) were analyzed. Based on the data obtained, recommendations for the treatment and follow-up of patients with tubal pregnancy were formed.

Metastatic Pattern Discriminates Survival Benefit of Type of Surgery in Patients With De Novo Stage IV Breast Cancer Based on SEER Database.

Background: The role of surgery and surgery type in de novo stage IV breast cancer (BC) is unclear.Methods: We carried out a retrospective cohort study that included the data of 4,108 individuals with de novo stage IV BC abstracted from SEER (Surveillance, Epidemiology, and End Results) data resource from 2010 to 2015. The patients were stratified into the non-surgery group, breast-conserving (BCS) surgery group, and mastectomy group. Inverse probability propensity score weighting (IPTW) was then used to balance clinicopathologic factors. Overall survival (OS), as well as the breast cancer-specific survival (BCSS), was assessed in the three groups using Kaplan–Meier analysis and COX model. Subgroups were stratified by metastatic sites for analysis.Results: Of the 4,108 patients, 48.5% received surgery and were stratified into the BCS group (574 cases) and mastectomy group (1,419 cases). After IPTW balance demographic and clinicopathologic factors, BCS and mastectomy groups had better OS (BCS group: HR, 0.61; 95% CI: 0.49–0.75; mastectomy group: HR, 0.7; 95% CI: 0.63–0.79) and BCSS (BCS group: HR, 0.6; 95% CI, 0.47–0.75; mastectomy group: HR, 0.71; 95% CI, 0.63–0.81) than the non-therapy group. Subgroup analyses revealed that BCS, rather than mastectomy, was linked to better OS (HR, 0.66; 95% CI: 0.48–0.91) and BCSS (HR, 0.63; 95% CI: 0.45–0.89) for patients with bone-only metastasis. For patients with viscera metastasis or bone+viscera metastases, BCS achieved similar OS (viscera metastasis: HR, 1.05; 95% CI: 0.74–1.48; bone+viscera metastases: HR, 1.01; 95% CI: 0.64–1.61) and BCSS (viscera metastasis: HR, 0.94; 95% CI: 0.64–1.38; bone+viscera metastases: HR, 1.06; 95% CI: 0.66–1.73) in contrast with mastectomy.Conclusions: Local surgery for patients with distant metastasis (DS) exhibited a remarkable survival advantage in contrast with non-operative management. BCS may have more survival benefits for patients with de novo stage IV BC with bone-only metastasis than other metastatic sites. Decisions on de novo stage IV BC primary surgery should be tailored to the metastatic pattern.

Bariatric surgery for non-alcoholic fatty liver disease in individuals with obesity (Base-NAFLD): protocol of a prospective multicenter observational follow-up study

BackgroundBariatric surgery may be indicated in patients with nonalcoholic fatty liver disease (NAFLD) to achieve and maintain the degree of weight loss required to ensure therapeutic effects. However, bariatric surgery is still underrecognized in the treatment of NAFLD, including its inflammatory subtype, nonalcoholic steatohepatitis (NASH). Moreover, there is a lack of follow-up outcome data on different types of bariatric surgery in patients with NAFLD. This study aims to adequately assess the effect of bariatric surgery on NAFLD remission in obese patients.MethodsThis prospective multicentre observational follow-up study will include 142 obese patients with NAFLD scheduled to undergo one of the following surgical procedures: sleeve gastrostomy, Roux-en-Y gastric bypass, and one anastomosis gastric bypass. The primary outcome is the complete remission rate of NAFLD one year postoperatively, which is defined by liver fat fraction < 5% on magnetic resonance imaging; the secondary outcomes includes (i) changes in NASH and liver fibrosis biopsy findings, (ii) changes in body weight and abdominal adipose weight, (iii) resolution of obesity-related comorbidities, and (iv) incidence of adverse events. A long-term follow-up related to this study will also be conducted.DiscussionThis study will provide a necessary and preliminary foundation for the early identification and targeted treatment of patients with NAFLD who can be referred for bariatric surgery, as indicated for management of obesity and metabolic disease.Trial registration: Clinicaltrials.gov: NCT04366999. Registered 21 April 2020. (https://clinicaltrials.gov/ct2/show/NCT04366999).

Bicuspid aortic valve disease - the influence of valve morphotype on age at and types of surgical treatment.

BackgroundPatients with bicuspid aortic valve (BAV) with zero or two raphes have been under-represented in previous studies. Whether these patients have unique clinical courses remains unclear. We describe the indications for and types of surgery in patients with BAV, and describe differences between valve morphotypes.MethodsAdults who had undergone aortic and/or aortic valve surgery for BAV disease at our centres were identified and classified according to the Sievers definitions.Results317 patients were included (74.4% male, median age at surgery 62 years). Of these, 187 (59.0%) had aortic valve surgery, 7 (2.2%) aortic surgery, 120 (37.9%) combined valve and aortic surgery and 3 had a Ross procedure. Most patients had aortic stenosis (71.9%), followed by aortic regurgitation (16.7%). 30-day mortality was low (1.6%).The commonest valve morphology was type-1 (one raphe) in 89.6%; type-0 (no raphes) occurred in 7.9% and type-2 (two raphes) in 2.5%. Patients with type-2 valves were substantially younger at time of surgery than type-1 patients (median 36 vs 63 years, p = 0.008). A higher proportion of patients with type-0 valves required aortic surgery than those with type-1 (68.0% vs 37.3%, p = 0.007). There were no differences between groups for the indication for surgery, valvular abnormality or 30-day mortality.ConclusionsThe number of BAV raphes was independently and significantly associated with age at surgery and the need for aortic intervention. Patients with type 0 and type 2 valves are a small but important proportion of the BAV population, potentially requiring different clinical surveillance and management.

Temporomandibular joint stability after two types of maxillary impaction surgery in patients with skeletal class II open bite due to condylar deformations: a preliminary study

ABSTRACT Purpose: The aim of this study was to evaluate the effect of two types of mandibular autorotation concept (MAC) surgery using maxillary impaction combined with a straight locking miniplate (SLM) technique on the condyles of patients with skeletal Class II open bite. Materials and methods: Fourteen female patients with skeletal Class II mandibular retrusion with open bite were included in this study. The patients were divided into two groups based on the type of MAC surgery performed: a group of subjects who underwent maxillary impaction only (MAC-1 group) and a group of subjects who underwent maxillary impaction combined with mandibular osteotomy (MAC-2 group). A 3D-printing CAD/CAM wafer was fabricated. The SLM technique was performed to stabilize the vertical maxillomandibular relationship during surgery. A computed tomographic image was obtained preoperatively as well as on the third post-surgical day and 1 year post-surgically to evaluate the relapse by assessing changes in cephalometric measurements, condylar volume, and condylar surface area. Results: Neither the MAC-1 group nor the MAC-2 group showed significant changes in their condylar surface area that could have led to skeletal relapse. The condylar volume was significantly decreased in the MAC-2 group, but the affected location did not contribute to the relapse of the mandibular position. Conclusion: Our findings suggest that MAC surgery with the SLM technique in patients with skeletal Class II retrognathia did not result in post-surgical relapse or further deformation and resorption of the condyle; rather, it yielded promising functional and morphological stability.

Method of monotonic functions and its application to the choice of the type of surgery in patients with prostate cancer according to preoperative data

Method of monotonic functions and its application to the choice of the type of surgery in patients with prostate cancer according to preoperative data

COMPREHENSIVE EVALUATION OF VARIOUS AVAILABLE SURGICAL MANAGEMENT OF FISTULA IN ANO :EXPERIENCE IN A TERTIARY CARE CENTRE OF INDIA

BACKGROUND: There are various conventional and emerging surgical modalities for management of fistula in ano. But every modality has its own pros and cons. The aim of our study was to compare various surgical modalities in term of its recurrence rate, cost and their complication rates Materials and methods: A prospective observational study was conducted with 50 patients from July 2016 to June 2018. Prospective data was collected on proforma basis regarding clinical presentation, imaging findings, various surgical modalities, complications and reoperation rate. RESULTS: The mean age of the patients was 40.04 ± 10.77 years. The most common type of surgery was Fistulectomy (28%) and Fistula plug (28%) followed by Fistulotomy (20%), Seton Application (16%) and Video Assisted Anal Fistula Treatment (VAAFT) (8%).8 (16%) patients required reoperation. There was no significant association of reoperation and type of surgery in patients (p&gt;0.05). The mean values of post-operative recovery (VAS Score) at different time intervals (post-op, post-op 3 months and post-op 6 months) was comparable and statistically not significant as per ANOVA test (p&gt;0.05). There was no significant association of post-operative recovery (VAS Score) and type of surgery in patients. There was no significant association of post-operative complications after 3 months and 6 months and type of surgery in patients (p&gt;0.05). CONCLUSION: All the surgical modalities used in our study revealed comparable success rate and no significant differences in complication rates. A large randomised controlled trial comparing various surgical modalities is required in future to decide the best surgical method to treat fistula in ano.

The Clinical Value and Appropriateness Criteria of Upper Abdominal Magnetic Resonance Examinations in Patients Before and After Bariatric Surgery: a Study of 837 Images.

The abdominal magnetic resonance (MR) examinations have been increasingly applied in patients with obesity. However, few studies analyzed the appropriateness of this examination. This study is aimed to evaluate the feasibility and clinical value of upper abdominal MR in quantification of visceral/subcutaneous adipose tissue (VAT/SAT) and liver fat fraction (LFF) in patients before and after bariatric surgery. All patients who underwent bariatric surgery from November 2017 to November 2019 in the prospectively maintained, IRB-approved database of our institution were queried. The images of all MR studies were retrospectively reviewed and analyzed. In total, 570 patients with 837 upper abdominal MR examinations were analyzed. The VAT/SAT can be clearly visualized and quantified on fat liver acquisition with volume acceleration-flexible (LAVA-Flex) sequence. The present rate of a single axial slice at the level of the L1-L2 intervertebral disc was 93.1% (779/837). The LFF could be quantitatively evaluated on all of the proton density fat fraction (PDFF) maps (100%, 837/837). Occasional findings may include cholelithiasis, cysts, hepatic hemangioma, and renal angiomyolipoma, which can be clearly diagnosed by MR. The upper abdominal MR is featured by well feasibility and clear clinical value when applying in patients with obesity. We can use the results to do clinical research and evaluate obesity-related disease risks before and after surgery, thus providing suggestions to choose the type of surgery for patients with different risk levels in the future. MR scanning including fat LAVA-Flex images with the inclusion of L1-L2 level and PDFF measurements is suggested for the VAT/SAT/LFF quantification. NCT03520699.

Abstract P2-14-19: Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer

Abstract Background: The addition of pertuzumab to trastuzumab and chemotherapy significantly improves the pathologic complete response (pCR) rate in HER2+ localized breast cancer in the preoperative setting. Although many patients are converted to breast conserving therapy (BCT) candidates by neoadjuvant HER2-directed therapy, a significant proportion opt for a mastectomy for various reasons. Among mastectomy procedures, nipple sparing mastectomy (NSM) is frequently chosen instead of non-nipple sparing mastectomy (NNSM). In this study, we evaluated the surgical and long-term outcomes of HER2+ patients receiving neoadjuvant pertuzumab-containing regimens. Methods: We performed a retrospective review of localized breast cancer patients treated with neoadjuvant pertuzumab-containing regimens from 2011 to 2016, who underwent BCT or mastectomy at an academic institution and two community-based practices. Disease characteristics, treatment regimens, surgical outcomes, and recurrence data were extracted from the electronic medical records. Results: Among 90 patients with stage II-III HER2+ breast cancer, 45 received AC-THP (50.0%), 26 received THP (with adjuvant AC) (29.0%), and 19 received TCHP (21.0%). The majority of patients had grade 3 tumors (61.1%), clinical stage II disease (80.0%), invasive ductal carcinoma (86.7%), and ER+ disease (65.6%). Thirty-seven (41.0%) patients underwent BCT and 53 (59.0%) patients underwent mastectomy. Among the mastectomy patients, 38 (71.7%) patients underwent bilateral mastectomies, specifically 33 (62.0%) patients underwent a NSM and 20 (38.0%) patients underwent a NNSM. The type of surgery that patients underwent stratified by type of neoadjuvant regimen is outlined in the Table 1 below. Most patients who underwent BCT and mastectomy received radiation, including 36 (97.3%) BCT, 24 (72.7%) NSM, and 18 (95.0%) NNSM. Over a median follow-up period of 33 months, 6 patients (6.7%) had recurrences with 2 (2.2%) local recurrences and 4 (4.4%) distant recurrences. The 2 local recurrences occurred in one patient who underwent BCT and one patient who underwent NNSM followed by post-mastectomy radiation. Conclusions: Among mastectomy patients, NSM was more commonly pursued than NNSM. Rates of local recurrence following pertuzumab-containing regimens for HER2-positive localized breast cancer were low overall, regardless of the type of surgery. Data on plastic surgery approaches and complication rates will be presented at the meeting. Table 1.Type of surgery in patients receiving neoadjuvant HER2-directed therapy. AC-THP (N = 45)TCHP (N = 19)THP (N = 26)BCT46.7%47.4%26.9%NNSM26.7%10.5%23.1%NSM26.7%42.1%50.0% Citation Format: Haddad SA, Spring LM, Jimenez RB, Vidula N, Comander A, Shin JA, Coopey SB, Gadd MA, Hughes KS, Taghian A, Smith BL, Isakoff SJ, Moy B, Bardia A, Specht MC. Surgical and long-term outcomes of patients receiving neoadjuvant pertuzumab-containing regimens for HER2-positive localized breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-19.

Diffuse massive adenomyosis and infertility. Is it possible to treat this condition?

Background Severe forms of adenomyosis are a serious gynecological problem. In most cases, conservative treatment of this pathology is unsuccessful. Adenomyomectomy by Osada's approach seems to be the most promising solution. The present study evaluated the follow-up results of this type of surgery in patients with adenomyosis and infertility. Materials and methods The prospective study included 26 patients with severe forms of adenomyosis who underwent an adenomyomectomy using Osada's approach. In 18 patients (69%), infertility was the main indication for surgical treatment. The follow-up period lasted from July 2012 to January 2018. Results The median post-operative follow-up period was 18 months. For the first 12 months patients received hormonal therapy. In all postoperative patients, the menstrual cycle had normalized, and other symptoms of the disease had disappeared. Seven patients continue to receive postoperative hormonal treatment. Three individuals got spontaneously pregnant; two of them delivered full-term babies by cesarean section. Six patients are planning a pregnancy with assisted reproductive technology. Conclusion In the present study, the organ-preserving surgery of severe adenomyosis performed using Osada's method appeared to be a good alternative to hysterectomy. It stopped the development of pathological symptoms of the disease and restored the patient's reproductive function.

Temporal Trends in Gender-Affirming Surgery Among Transgender Patients in the United States

Little is known about the incidence of gender-affirming surgical procedures for transgender patients in the United States. To investigate the incidence and trends over time of gender-affirming surgical procedures and to analyze characteristics and payer status of transgender patients seeking these operations. In this descriptive observational study from 2000 to 2014, data were analyzed from the National Inpatient Sample, a representative pool of inpatient visits across the United States. The initial analyses were done from June to August 2015. Patients of interest were identified by International Classification of Diseases, Ninth Revision, diagnosis codes for transsexualism or gender identity disorder. Subanalysis focused on patients with procedure codes for surgery related to gender affirmation. Demographics, health insurance plan, and type of surgery for patients who sought gender-affirming surgery were compared between 2000-2005 and 2006-2011, as well as annually from 2012 to 2014. This study included 37 827 encounters (median [interquartile range] patient age, 38 [26-49] years) identified by a diagnosis code of transsexualism or gender identity disorder. Of all encounters, 4118 (10.9%) involved gender-affirming surgery. The incidence of genital surgery increased over time: in 2000-2005, 72.0% of patients who underwent gender-affirming procedures had genital surgery; in 2006-2011, 83.9% of patients who underwent gender-affirming procedures had genital surgery. Most patients (2319 of 4118 [56.3%]) undergoing these procedures were not covered by any health insurance plan. The number of patients seeking these procedures who were covered by Medicare or Medicaid increased by 3-fold in 2014 (to 70) compared with 2012-2013 (from 25). No patients who underwent inpatient gender-affirming surgery died in the hospital. Most transgender patients in this national sample undergoing inpatient gender-affirming surgery were classified as self-pay; however, an increasing number of transgender patients are being covered by private insurance, Medicare, or Medicaid. As coverage for these procedures increases, likely so will demand for qualified surgeons to perform them.

Trimodality Therapy for Esophageal Cancer: Radiation to the Gastric Conduit Is Not Associated With Post-operative Anastomotic Complication

Since publication of the CROSS study, the majority of patients with locally advanced esophageal cancer are treated with neoadjuvant chemoradiotherapy prior to esophagectomy (trimodality therapy, TMT). The stomach, specifically the fundus and greater curvature, is used to re-create neo-esophagus and is often located in the pre-operative radiation (RT) field. This study aims to determine if RT to the stomach and its substructures correlate with anastomotic complication (AC). From 2007 to 2016, patients with esophageal cancer treated with TMT at a tertiary academic institution with restored digital RT plans were included in this IRB approved study. Clinical and pathologic data were obtained retrospectively. The stomach and its substructures were contoured on the preoperative RT planning scans and dosimetric parameters were extracted. AC was defined as a leak and/or a stricture. Fisher-exact and Wilcoxon rank-sum tests were used. 96 patients were included in the analysis. The median age was 63 (55-70); 82% of patients were male. Majority of the tumors were located in the distal esophagus (52%) and gastroesophageal junction (GEJ, 30%) versus 15% and 3% in the middle and proximal esophagus, respectively. Adenocarcinoma was the predominant histology (80%). Carboplatin and paclitaxel was used in majority of the patients (36%). Median RT dose was 45 Gy (range, 41.4-54 Gy). Transhiatal esophagectomy was the common surgery performed (50%), followed by Ivor-Lewis (33%), 3-incision (14%) and other (3%). AC developed in 57% of the patients (47 strictures,49%; 16 leaks, 17%; 8 both, 8%). Diabetes (DM) was more common in patients with AC (n=16, 29% vs. n=7, 17%, p=0.172). Esophagectomy type was associated with AC (p<0.000). The predominant type of surgery in patients with AC was transhiatal (62%) followed by 3-incision (18%), Ivor-Lewis (16%) and others (4%). The mean dose to the stomach, fundus, and greater curvature was 27 Gy (18-35 Gy), 33 Gy (23-45 Gy), and 23 Gy (13-33 Gy), respectively. RT dose to the stomach and its substructures were not associated with AC (p>0.05). Of the 47 patients with distal/GEJ tumor location and esophagectomies with cervical anastomoses, 72% of them developed AC (31 strictures, 66%; 11 leaks, 23%; 8= both, 17%). DM was more common in patients with AC (n=9, 27% vs. 0%, p=0.047). RT was not associated with AC (p>0.05). Our analysis does not demonstrate an association between RT to gastric substructures that form the neo-esophagus and AC. However, it does show an increased risk of AC in patients who undergo esophagectomies with cervical anastomosis. In this population, the majority with a leak had anastomosis in the neck and distal esophageal or GEJ tumor undergoing cervical anastomosis. Patients with distal tumors may be better served with anastomosis in the thorax rather than neck. Further analysis in a larger study population is needed to clarify associations.

The impact of surgical approach on quality of life for pleural malignant mesothelioma.

A comprehensive review of quality of life (QoL) after surgery for malignant pleural mesothelioma (MPM) was conducted to assess differences between pleurectomy decortication (P/D) and extrapleural pneumonectomy (EPP). Original research studies on quality of life after mesothelioma surgery were identified through June 2016; 15 articles and 12 distinct datasets, for a total of 523 patients, were retrieved. QoL data was available for 102 patients treated with EPP and 296 with P/D. Two studies directly compared QoL outcomes between the two techniques. Symptoms, lung function parameters, and physical and social functioning were still compromised 6 months following surgery. However, P/D patients fared better than EPP patients across QoL measures. Quality of life is generally better for patients undergoing P/D compared to EPP, for an extended period following surgery. Given the need for multimodality therapy and the aggressive nature of MPM, QoL outcomes should be strongly considered when recommending type of surgery for patients with this disease.

CT typing and surgical approach for adenocarcinoma of the esophagogastric junction

Objective: To investigate the feasibility, safety and efficacy of preoperative CT in the classification of adenocarcinoma of the esophagogastric junction. Methods: A total of 517 consecutive patients from May 2012 to June 2016 with esophagogastric junction carcinoma in the department of general surgery of Henan Cancer Hospital was retrospectively analyzed, according to the clinical pathological data of three type four layer method and statistics of various types of surgery in patients with preoperative enhanced CT. Results: 517 patients were successfully received surgery, including 152 cases of type Ⅰ(131 cases of complete abdominal surgery, 21 cases of abdominal incision diaphragm in thoracic surgery), 239 cases of type Ⅱ (177 cases of complete abdominal surgery, 62 cases of abdominal incision diaphragm in thoracic surgery), Ⅲ/Ⅳ type choice of chest abdominal surgery in 126 cases. The operation time was (102±17) min, the amount of hemorrhage was (136±18) ml, the dominant anastomotic fistula happened in 16 cases, 5 cases of pancreatic fistula, 7 cases of intestinal obstruction, anastomotic stenosis in 3 cases, thoracic and abdominal sensation in 12 cases, all the complications were cured by conservative treatment. The average value of esophageal resection margin was(5.1±0.6)cm, 2 cases with positive residual tumor margin and average length of stay was (8.9±1.6)d. Conclusion: Using preoperative enhanced CT in the adenocarcinoma of the esophagogastric junction to choose surgical approach can ensure the safety margin. What's more, unnecessary thoracotomy is reduced which is expected to be a new classification method for the operation of esophagogastric junction cancer.