Underwent Salvage Procedures Research Articles

Transanal Endoscopic Microsurgery Resection of Rectal Tumors: Outcomes and Recommendations

Transanal endoscopic microsurgery provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. The purpose of this study was to review our experience with transanal endoscopic microsurgery to clarify its role in the treatment of different types of rectal pathology. A prospective database documented all patients undergoing transanal endoscopic microsurgery from October 1996 through June 2008. We analyzed patient and operative factors, complications, and tumor recurrence. For recurrence analysis, we excluded patients with fewer than 6 months of follow-up, previous excisions, known metastases at initial presentation, and those who underwent immediate radical resection following transanal endoscopic microsurgery. Two hundred sixty-nine patients underwent transanal endoscopic microsurgery for benign (n = 158) and malignant (n = 111) tumors. Procedure-related complications (21%) included urinary retention (10.8%), fecal incontinence (4.1%), fever (3.8%), suture line dehiscence (1.5%), and bleeding (1.5%). Local recurrence rates for 121 benign and 83 malignant tumors were 5% for adenomas, 9.8% for T1 adenocarcinoma, 23.5% for T2 adenocarcinoma, 100% for T3 adenocarcinoma, and 0% for carcinoid tumors. All 6 (100%) recurrent adenomas were retreated with endoscopic techniques, and 8 of 17 (47%) recurrent adenocarcinomas underwent salvage procedures with curative intent. Transanal endoscopic microsurgery is a safe and effective method for excision of benign and malignant rectal tumors. Transanal endoscopic microsurgery can be offered for (1) curative resection of benign tumors, carcinoid tumors, and select T1 adenocarcinomas, (2) histopathologic staging in indeterminate cases, and (3) palliative resection in patients medically unfit or unwilling to undergo radical resection.

Ileal pouch salvage following failed ileal pouch—anal anastomosis

Attempts have been made to salvage failed ileal pouch—anal anastomoses (IPAA) performed for ulcerative colitis or familial polyposis coli. These can be categorized as total reconstruction of the IPAA, partial transabdominal approach, and partial transperineal approach. The aims of our study were to determine the overall success of pouch salvage; to examine the demographics, indications, and outcomes for each approach; and to assess anorectal physiology and patient satisfaction in those with successful salvage operations. We reviewed data, including results of anorectal manometry, from 29 patients undergoing salvage procedures for failed IPAA. Seventeen salvage attempts were successful, 11 attempts failed, and one patient was lost to follow-up. Success rates were 100% in the total reconstruction group, 25% in the partial transabdominal group, and 55% in the transperineal group. In those undergoing total reconstruction of the IPAA (n = 9), functional outcome, as measured by incontinence, improved with 50% reporting incontinence preoperatively compared to 0% postoperatively ( P = 0.055). Mean 24-hour stool frequency and nighttime stool frequency declined. All patients reported satisfaction with their outcomes. Sixty percent of patients who underwent ileal pouch salvage following IPAA have been successful in avoiding permanent ileostomy. These results suggest that a continued effort to salvage failed IPAA, including the use of total reconstruction, is a viable alternative to permanent ileostomy.

Quality of life in patients undergoing salvage procedures for locally recurrent prostate cancer.

As patients are being treated for prostate cancer at a younger age, a significant number of them will ultimately fail the primary treatment and will be candidates for potentially curative salvage therapy. The purpose of this study was to evaluate the impact of salvage therapy for locally recurrent prostate cancer upon the patients' quality of life. A cohort of 68 men with locally recurrent prostate cancer undergoing salvage treatment was included in this analysis. Data were collected for the study by mailing the subjects a self-administered questionnaire that included a General Functional Assessment of Cancer Therapy (FACT-G) and a Prostate Cancer Treatment Outcome Questionnaire (FACT-P). Group comparisons were conducted using one-way analysis of variance (ANOVA). Overall, 50% and 88.6% of patients were free of biochemical recurrence in the salvage surgery (SS) and salvage radiotherapy (SRt) group, respectively (P=0.4). The physical well-being (PWB) subscale of FACT-G was significantly higher for the SRt patients (P=0.008). Using the Trial Outcome Index Prostate subscale, the Trial Outcome Index Incontinence Urinary scores, and the Functional Assessment of Incontinence Therapy-Urinary score group comparisons, patients in the SRt group had a higher quality of life than patients in the SS group (P=0.038, P=0.001, and P=0.001, respectively). In the current study, patients with clinically localized prostate cancer who are at high risk for local disease recurrence may have a trend toward better disease-free survival and a better urinary continence rates if the primary treatment is radical prostatectomy rather than radiation therapy.

Radial recession osteotomy for Kienböck's disease

Sixty-eight patients underwent radial recession osteotomy for avascular necrosis of the lunate were retrospectively evaluated after an average follow-up period of 52 months. Twenty-five patients had undergone 1 or more additional procedures concurrently for treatment of Kienböck's disease. Pain diminished in 93% of patients, grip strength improved, and wrist motion was preserved; 75% of patients continued in their original occupations, including heavy labor. Surgical complications were uncommon. Four patients subsequently underwent salvage procedures, including 2 total wrist arthrodeses. Three of these 4 patients were receiving workers' compensation. One third of patients demonstrated lunate healing after joint leveling. Preliminary results suggest that concomitant lunate revascularization or vascularized bone grafting may improve the radiographic result. With rare exceptions, radial recession osteotomy relieves pain and improves function in Kienböck's disease.

Techniques to Create Continence in the Failed Bladder Exstrophy Closure Patient

We reviewed retrospectively 315 patients with bladder exstrophy treated at our hospital between July 1976 and April 1992 to assess the outcome of those who failed primary closure of the bladder. Of the patients 47 required reclosure of the bladder, including 28 who have undergone a procedure to restore urinary continence. Methods used to achieve dryness included bladder neck reconstruction in 18 patients, bladder neck reconstruction along with augmentation in 4, augmentation alone in 4, repeat bladder neck reconstruction in 1, and reclosure with creation of a continent stoma and augmentation in 1. Nine of 18 patients who underwent primary bladder neck reconstruction are dry on intermittent catheterization, while 8 of the remaining 9 are dry and voiding without catheterization. Four patients who underwent primary bladder neck reconstruction and augmentation, and 4 who underwent augmentation after bladder neck reconstruction are dry on intermittent catheterization. The patient who underwent reclosure, bladder augmentation and creation of a continent abdominal stoma is dry on intermittent catheterization. Virtually all patients who failed the initial closure and later bladder neck reconstruction for continence require augmentation and intermittent catheterization to remain dry. Of 28 patients who underwent salvage procedures only 1 had upper tract changes. With attention to detail and the use of a variety of reconstructive techniques children who have failed exstrophy closure can achieve continence and have stable renal function.

T2 Glottic Cancer: Recurrence, Salvage, and Survival After Definitive Radiotherapy

The records of all patients with T2, NO squamous cell carcinoma of the true vocal cords treated with definitive radiotherapy at The University of Texas M. D. Anderson Cancer Center between 1970 and 1985 were analyzed to investigate treatment outcome, prognostic factors associated with tumor recurrence, and the potential impact of improved initial treatment on patient survival. There were 114 patients (male to female ratio, 13:1) with a median age of 62 years at presentation. All were treated with external beam irradiation to a modal dose of 70 Gy in 35 fractions over 7 weeks. The median field size was 25 cm2 and no elective treatment to the neck was routinely given. The crude recurrence rate after definitive radiotherapy was 32%. Of the 37 local regional failures, 32 were in the larynx only, 3 in the neck, and 2 in both the larynx and the neck. All patients who had recurrence after radiotherapy underwent salvage procedures, which increased the ultimate control rate above the clavicles to 94%. Overall and disease-specific survival rates at 5 years were 69% and 92%, respectively. Fifty patients died: 7 of laryngeal cancer, 2 of complications of salvage surgery, 13 of unrelated second cancers, and 28 of other intercurrent disease. The prospects for improved survival through more effective initial treatment of this stage of glottic cancer are therefore very limited. Significant complications of radiotherapy occurred in only 4 patients (3.5%), and overall, 74% of patients retained a functional larynx. Analysis of a wide variety of patient-, tumor-, and treatment-related variables failed to identify any statistically significant prognostic factors.(ABSTRACT TRUNCATED AT 250 WORDS)