Resection Volume Research Articles

A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials.

ObjectiveThe exact role of the extent of resection or residual tumor volume on overall survival in glioblastoma patients is still controversial. Our aim was to create a statistical model showing the association between resection extent/residual tumor volume and overall survival and to provide a nomogram that can assess the survival benefit of individual patients and serve as a reference for non-randomized studies.MethodsIn this retrospective multicenter cohort study, we used the non-parametric Cox regression and the parametric log-logistic accelerated failure time model in patients with glioblastoma. On 303 patients (training set), we developed a model to evaluate the effect of the extent of resection/residual tumor volume on overall survival and created a score to estimate individual overall survival. The stability of the model was validated by 20-fold cross-validation and predictive accuracy by an external cohort of 253 patients (validation set).ResultsWe found a continuous relationship between extent of resection or residual tumor volume and overall survival. Our final accelerated failure time model (pseudo R2 = 0.423; C-index = 0.749) included residual tumor volume, age, O6-methylguanine-DNA-methyltransferase methylation, therapy modality, resectability, and ventricular wall infiltration as independent predictors of overall survival. Based on these factors, we developed a nomogram for assessing the survival of individual patients that showed a median absolute predictive error of 2.78 (mean: 1.83) months, an improvement of about 40% compared with the most promising established models.ConclusionsA continuous relationship between residual tumor volume and overall survival supports the concept of maximum safe resection. Due to the low absolute predictive error and the consideration of uneven distributions of covariates, this model is suitable for clinical decision making and helps to evaluate the results of non-randomized studies.

Facility-level national trends in racial disparities of surgical therapy for early-stage lung cancer

ObjectiveThe racial gap in surgical treatment for early-stage non–small cell lung cancer (NSCLC) has been narrowing at the population level, but it is unknown if this trend persists at the facility level. Patients and MethodsWe queried the National Cancer Database Participant User File from 2006 to 2016 for patients with stage I NSCLC. Facilities were grouped by type, location, and resection volume. The cumulative surgery rate for Black and White patients in each group was calculated, and an incidence rate difference of receipt of surgery was determined. Logistic regression with estimation of marginal effects was used to assess the probability difference of receiving surgery in Black versus White patients in each year. ResultsIn total, 315,474 patients were included; 287,585 (91.2%) were White and 27,889 (8.8%) were Black. The surgery rate was greater for White patients (60.2% vs 55.8%, P < .001). For most groups, the surgery disparity narrowed over the study period. The disparity widened in community cancer programs; facilities in the New England, West North Central, and Pacific regions; and the lowest volume facilities. The probability difference for receiving surgery was significantly smaller in 2016 versus 2006 in the Middle Atlantic region and community cancer programs; the difference was unchanged for all other groupings. ConclusionsTrends in disparities in the use of resection for early-stage NSCLC are not universal across facility groupings. As efforts are made toward addressing racial disparities in surgical care for NSCLC, it will be important to remember that population-level analyses may mask lack of progress in certain facility groups.

Cold chain logistics: a possible mode of SARS-CoV-2 transmission?

<b>Objective:</b> To determine whether the improved outcome of a surgical procedure in high volume hospitals is specific to the volume of the same procedure. <b>Design and setting:</b> Analysis of secondary...

Evaluation of Carbon Nanoparticle Suspension and Methylene Blue Localization for Preoperative Localization of Nonpalpable Breast Lesions: A Comparative Study.

Background: The resection of nonpalpable breast lesions (NPBLs) largely depends on the preoperative localization technology. Although several techniques have been used for the guidance of NPBL resection, more comfortable and effective methods are needed. This aim of this study was to evaluate the use and feasibility of carbon nanoparticle suspension (CNS) and methylene blue (MB)-guided resection of NPBL, to introduce alternative techniques.Methods: A total of 105 patients with 172 NPBLs detected by breast ultrasound were randomized to CNS localization (CNSL) group and MB localization (MBL) group. The injection times of the two groups were divided into 2, 4, 6, 12, 16, and 20 h before surgery. In this study, localization time, stained area, operation time, total resection volume (TRV), calculated resection ratio (CRR), and pathological diagnosis were assessed.Results: All of the 172 lesions were finally confirmed benign. Dye persisted in all cases in the CNSL group (109/109, 100%), while that persisted in only 53 cases in the MBL group (53/63, 84.1%) (P < 0.001). There was a significant correlation between dyeing time and dyeing area in the MBL group (r = −0.767, P < 0.001); however, there was no significant correlation in the CNSL group (r = −0.154, P = 0.110). The operation time was 11.05 ± 3.40 min in the CNSL group and 13.48 ± 6.22 min in the MBL group (P < 0.001). The TRV was 2.51 ± 2.42 cm3 in the CNSL group and 3.69 ± 3.24 cm3 in the MBL group (P = 0.016). For CRR, the CNSL group was lower than the MBL group (7.62 ± 0.49 vs. 21.93 ± 78.00, P = 0.018). There is no dye remained on the skin in the MBL group; however, dye persisted in 12 patients (19.4%) in the CNSL group (P = 0.001).Conclusion: Carbon nanoparticle suspension localization and MBL are technically applicable and clinically acceptable procedures for intraoperatively localizing NPBL. Moreover, given the advantages of CNSL compared to MBL, including the ability to perform this technique 5 days before operation and smaller resection volume, it seems to be a more attractive alternative to be used in intraoperative localization of NPBL.

CT for estimating adequacy of lymph node dissection in patients with squamous cell carcinoma of the head and neck

BackgroundIndices obtained from lymph node dissection specimens, specifically lymph node yield (LNY) and lymph node ratio (LNR), have prognostic significance in the setting of head and neck squamous cell carcinoma (HNSCCa). However, there are currently no validated tools to estimate adequacy of planned lymph node dissection using preoperative data. The present study sought to evaluate CT-derived estimates of lymphatic tissue volumes as a preoperative tool to guide cervical node dissection.MethodsFifteen cervical lymph node dissections were performed in 14 subjects with HNSCCa. Preoperative CT-derived estimates of lymphatic tissue volumes were compared with gross pathology tissue volume estimates and pathologically-determined LNY.ResultsResected tissue volume (calculated using the triaxial ellipsoid method) correlates with CT-derived preoperative lymphatic volume estimates (r = 0.74, p = 0.003) while LNY does not(r = − 0.12, p = 0.67). When excluding pathologically enlarged lymph nodes (“refined” data), a negative correlation was observed between refined CT-derived volume estimates and refined LNY (r = − 0.65, p = 0.009).ConclusionIn the setting of cervical lymph node dissection, CT-derived lymphatic volume estimates correlate with resected tissue volume, but refined CT-derived volume estimates correlate negatively with refined LNY.Trial registrationRetrospectively registered.Level of evidence4

Longer preserved urethral length in robot-assisted radical prostatectomy significantly contributes to post-operative urinary continence recovery.

ObjectivesTo assess the relationship between the surgical procedure of robot‐assisted radical prostatectomy (RARP) and urinary continence recovery by reviewing the video database.MethodsVideo and data about men diagnosed with prostate cancer and underwent RARP were extracted and reviewed. Preserved urethral length (PUL) was semi‐quantitatively measured using the lateral width of a 16‐Fr urethral balloon catheter while cutting the urethra on a video screen. In addition, by reviewing intraoperative RARP video database, other surgical skill outcomes were also collected. Kaplan–Meier analysis with log‐rank test was used to compare the urinary continence recovery rate, stratified by the PUL. Univariate and multivariate analyses were performed using the Cox proportional hazards model, and p‐values of <0.05 were considered significant.ResultsThe number of patients included in this study was 213. In univariate analysis, a PUL of ≥16 mm, a body mass index of <23.1 kg/m2 and a resected prostate volume of <44.3 g were statistically significant factors that influenced urinary continence recovery [hazard ratio (HR) 1.58, p = 0.036; HR 0.67, p = 0.021; and HR 0.58, p = 0.005, respectively]. Those factors also remained statistically significant in the multivariate analysis (HR 1.87, p = 0.022; HR 0.54, p = 0.001; and HR 0.57, p = 0.005, respectively). One year post‐operatively, the recovery rate from urinary continence was 79.0% for patients with a PUL of ≥16 mm and 66.5% for patients with a PUL of <16 mm.ConclusionThese results suggest that patients with longer PUL in RARP have a significantly higher rate of post‐operative urinary continence recovery.

NCOG-17. FACTORS INFLUENCING POOR INDEPENDENCE LEVEL FOLLOWING RESECTION OF THE RIGHT TEMPORO-PARIETAL GLIOBLASTOMAS

Abstract In glioma surgeries, cognitive outcomes for the dominant hemisphere have gained much attention compared to the non-dominant hemisphere. For non-dominant hemispheric glioblastomas, we previously observed decreased independence level following glioblastoma resection of the posterior temporal to the parietal lobes. Here, we investigated the reason for the poor Karnofsky Performance Status (KPS) in such glioblastomas. A total of 41 patients with resection of the right cerebral hemispheric primary glioblastoma were enrolled for the study. Several kinds of neuropsychological functions and KPS of the brain regions were evaluated at pre- and postoperative 3 months by performing the Spearman’s correlation analysis and voxel-based lesion symptom mapping (VLSM). Additionally, the correlation between the resected volume of each gyrus or white matter tract and neuropsychological function score was analyzed. KPS at chronic phase (73.6) declined significantly compared with preoperation (81.0, p = 0.020). Functional factors influencing the KPS were general cognitive function, visuospatial cognition, emotion recognition, executive function, and apathy. The VLSM analysis revealed that the resection of the ventral parietal lobe and supramarginal gyrus (VPL-SMG) resulted in significantly poor KPS. Among the functional factors affecting KPS, VPL-SMG resection contributed to significantly lower scores in visuospatial cognition, emotion recognition, and apathy than those without resection (p = 0.0045, 0.047, and 0.0002, respectively). Further, we investigated whether the damage of the VPL-SMG could result in KPS related functional deficit. We found visuospatial cognition related to the posterior occipital lobe, SMG, arcuate fasciculus (AF), and dorsal superior longitudinal fasciculus, emotion recognition to the middle to inferior occipital gyrus and AF, and apathy to the inferior parietal lobe and middle temporal gyrus. We concluded that deficits of visuospatial cognition, emotion recognition, and apathy due to the damage of the cortical and white matter areas, including the VPL-SMG, were responsible for KPS of the non-dominant hemispheric glioblastomas.

3D modeling in the planning of treatment of femoral tumors

Background. The outcome of surgical treatment of fe-moral tumors (FT) depends on the knowledge of the real picture of the extent of bone and soft tissue damage. The objective picture of the lesion can be significantly supplemented by virtual modeling in the framework of MRI, CT, and 3D modeling of the process, which is practically not studied in Ukraine. Real solid modeling of a skeletal segment with a tumor can produce the most optimal volume of resection and structure formation for stable fixation of bone fragments. The purpose of the work is to improve the technique of 3D modeling of hip tumors for preoperative planning of surgical intervention and the development of the most optimal design of the device. Materials and methods. The available literature data were analyzed; the radiographs, case histories of 15 patients with FT were studied. Good results of treatment of the last are possible at thorough preoperative planning. Results. We use technologies of 3D modeling and 3D printing of solid models of FT. This allows planning the line of the proposed bone resection, to properly form a graft from bioactive ceramics, tutoplast or own bones. 3D modeling helps to create the most optimal design of the device, which provides stable fixation of these grafts to the femoral fragments. The length of resection of the tumor segment with the tumor was calculated using multidetector compu-ted tomography (MDC) perfusion. This makes it possible to conduct preoperative training to establish the structures of the formed fixators on the segment of bone fragments — graft (BFG), to determine its bearing capacity. Based on planning and preoperative training, 5 ope-rations were performed on the hip. To stabilize the BFG segment, optimized constructions based on a DHS-type clamp, LCP-plates, or a clamp for low-contact multiplane osteosynthesis were used. Conclusions. Application of the technology of 3D modeling and 3D printing of solid models of specific SC and tumors allow planning the line of the proposed bone resection. Based on this, you can form the size of the graft, create a fixator structure that provides stability in the BFG. The preoperative training facilitates surgery. All this helps to choose the most optimal treatment tactics.

Justification of the diagnostic algorithm and treatment strategies in patients with severe chronic slow-transit constipation

Surgical treatment of patients with chronic slow-transit constipation leads to unsatisfactory results in almost a third of cases. It appears relevant to the search for the causes of unsatisfactory results of surgical interventions in such patients and the need to develop a rational diagnostic algorithm; its implementation will allow us to determine the indications for surgical treatment and justify the volume of colon resection. For this purpose, the results of the examination and treatment of 53 patients with constipation were analyzed. The median disease duration was 15 years, and the median duration of constipation was 6.2 1.6 days. Patients were divided into a group with a positive effect of conservative treatment and a group without the expected effect. The symptoms, results of laboratory tests of blood and feces, and instrumental studies of the colon were analyzed. A balloon expulsion test was used to exclude proctogenic constipation. The evacuation function of the colon was studied by X-ray examination, while the transit time of barium sulfate or X-ray contrast markers through the gastrointestinal tract was estimated. Twenty-four patients underwent surgery for chronic slow-transit constipation, while the sigmoid colon was removed in one patient, including 7-left-sided hemicolectomy and 16-subtotal resection of the colon. Long-term results were examined in the period from 3 to 6 months after surgery. In the total examination of the semiotics of chronic slow-transit constipation, the results did not show significant differences between the groups of patients and did not allow us to justify the stratification into severe and non-severe disease course by its specific symptoms. The use of X-ray contrast markers for the assessment of the state of the evacuation function of the colon makes it possible to quantify the severity of various motor disorders and justify the choice of the volume of its resection. The analysis of the long-term results of the treatment of patients with chronic slow-transit constipation allows us to conclude that segmental resections of the colon (left-sided hemicolectomy, resection of the sigmoid colon) have a good therapeutic effect if the preoperative examination revealed a segmental type of failure of the evacuation function of the colon, and subtotal resection of the colon is appropriate for the common type. The absence of negative results of surgical treatment of patients with chronic slow-transit constipation, in which the formation of a colonic anastomosis was performed with a short stump of the sigmoid colon, indicates the possibility of using this option to complete the surgical intervention.

Electric Source Imaging on Intracranial EEG Localizes Spatiotemporal Propagation of Interictal Spikes in Children with Epilepsy.

Interictal epileptiform discharges (IEDs) serve as sensitive but not specific biomarkers of epilepsy that can delineate the epileptogenic zone (EZ) in patients with drug resistant epilepsy (DRE) undergoing surgery. Intracranial EEG (icEEG) studies have shown that IEDs propagate in time across large areas of the brain. The onset of this propagation is regarded as a more specific biomarker of epilepsy than areas of spread. Yet, the limited spatial resolution of icEEG does not allow to identify the onset of this activity with high precision. Here, we propose a new method of mapping the spatiotemporal propagation of IEDs (and identify its onset) by using Electrical Source Imaging (ESI) on icEEG bypassing the spatial limitations of icEEG. We validated our method on icEEG recordings from 8 children with DRE who underwent surgery with good outcome (Engel score =1). On each icEEG channel, we detected IEDs and identified the propagation onset using an automated algorithm. We localized the propagation of IEDs with dynamic Statistical Parametric Mapping (dSPM) using a time-sliding window approach. We defined two brain regions: the ESI-onset and ESI-spread zone. We estimated the overlap of these regions with resection volume (in percentage), which served as the gold-standard of the EZ. We also estimated the mean distance of these regions from resection and clinically defined seizure onset zone (SOZ). We observed spatio-temporal propagation of IEDs in all patients across several channels (98 [85-102]) with a mean duration of 155 ms [96-186 ms]. A higher overlap with resection was seen for the ESI-onset zone compared to spread (73.3 % [ 47.4-100 %], 36.5 % [20.3-59.9 %], p = 0.008). The distance of the ESI-onset from resection was shorter compared to the ESI-spread zone (4.3 mm [3.4-5.5 mm], 7.4 mm [6.0-20.6 mm], p = 0.008) and the same trend was observed for the distance from the SOZ (11.9 mm [7.2-15.1 mm], 20.6 mm [15.4-27.2 mm], p = 0.02). These findings show that our method can map the spatiotemporal propagation of IEDs and de-lineate its onset, which is a reliable and focal biomarker of the EZ in children with DRE.Clinical Relevance - ESI on icEEG recordings of children with DRE can localize the spikes propagation phenomenon and help in the delineation of the EZ.

Arthroscopic Saucerization With Inside-Out Repair and Anterocentral Shift of a Discoid Lateral Meniscus With Retention of Adequate Volume of Residual Meniscus

AbstractPreservation of the meniscus has been shown to influence the progression of osteoarthritic changes in the knee. Discoid lateral meniscus (DLM) is classified on the basis of the presence and location of instability resulting from deficient capsular attachments. Recently, meniscal stabilization after saucerization was recommended in cases of DLM to preserve the meniscus shape and avoid the progression of osteoarthritis. However, it is difficult to identify the accurate resection volume and residual meniscal width during surgery, especially when there is an anterocentral shift of the DLM. This Technical Note describes an arthroscopic technique for an anterocentral shift of the DLM in which we highlight the resection point and confirm the methods of retaining an adequate volume of residual meniscus to restore and maintain the shape and function of the meniscus. Level of EvidenceLevel 1, Knee; Level 2, Meniscus.

Laparoscopic resections in the treatment of children with liver tumors: the first experience

Relevance: Surgery is one of the main methods of treating patients with liver neoplasms. At that, minimally invasive surgical techniques facilitate the course of the postoperative period and rehabilitation.&#x0D; The purpose of the study was the selection of optimal surgical treatment for children with liver tumors.&#x0D; Results: In 2014-2020, five patients aged 3-9 years with liver tumors underwent laparoscopic resection at the Morozovskaya Children’s City Clinical Hospital (Moscow, Russia). Out of 3 patients with hepatoblastomas, two patients had stage PRETEXT I, one – stage II. All patients underwent radical surgical treatment (R0); in one child(4%), the resection volume was R1. The duration of operations did not exceed 60 minutes; intraoperative blood loss was within 10 ml/kg; no intraoperative complications were registered.&#x0D; Conclusion: Laparoscopic techniques reduce surgery time and blood loss, prevent intraoperative and postoperative complications, shorten the hospital stay, decrease enteral and drug burden, and the need for chemotherapy. They also facilitate radical surgery and early patient mobilization.

Computed tomography pneumogastrography in determining clinical t-stage and yt-stage of gastric cancer

Оbjective. To assess the sensitivity of CT pneumogastrography in determining the T-stage and yT-stage. Materials and methods. This is a prospective, single-center study that included 267 patients with a histologically diagnosed stomach cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. 162 (60.7%) patients underwent preoperative chemotherapy. All patients underwent surgery: 22 in the volume of proximal subtotal gastrectomy, 95 in the volume of distal subtotal resection, 123 in the volume of gastrectomy, and 27 in the volume of endoscopic dissection. All patients underwent staging computed tomography at the preoperative stage according to a single protocol - CT pneumogastrography on a 64-slice X-ray computed tomography. The sensitivity of the method in assessing the depth of invasion was calculated separately for patients without preoperative chemotherapy (T-stage) and for patients who underwent preoperative chemotherapy (уT-stage) by comparison with pathological data. Results. The sensitivity indicators of CT pneumogastrography for patients without preoperative chemotherapy were: for T1a – 80.6%, T1b – 72.7%, T2 – 80.0%, T3 – 88.0%, T4a – 83.3%, T4b –100%. The sensitivity indicators of CT pneumogastrography for patients receiving preoperative chemotherapy were: for уT2 – 65.2%, уT3 – 83.5%, уT4a – 83.9%, уT4b – 75.0%. It is difficult to restore locally advanced gastric cancer with a depth of invasion cT2 – cT4b in the category yT0, yT1a, and yT1b after preoperative chemotherapy due to the persisting pathological tissue with impaired differentiation of all layers of the stomach wall, which is pathomorphologically a large fibrous tissue. Сonclusion. CT-pneumogastrography demonstrates high diagnostic indicators in determining the T-stage and yT-stage of gastric cancer.

Retrospective, Multicenter Analysis Comparing Conventional with Oncoplastic Breast Conserving Surgery: Oncological and Surgical Outcomes in Women with High-Risk Breast Cancer from the OPBC-01/iTOP2 Study

IntroductionRecent data suggest that margins ≥2 mm after breast-conserving surgery may improve local control in invasive breast cancer (BC). By allowing large resection volumes, oncoplastic breast-conserving surgery (OBCII; Clough level II/Tübingen 5-6) may achieve better local control than conventional breast conserving surgery (BCS; Tübingen 1-2) or oncoplastic breast conservation with low resection volumes (OBCI; Clough level I/Tübingen 3-4).MethodsData from consecutive high-risk BC patients treated in 15 centers from the Oncoplastic Breast Consortium (OPBC) network, between January 2010 and December 2013, were retrospectively reviewed.ResultsA total of 3,177 women were included, 30% of whom were treated with OBC (OBCI n = 663; OBCII n = 297). The BCS/OBCI group had significantly smaller tumors and smaller resection margins compared with OBCII (pT1: 50% vs. 37%, p = 0.002; proportion with margin <1 mm: 17% vs. 6%, p < 0.001). There were significantly more re-excisions due to R1 (“ink on tumor”) in the BCS/OBCI compared with the OBCII group (11% vs. 7%, p = 0.049). Univariate and multivariable regression analysis adjusted for tumor biology, tumor size, radiotherapy, and systemic treatment demonstrated no differences in local, regional, or distant recurrence-free or overall survival between the two groups.ConclusionsLarge resection volumes in oncoplastic surgery increases the distance from cancer cells to the margin of the specimen and reduces reexcision rates significantly. With OBCII larger tumors are resected with similar local, regional and distant recurrence-free as well as overall survival rates as BCS/OBCI.

A Comparative Study between Round Block Technique and Standard Wide Local Excision in Breast Cancer Patients

Abstract Background The goal of optimizing the cosmetic and oncologic outcomes of BCS has been addressed in recent years by the emergence of the field of oncoplastic surgery, that originally defined as an assortment of volume replacement techniques performed by plastic surgeons to replace all or part of the resected breast volume with myocutaneous tissue flaps. The definition of oncoplastic surgery has more recently been expanded to include a wide range of volume displacement or volume redistribution procedures performed by breast surgeons and general surgeons to optimize breast shape and breast volume following breast cancer surgery. Aim of the Work To assess the round block technique as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Patients and Methods This is a prospective randomized study to assess the round block technique as an oncological procedure for management of early breast cancer near to nipple-areola complex as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Twenty breast cancer patients are subdivided into group (A) 10 females which underwent round block technique and group (B) 10 femaleswhich underwent standard wide local excision. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be non-significant between 2 groups so the only difference is the surgical technique. Results The round block technique and SWLE have the same results regarding operative time, intra-operative blood loss and post operative complications with the advantage to RBT because of its better cosmetic outcomes and lower re-excision rates. So, the round block technique is superior to SWLE in selected cases. Conclusion The round block technique has comparable operative parameters to SWLE with no evidence of increased surgical complications. With a lower re-excision rates and better cosmoses were observed in the round block patients as it is scarless operation without nipple and areola shift suggesting that the round block technique is superior to SWLE in selected cases.

Laparoscopic resections in the treatment&#x0D; of children with liver tumors: the first&#x0D; experience

Relevance: Surgery is one of the main methods of&#x0D; treating patients with liver neoplasms. At that, minimally invasive surgical techniques facilitate the course of the&#x0D; postoperative period and rehabilitation.&#x0D; The purpose of the study was the selection of optimal surgical treatment for children with liver tumors.&#x0D; Results: In 2014-2020, five patients aged 3-9 years&#x0D; with liver tumors underwent laparoscopic resection at&#x0D; the Morozovskaya Children’s City Clinical Hospital (Moscow, Russia). Out of 3 patients with hepatoblastomas,&#x0D; two patients had stage PRETEXT I, one – stage II. All patients underwent radical surgical treatment (R0); in one&#x0D; child (4%), the resection volume was R1. The duration&#x0D; of operations did not exceed 60 minutes; intraoperative&#x0D; blood loss was within 10 ml/kg; no intraoperative complications were registered.&#x0D; Conclusion: Laparoscopic techniques reduce surgery time and blood loss, prevent intraoperative and&#x0D; postoperative complications, shorten the hospital stay,&#x0D; decrease enteral and drug burden, and the need for chemotherapy. They also facilitate radical surgery and early&#x0D; patient mobilization.

Application of the Preoperative Assistant System Based on Machine Learning in Hepatocellular Carcinoma Resection.

To conduct better research in hepatocellular carcinoma resection, this paper used 3D machine learning and logistic regression algorithm to study the preoperative assistance of patients undergoing hepatectomy. In this study, the logistic regression model was analyzed to find the influencing factors for the survival and recurrence of patients. The clinical data of 50 HCC patients who underwent extensive hepatectomy (≥4 segments of the liver) admitted to our hospital from June 2020 to December 2020 were selected to calculate the liver volume, simulated surgical resection volume, residual liver volume, surgical margin, etc. The results showed that the simulated liver volume of 50 patients was 845.2 + 285.5 mL, and the actual liver volume of 50 patients was 826.3 ± 268.1 mL, and there was no significant difference between the two groups (t = 0.425; P > 0.05). Compared with the logistic regression model, the machine learning method has a better prediction effect, but the logistic regression model has better interpretability. The analysis of the relationship between the liver tumour and hepatic vessels in practical problems has specific clinical application value for accurately evaluating the volume of liver resection and surgical margin.

Mapping Epileptic Networks Using Simultaneous Intracranial EEG-fMRI.

Background: Potentially curative epilepsy surgery can be offered if a single, discrete epileptogenic zone (EZ) can be identified. For individuals in whom there is no clear concordance between clinical localization, scalp EEG, and imaging data, intracranial EEG (icEEG) may be needed to confirm a predefined hypothesis regarding irritative zone (IZ), seizure onset zone (SOZ), and EZ prior to surgery. However, icEEG has limited spatial sampling and may fail to reveal the full extent of epileptogenic network if predefined hypothesis is not correct. Simultaneous icEEG-fMRI has been safely acquired in humans and allows exploration of neuronal activity at the whole-brain level related to interictal epileptiform discharges (IED) captured intracranially.Methods: We report icEEG-fMRI in eight patients with refractory focal epilepsy who had resective surgery and good postsurgical outcome. Surgical resection volume in seizure-free patients post-surgically reflects confirmed identification of the EZ. IEDs on icEEG were classified according to their topographic distribution and localization (Focal, Regional, Widespread, and Non-contiguous). We also divided IEDs by their location within the surgical resection volume [primary IZ (IZ1) IED] or outside [secondary IZ (IZ2) IED]. The distribution of fMRI blood oxygen level-dependent (BOLD) changes associated with individual IED classes were assessed over the whole brain using a general linear model. The concordance of resulting BOLD map was evaluated by comparing localization of BOLD clusters with surgical resection volume. Additionally, we compared the concordance of BOLD maps and presence of BOLD clusters in remote brain areas: precuneus, cuneus, cingulate, medial frontal, and thalamus for different IED classes.Results: A total of 38 different topographic IED classes were identified across the 8 patients: Focal (22) and non-focal (16, Regional = 9, Widespread = 2, Non-contiguous = 5). Twenty-nine IEDs originated from IZ1 and 9 from IZ2. All IED classes were associated with BOLD changes. BOLD maps were concordant with the surgical resection volume for 27/38 (71%) IED classes, showing statistical global maximum BOLD cluster or another cluster in the surgical resection volume. The concordance of BOLD maps with surgical resection volume was greater (p < 0.05) for non-focal (87.5%, 14/16) as compared to Focal (59%, 13/22) IED classes. Additionally, BOLD clusters in remote cortical and deep brain areas were present in 84% (32/38) of BOLD maps, more commonly (15/16; 93%) for non-focal IED-related BOLD maps.Conclusions: Simultaneous icEEG-fMRI can reveal BOLD changes at the whole-brain level for a wide range of IEDs on icEEG. BOLD clusters within surgical resection volume and remote brain areas were more commonly seen for non-focal IED classes, suggesting that a wider hemodynamic network is at play.

Awake focussed craniotomy for oedematous/large brain lesions

Aim: Awake craniotomy has been proven to be safe and effective. It has generally been used for non-edematous conditions. If done in edematous states, large craniotomies are advised. Here, we report the combined use of techniques of awake anaesthesia and focussed craniotomy for dealing with large/edematous brain lesions. Materials and Methods: This was a prospective single-centre study from May to October 2019. Included were adult cooperative patients presenting with edematous brain lesions. A completely awake cycle was used using ring scalp block, Dexmedetomidine loading, and maintenance infusion, and use of Midazolam and Fentanyl. The dural flap was lifted limited to the lesion, and sometimes in stages to tackle the bulging brain. Data was collected for resection volume, pain scores using visual analogue scale (VAS) during the surgery, seizures, complications, new deficits, blood loss, duration of surgery, ICU, and postoperative hospital stay. Results: Fifteen patients underwent the procedure. Pathologies were high-grade gliomas (7), low-grade gliomas (3), tuberculoma (2), metastasis (1), ependymoma (1), and meningioma (1). Fourteen patients underwent total, and one underwent subtotal excision. Brain bulge could be handled with the staged opening of the dura and intratumoral decompression. No patient required postoperative ventilatory support. Intraoperative pain scores ranged from 2-3. The duration of surgery ranged from 60-280min. Blood loss ranged from 75-300ml. Postoperative stay varied from 3-20 days. There were two intraoperative seizures (managed), two CSF leaks, and two infections. Two patients developed transitory motor deficits. Conclusion: Awake focussed craniotomy was found safe and effective for large/edematous brain lesions in appropriately selected patients.

The benefit of early surgery on overall survival in incidental low-grade glioma patients: A multicenter study.

The role of surgery for incidentally discovered diffuse incidental low-grade gliomas (iLGGs) is debatable and poorly documented in current literature. The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population. Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR). The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2%, respectively. OS was significantly longer for patients with a lower preoperative tumor volume (P = .001) and higher extent of resection (EOR) (P = .037), regardless the WHO-defined molecular class (P = .2). In the final model, OS was influenced only by the preoperative tumor volume (P = .006), while TR by early surgery (P = .028). A negative association was found between preoperative tumor volumes and EOR (rs = -0.44, P < .001). The median preoperative tumor volume was 15 cm3. The median EOR was 95%. Total or supratotal resection of T2-FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high-grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases. This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favor of early surgery for these lesions.