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Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England. 治疗性乳房成形术的当前实践:英国肿瘤乳房外科医生的调查。
IF 1.5 Q2 Medicine Pub Date : 2016-01-01 Epub Date: 2016-03-23 DOI: 10.1155/2016/1947876
Shweta Aggarwal, Sekhar Marla, Donald Nyanhongo, Sita Kotecha, Narendra Nath Basu

Introduction: Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown.

Methods: Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding.

Results: We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease.

Discussion: There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.

简介:治疗性乳房成形术(TM)是乳腺肿瘤外科医生(OBS)的一项有用的技术。在患者选择、技术、编码和受病灶边缘管理方面的指导有限。OBS在英国的做法尚不为人所知。方法:对参与培训界面组的所有在线商学院进行问卷调查。我们评估了每位外科医生的TM病例数量、患者选择标准、椎弓根偏好、对侧对称性、常规术前MRI的使用、受病灶边缘的处理和临床编码。结果:总有效率为43%。最常用的皮肤切除技术是智慧模式,其次是垂直疤痕。大多数外科医生(62%)选择上内侧椎弓根,其次是下椎弓根(34%)。20%的外科医生总是在乳房边缘受累后进行乳房切除术,而大多数医生会根据几个参数进行再切除。TM的主要绝对禁忌症是肿瘤与乳房的比例大于50%。五分之一的外科医生不愿为吸烟者和多灶性疾病患者实施TM手术。讨论:OBS之间的TM实践有很大的差异。进一步的研究和指导将有助于使实践标准化,特别是对所涉差额的管理和最佳补偿的编码。
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引用次数: 6
Liposarcoma of the Spermatic Cord: Impact of Final Surgical Intervention--An Institutional Experience. 精索脂肪肉瘤:最终手术干预的影响——一个机构经验。
IF 1.5 Q2 Medicine Pub Date : 2016-01-01 Epub Date: 2016-04-14 DOI: 10.1155/2016/4785394
R Bachmann, J Rolinger, P Girotti, H G Kopp, K Heissner, B Amend, A Königsrainer, R Ladurner

Background: Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation.

Methods: 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined.

Results: In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18-180) months) was 64%.

Conclusion: An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins.

背景:睾丸旁脂肪肉瘤几乎总是被误诊为腹股沟疝,随后又因手术不当。方法:对连续收治的14例睾丸旁脂肪肉瘤进行回顾性分析。评估术前管理。测定无病生存期和总生存期。结果:原发精索脂肪肉瘤11例,复发精索脂肪肉瘤3例。在初次手术干预中,14例患者中有7例(50%)为根治性(R0), 6例(43%)为边缘性(R1), 1例(7%)为不完全伴肉眼肿瘤残留(R2)。4例患者进行了初步治疗和二次手术干预:3例(75%)患者进行了根治性(R0)切除,1例(25%)患者进行了边缘性(R1)切除。对于复发性疾病的二次治疗,3例(100%)患者切除边缘(R1)。10例原发疾病患者(71%)的最终组织学边缘呈阴性,4例随后复发疾病患者的最终组织学边缘呈阳性。根治性切除后3年无病生存率为100%。4.5年(54(18-180)个月)总生存率为64%。结论:不完整的第一步手术增加了阳性切缘的数量,导致局部复发和不良预后。积极的手术应该尝试获得三维负切缘。
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引用次数: 15
Mucus containing cystic lesions "mucocele" of the appendix: the unresolved issues. 阑尾粘液囊肿:未解决的问题。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-03-23 DOI: 10.1155/2015/139461
Mohammad Ezzedien Rabie, Mubarak Al Shraim, Mohammad Saad Al Skaini, Saad Alqahtani, Ismail El Hakeem, Abdulla Saad Al Qahtani, Tarek Malatani, Abduelah Hummadi

Background: Mucocele of the appendix is a rare condition, the pathological classification and management strategy of which have not been standardized yet.

Aim: To report on our management of appendiceal mucocele, highlighting the pitfalls and possible means for avoiding them.

Materials and methods: Our registries were reviewed to retrieve cases of appendiceal mucocele, encountered in the period from July 2008 to May 2013.

Results: We had 9 cases, three males and sex females, with a median age of 62 years. Abdominal ultrasound (US) and computerized axial tomography scan (CT) suspected the diagnosis in only one case each. Open appendectomy was done in two cases of mucinous cystadenoma with no further surgery performed, despite the positive margin in one. Laparoscopic appendectomy was done in three cases: mucinous cystadenoma in one case which needed no further surgery, mucinous cystadenocarcinoma with pseudomyxoma peritonei in another, and low grade mucinous tumour in a third case, and all needed subsequent right hemicolectomy. Exploratory laparotomy was done in three cases: of these, synchronous right hemicolectomy was done in one case of mucinous cystadenoma/?mucinous tumour of uncertain malignant potential; in the other two cases, appendectomy only was done for mucinous hyperplasia with carcinoid tumour of the appendix in one case and mucinous cystadenoma/?mucinous tumour of uncertain malignant potential in another. The 9th case was discovered upon laparoscopy for cholecystectomy; when pseudomyxoma peritonei arising from an appendiceal mucocele was found, laparoscopic appendectomy with peritoneal biopsy was then performed instead. Histopathologic diagnostic uncertainty was present in two cases of mucinous cystadenoma where mucinous tumour of uncertain malignant potential was an alternative possibility. Perioperative colonoscopy was performed in only one case and our follow-up programme was defective, with the longest period being 180 days.

Conclusion: Mucocele of the appendix should be considered in the differential diagnosis of cystic lesions in the right lower abdomen. Owing to its rarity, it continues to intrigue the surgeon as well as the radiologist and pathologist alike. For mucinous cystadenocarcinoma, right hemicolectomy is usually needed, whereas for hyperplasia and cystadenoma, appendectomy usually suffices if the resection margins are free. For mucinous tumours of uncertain malignant potential and low grade mucinous tumours as well as pseudomyxoma peritonei, the decision is not as simple. As for laparoscopic surgery, no solid proof exists with or against its safety. Although not yet standardized, perioperative colonoscopy and regular follow-up to detect early recurrences should probably be part of the management plan.

背景:阑尾粘液囊肿是一种罕见的疾病,其病理分类和治疗策略尚未规范。目的:报告我们对阑尾黏液囊肿的处理,强调其陷阱和可能的避免方法。材料与方法:回顾我院2008年7月至2013年5月收治的阑尾黏液囊肿病例。结果:9例,男3例,女1例,中位年龄62岁。腹部超声(US)和计算机轴位断层扫描(CT)各有1例怀疑诊断。2例粘液囊腺瘤行开放性阑尾切除术,其中1例边缘呈阳性,但未行进一步手术。腹腔镜阑尾切除术3例,1例为粘液囊腺瘤,无需进一步手术,1例为粘液囊腺癌合并腹膜假性粘液瘤,3例为低级别粘液瘤,均需行右半结肠切除术。探查性剖腹探查3例,其中1例粘液囊腺瘤/?恶性潜能不确定的粘液瘤;在另外2例中,仅因粘液性增生伴阑尾类癌1例和粘液性囊腺瘤/?有不确定恶性潜能的粘液瘤。第9例为腹腔镜胆囊切除术时发现;当发现由阑尾黏液囊肿引起的腹膜假性粘液瘤时,则行腹腔镜阑尾切除术并腹膜活检。两例粘液囊腺瘤的组织病理学诊断不确定,其中粘液瘤的恶性潜能不确定是另一种可能性。围手术期结肠镜检查仅1例,随访计划有缺陷,最长随访时间为180天。结论:右下腹部囊性病变的鉴别诊断应考虑阑尾粘液囊肿。由于它的罕见性,它继续引起外科医生、放射科医生和病理学家的兴趣。对于粘液囊腺癌,通常需要右半结肠切除术,而对于增生和囊腺瘤,如果切除边缘自由,阑尾切除术通常就足够了。对于恶性潜能不确定的黏液性肿瘤和低级别黏液性肿瘤以及腹膜假性黏液瘤,判断就不那么简单了。至于腹腔镜手术,没有可靠的证据支持或反对其安全性。虽然尚未标准化,围手术期结肠镜检查和定期随访,以发现早期复发可能应该是管理计划的一部分。
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引用次数: 28
Clinical characteristics and prognosis of incidentally detected lung cancers. 偶然发现肺癌的临床特点及预后。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-02-03 DOI: 10.1155/2015/287604
S Quadrelli, G Lyons, H Colt, D Chimondeguy, A Buero

Objective: To evaluate clinical characteristics and outcomes in incidentally detected lung cancer and in symptomatic lung cancer.

Material and methods: We designed a retrospective study including all patients undergoing pulmonary resection with a curative intention for NSCLC. They were classified into two groups according to the presence or absence of cancer-related symptoms at diagnosis in asymptomatic (ASX)—incidental diagnosis—or symptomatic.

Results: Of the 593 patients, 320 (53.9%) were ASX. In 71.8% of these, diagnosis was made by chest X-ray. Patients in the ASX group were older (P = 0.007), had a higher prevalence of previous malignancy (P = 0.002), presented as a solitary nodule more frequently (P < 0.001), and were more likely to have earlier-stage disease and smaller cancers (P = 0.0001). A higher prevalence of incidental detection was observed in the last ten years (P = 0.008). Overall 5-year survival was higher for ASX (P = 0.001). Median survival times in pathological stages IIIB-IV were not significantly different.

Conclusion: Incidental finding of NSCLC is not uncommon even among nonsmokers. It occurred frequently in smokers and in those with history of previous malignancy. Mortality of incidental diagnosis group was lower, but the better survival was related to the greater number of patients with earlier-stage disease.

目的:评价偶然发现的肺癌和有症状的肺癌的临床特点和预后。材料和方法:我们设计了一项回顾性研究,包括所有接受肺切除术的非小细胞肺癌患者。根据无症状诊断(ASX) -偶然诊断-或有症状诊断时是否存在癌症相关症状,将患者分为两组。结果:593例患者中,ASX 320例(53.9%)。其中71.8%是通过胸片诊断的。ASX组患者年龄较大(P = 0.007),既往恶性肿瘤患病率较高(P = 0.002),更频繁地表现为孤立结节(P < 0.001),更可能患有早期疾病和较小的癌症(P = 0.0001)。近10年意外检出率较高(P = 0.008)。ASX患者总体5年生存率较高(P = 0.001)。病理分期iib - iv期的中位生存时间差异无统计学意义。结论:意外发现的非小细胞肺癌即使在不吸烟者中也不罕见。常见于吸烟者和既往有恶性肿瘤病史者。意外诊断组死亡率较低,但较好的生存率与早期发病人数较多有关。
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引用次数: 0
A Single Centre Analysis of Clinical Characteristics and Treatment of Endocrine Pancreatic Tumours. 胰腺内分泌肿瘤临床特点及治疗的单中心分析。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-06-08 DOI: 10.1155/2015/538948
M T Adil, R Nagaraja, V Varma, N Mehta, V Kumaran, S Nundy

Background. Endocrine Pancreatic Tumours (PENs) are rare and can be nonfunctioning or functioning. They carry a good prognosis overall though high grade lesions show a relatively shorter survival. The aim of the current study is to describe a single centre analysis of the clinical characteristics and surgical treatment of PENs. Patients and Methods. This is a cohort analysis of 40 patients of PENs who underwent surgery at Sir Ganga Ram Hospital, New Delhi, India, from 1995 to 2013. Patient particulars, clinical features, surgical interventions, postoperative outcome, and followup were done and reviewed. The study group was divided based on grade (G1, G2, and G3) and functionality (nonfunctioning versus functioning) for comparison. Results. PENs comprised 6.3% of all pancreatic neoplasms (40 of 634). Twenty-eight patients (70%) had nonfunctioning tumours. Eighteen PENs (45%) were carcinomas (G3), all of which were nonfunctioning. 14 (78%) of these were located in the pancreatic head and uncinate process (P = 0.09). The high grade (G3) lesions were significantly larger in size than the lower grade (G1 + G2) tumours (7.0 ± 3.5 cms versus 3.1 ± 1.6 cms, P = 0.007). Pancreatoduodenectomy was performed in 18 (45%), distal pancreatectomy in 10 (25%), and local resection in 8 (20%) and nonresective procedures were performed in 4 patients (10%). Fourteen patients (35%) had postoperative complications. All G3 grade tumours which were resected had positive lymph nodes (100%) and 10 had angioinvasion (71%). Eight neoplasms (20%) were cystic, all being grade G3 carcinomas, while the rest were solid. The overall disease related mortality attributable to PEN was 14.3% (4 of 28) and for malignant PENs was 33.3% (4 of 12) after a mean follow-up period of 49.6 months (range: 2-137 months). Conclusion. Majority of PENs are nonfunctioning. They are more likely malignant if they are nonfunctioning and large in size, show cystic appearance, and are situated in the pancreatic head. Early surgery leads to good long term survival with acceptable postoperative morbidity.

背景。胰腺内分泌肿瘤(钢笔)是罕见的,可以是无功能或功能。它们总体预后良好,尽管高级别病变的生存期相对较短。本研究的目的是对pen的临床特征和手术治疗进行单中心分析。患者和方法。这是一项对1995年至2013年在印度新德里Sir Ganga Ram医院接受手术的40例pen患者的队列分析。对患者资料、临床特征、手术干预、术后结果和随访进行了回顾。研究组根据分级(G1、G2和G3)和功能(无功能与功能)进行分组进行比较。结果。PENs占所有胰腺肿瘤的6.3%(634例中有40例)。28例患者(70%)存在无功能肿瘤。18例(45%)为癌(G3),均无功能。其中14例(78%)位于胰头和钩突(P = 0.09)。高分级(G3)肿瘤的大小明显大于低分级(G1 + G2)肿瘤(7.0±3.5 cms vs 3.1±1.6 cms, P = 0.007)。18例(45%)行胰十二指肠切除术,10例(25%)行远端胰切除术,8例(20%)行局部切除术,4例(10%)行非切除术。术后并发症14例(35%)。所有切除的G3级肿瘤均有淋巴结阳性(100%),10例有血管浸润(71%)。8例(20%)为囊性,均为G3级癌,其余为实性癌。平均随访时间为49.6个月(范围:2-137个月),由PEN引起的总体疾病相关死亡率为14.3%(28 / 4),恶性PEN的死亡率为33.3%(12 / 4)。结论。大多数钢笔都不能正常工作。如果它们没有功能,体积大,呈囊状,位于胰腺头部,则更有可能是恶性的。早期手术可导致良好的长期生存和可接受的术后发病率。
{"title":"A Single Centre Analysis of Clinical Characteristics and Treatment of Endocrine Pancreatic Tumours.","authors":"M T Adil,&nbsp;R Nagaraja,&nbsp;V Varma,&nbsp;N Mehta,&nbsp;V Kumaran,&nbsp;S Nundy","doi":"10.1155/2015/538948","DOIUrl":"https://doi.org/10.1155/2015/538948","url":null,"abstract":"<p><p>Background. Endocrine Pancreatic Tumours (PENs) are rare and can be nonfunctioning or functioning. They carry a good prognosis overall though high grade lesions show a relatively shorter survival. The aim of the current study is to describe a single centre analysis of the clinical characteristics and surgical treatment of PENs. Patients and Methods. This is a cohort analysis of 40 patients of PENs who underwent surgery at Sir Ganga Ram Hospital, New Delhi, India, from 1995 to 2013. Patient particulars, clinical features, surgical interventions, postoperative outcome, and followup were done and reviewed. The study group was divided based on grade (G1, G2, and G3) and functionality (nonfunctioning versus functioning) for comparison. Results. PENs comprised 6.3% of all pancreatic neoplasms (40 of 634). Twenty-eight patients (70%) had nonfunctioning tumours. Eighteen PENs (45%) were carcinomas (G3), all of which were nonfunctioning. 14 (78%) of these were located in the pancreatic head and uncinate process (P = 0.09). The high grade (G3) lesions were significantly larger in size than the lower grade (G1 + G2) tumours (7.0 ± 3.5 cms versus 3.1 ± 1.6 cms, P = 0.007). Pancreatoduodenectomy was performed in 18 (45%), distal pancreatectomy in 10 (25%), and local resection in 8 (20%) and nonresective procedures were performed in 4 patients (10%). Fourteen patients (35%) had postoperative complications. All G3 grade tumours which were resected had positive lymph nodes (100%) and 10 had angioinvasion (71%). Eight neoplasms (20%) were cystic, all being grade G3 carcinomas, while the rest were solid. The overall disease related mortality attributable to PEN was 14.3% (4 of 28) and for malignant PENs was 33.3% (4 of 12) after a mean follow-up period of 49.6 months (range: 2-137 months). Conclusion. Majority of PENs are nonfunctioning. They are more likely malignant if they are nonfunctioning and large in size, show cystic appearance, and are situated in the pancreatic head. Early surgery leads to good long term survival with acceptable postoperative morbidity. </p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2015/538948","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34282467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Minimising unnecessary mastectomies in a predominantly Chinese community. 在以华人为主的社区,尽量减少不必要的乳房切除术。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-01-26 DOI: 10.1155/2015/684021
Mona P Tan, Nadya Y Sitoh, Yih Y Sitoh

Background: Recent data shows that the use of breast conservation treatment (BCT) for breast cancer may result in superior outcomes when compared with mastectomy. However, reported rates of BCT in predominantly Chinese populations are significantly lower than those reported in Western countries. Low BCT rates may now be a concern as they may translate into suboptimal outcomes. A study was undertaken to evaluate BCT rates in a cohort of predominantly Chinese women.

Methods: All patients who underwent surgery on the breast at the authors' healthcare facility between October 2008 and December 2011 were included in the study and outcomes of treatment were evaluated.

Results: A total of 171 patients were analysed. Two-thirds of the patients were of Chinese ethnicity. One hundred and fifty-six (85.9%) underwent BCT. Ninety-eight of 114 Chinese women (86%) underwent BCT. There was no difference in the proportion of women undergoing BCT based on ethnicity. After a median of 49 months of follow-up, three patients (1.8%) had local recurrence and 5 patients (2.9%) suffered distant metastasis. Four patients (2.3%) have died from their disease.

Conclusion: BCT rates exceeding 80% in a predominantly Chinese population are possible with acceptable local and distant control rates, thereby minimising unnecessary mastectomies.

背景:最近的数据显示,与乳房切除术相比,使用乳房保留治疗(BCT)治疗乳腺癌可能会产生更好的结果。然而,在以中国人为主的人群中,报告的BCT发病率明显低于西方国家。低BCT率现在可能是一个问题,因为它们可能转化为次优结果。我们进行了一项研究,以评估以中国女性为主的队列中的BCT率。方法:2008年10月至2011年12月期间在作者医疗机构接受乳房手术的所有患者纳入研究,并对治疗结果进行评估。结果:共分析了171例患者。三分之二的患者是华裔。156例(85.9%)行BCT。114名中国女性中有98名(86%)接受了BCT。妇女接受BCT的比例没有种族差异。中位随访49个月后,3例(1.8%)局部复发,5例(2.9%)远处转移。4名患者(2.3%)死于疾病。结论:在以中国人为主的人群中,BCT率超过80%是可能的,局部和远处控制率可以接受,从而最大限度地减少不必要的乳房切除术。
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引用次数: 2
Influence of Individual Surgeon Volume on Oncological Outcome of Colorectal Cancer Surgery. 个体外科医生数量对结直肠癌手术预后的影响。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-09-03 DOI: 10.1155/2015/464570
Marleen Buurma, Hidde M Kroon, Marlies S Reimers, Peter A Neijenhuis

Background: Surgery performed by a high-volume surgeon improves short-term outcomes. However, not much is known about long-term effects. Therefore we performed the current study to evaluate the impact of high-volume colorectal surgeons on survival.

Methods: We conducted a retrospective analysis of our prospectively collected colorectal cancer database between 2004 and 2011. Patients were divided into two groups: operated on by a high-volume surgeon (>25 cases/year) or by a low-volume surgeon (<25 cases/year). Perioperative data were collected as well as follow-up, recurrence rates, and survival data.

Results: 774 patients underwent resection for colorectal malignancies. Thirteen low-volume surgeons operated on 453 patients and 4 high-volume surgeons operated on 321 patients. Groups showed an equal distribution for preoperative characteristics, except a higher ASA-classification in the low-volume group. A high-volume surgeon proved to be an independent prognostic factor for disease-free survival in the multivariate analysis (P = 0.04). Although overall survival did show a significant difference in the univariate analysis (P < 0.001) it failed to reach statistical significance in the multivariate analysis (P = 0.09).

Conclusions: In our study, a higher number of colorectal cases performed per surgeon were associated with longer disease-free survival. Implementing high-volume surgery results in improved long-term outcome following colorectal cancer.

背景:由大容量外科医生进行的手术可改善短期预后。然而,对长期影响的了解并不多。因此,我们进行了当前的研究,以评估大容量结肠直肠手术对生存率的影响。方法:我们对2004年至2011年间前瞻性收集的结直肠癌数据库进行回顾性分析。患者分为两组:大容量外科医生(>25例/年)和小容量外科医生(结果:774例患者行结直肠恶性肿瘤切除术)。13名小容量外科医生手术453例,4名大容量外科医生手术321例。各组术前特征分布均匀,除低容积组asa分级较高外。在多变量分析中,高容量外科医生被证明是无病生存的独立预后因素(P = 0.04)。虽然在单因素分析中总生存率有显著差异(P < 0.001),但在多因素分析中未达到统计学意义(P = 0.09)。结论:在我们的研究中,每位外科医生手术的结直肠病例数量越多,无病生存期越长。实施大容量手术可改善结直肠癌后的长期预后。
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引用次数: 26
Gastrectomy and D2 Lymphadenectomy for Gastric Cancer: A Meta-Analysis Comparing the Harmonic Scalpel to Conventional Techniques. 胃癌胃切除术和D2淋巴结切除术:谐波手术刀与常规手术刀的meta分析比较。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-05-14 DOI: 10.1155/2015/397260
Hang Cheng, Chia-Wen Hsiao, Jeffrey W Clymer, Michael L Schwiers, Bryanna N Tibensky, Leena Patel, Nicole C Ferko, Edward Chekan

The ultrasonic Harmonic scalpel has demonstrated clinical and surgical benefits in dissection and coagulation. To evaluate its use in gastrectomy, we conducted a systematic review and meta-analysis of randomized controlled trials comparing the Harmonic scalpel to conventional techniques in gastrectomy for patients with gastric cancer. International databases were searched without language restrictions for comparisons in open or laparoscopic gastrectomy and lymphadenectomy. The meta-analysis used a random-effects model for all outcomes; continuous variables were analyzed for mean differences and dichotomous variables were analyzed for risk ratios. Sensitivity analyses were conducted for study quality, type of conventional technique, and imputation of study results. Ten studies (N = 935) met the inclusion criteria. Compared with conventional hemostatic techniques, the Harmonic scalpel demonstrated significant reductions in operating time (-27.5 min; P < 0.001), intraoperative blood loss (-93.2 mL; P < 0.001), and drainage volume (-138.8 mL; P < 0.001). Results were numerically higher for conventional techniques for hospital length of stay, complication risk, and transfusions but did not reach statistical significance. Results remained robust to sensitivity analyses. This meta-analysis demonstrates the clear advantages of using the Harmonic scalpel compared to conventional techniques, with improvements demonstrated across several outcome measures for patients undergoing gastrectomy and lymphadenectomy.

超声调和手术刀在解剖和凝血方面已经证明了临床和外科的好处。为了评估其在胃切除术中的应用,我们对随机对照试验进行了系统回顾和荟萃分析,比较了调和手术刀与常规手术刀在胃癌患者胃切除术中的应用。在没有语言限制的情况下检索国际数据库,比较开放或腹腔镜胃切除术和淋巴结切除术。荟萃分析对所有结果采用随机效应模型;连续变量分析平均差异,二分类变量分析风险比。对研究质量、常规技术类型和研究结果的归因进行敏感性分析。10项研究(N = 935)符合纳入标准。与传统止血技术相比,谐波手术刀显著缩短了手术时间(-27.5 min;P < 0.001),术中出血量(-93.2 mL;P < 0.001),引流量(-138.8 mL;P < 0.001)。在住院时间、并发症风险和输血方面,传统技术的结果在数字上更高,但没有达到统计学意义。结果在敏感性分析中仍然是稳健的。这项荟萃分析表明,与传统技术相比,使用谐波手术刀具有明显的优势,在接受胃切除术和淋巴结切除术的患者的几个结果测量中都有改善。
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引用次数: 27
Evaluating the feasibility of performing window of opportunity trials in breast cancer. 评估在乳腺癌中进行机会之窗试验的可行性。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-01-20 DOI: 10.1155/2015/785793
Angel Arnaout, Susan Robertson, Iryna Kuchuk, Demetrios Simos, Gregory R Pond, Christina L Addison, Mehrzad Namazi, Mark Clemons

Background: The waiting period to surgery represents a valuable "window of opportunity" to evaluate novel therapeutic strategies. Interventional studies performed during this period require significant multidisciplinary collaboration to overcome logistical hurdles. We undertook a one-year prospective window of opportunity study to assess feasibility.

Methods: Eligible newly diagnosed postmenopausal, estrogen receptor positive breast cancer patients awaiting primary surgery received anastrozole daily until surgery. Feasibility was assessed by (a) the proportion of patients who consented and (b) completed the study. Comparison of pre- and poststudy Ki67 labelling index and cleaved caspase 3 scores (CC3) was performed.

Results: 22/131 (16.8%) patients were confirmed eligible and 20/22 (91%) patients completed the study. 19/20 (95%) patients agreed to undergo optional additional tissue biopsies. The mean duration of anastrozole use was 24.7 (15-44) days. There were a statistically significant decline in mean Ki67 indices of 48.8% (p < 0.001) and a trend towards significance in the decline of CC3 (p = 0.17) when comparing pre- with posttreatment values.

Conclusion: window of opportunity trials in breast cancer are a feasible way of assessing the biologic efficacy of different therapies in the presurgical setting. The majority of eligible women were willing to participate including undergoing additional tissue biopsies.

背景:手术前的等待期是评估新治疗策略的宝贵“机会之窗”。在此期间进行的介入性研究需要重要的多学科合作来克服后勤障碍。我们进行了为期一年的前瞻性机会窗研究,以评估可行性。方法:符合条件的新诊断绝经后,雌激素受体阳性的乳腺癌患者等待初次手术,每天服用阿那曲唑直到手术。可行性通过(a)同意和(b)完成研究的患者比例进行评估。比较研究前后Ki67标记指数和cleaved caspase 3评分(CC3)。结果:22/131(16.8%)例患者确认符合条件,20/22(91%)例患者完成研究。19/20(95%)患者同意接受选择性的额外组织活检。阿那曲唑的平均使用时间为24.7(15-44)天。与治疗前后比较,Ki67指数平均下降48.8% (p < 0.001), CC3下降趋势有统计学意义(p = 0.17)。结论:乳腺癌机会之窗试验是评估手术前不同治疗方法生物学疗效的可行方法。大多数符合条件的妇女愿意参与,包括接受额外的组织活检。
{"title":"Evaluating the feasibility of performing window of opportunity trials in breast cancer.","authors":"Angel Arnaout,&nbsp;Susan Robertson,&nbsp;Iryna Kuchuk,&nbsp;Demetrios Simos,&nbsp;Gregory R Pond,&nbsp;Christina L Addison,&nbsp;Mehrzad Namazi,&nbsp;Mark Clemons","doi":"10.1155/2015/785793","DOIUrl":"https://doi.org/10.1155/2015/785793","url":null,"abstract":"<p><strong>Background: </strong>The waiting period to surgery represents a valuable \"window of opportunity\" to evaluate novel therapeutic strategies. Interventional studies performed during this period require significant multidisciplinary collaboration to overcome logistical hurdles. We undertook a one-year prospective window of opportunity study to assess feasibility.</p><p><strong>Methods: </strong>Eligible newly diagnosed postmenopausal, estrogen receptor positive breast cancer patients awaiting primary surgery received anastrozole daily until surgery. Feasibility was assessed by (a) the proportion of patients who consented and (b) completed the study. Comparison of pre- and poststudy Ki67 labelling index and cleaved caspase 3 scores (CC3) was performed.</p><p><strong>Results: </strong>22/131 (16.8%) patients were confirmed eligible and 20/22 (91%) patients completed the study. 19/20 (95%) patients agreed to undergo optional additional tissue biopsies. The mean duration of anastrozole use was 24.7 (15-44) days. There were a statistically significant decline in mean Ki67 indices of 48.8% (p < 0.001) and a trend towards significance in the decline of CC3 (p = 0.17) when comparing pre- with posttreatment values.</p><p><strong>Conclusion: </strong>window of opportunity trials in breast cancer are a feasible way of assessing the biologic efficacy of different therapies in the presurgical setting. The majority of eligible women were willing to participate including undergoing additional tissue biopsies.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2015/785793","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33057227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 17
Contralateral risk-reducing mastectomy: review of risk factors and risk-reducing strategies. 降低风险的对侧乳房切除术:风险因素和降低风险策略回顾。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-01-27 DOI: 10.1155/2015/901046
N N Basu, L Barr, G L Ross, D G Evans

Rates of contralateral risk-reducing mastectomy have increased substantially over the last decade. Surgical oncologists are often in the frontline, dealing with requests for this procedure. This paper reviews the current evidence base regarding contralateral breast cancer, assesses the various risk-reducing strategies, and evaluates the cost-effectiveness of contralateral risk-reducing mastectomy.

在过去十年中,降低风险的对侧乳房切除术的比例大幅增加。肿瘤外科医生往往站在第一线,处理这种手术的请求。本文回顾了目前有关对侧乳腺癌的证据基础,评估了各种降低风险的策略,并对降低对侧风险的乳房切除术的成本效益进行了评估。
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引用次数: 0
期刊
International Journal of Surgical Oncology
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