BMC Surgery最新文献

Objective: Although numerous studies have assessed the prognostic value of negative lymph nodes (NLN) counts in breast cancer (BC), their findings on survival outcomes have been inconsistent. This study aimed to determine the impact of the number of NLNs removed on overall survival (OS) and recurrence-free survival (RFS) in patients with BC undergoing surgical treatment.

Methods: In this multicenter cohort study, we reviewed medical records of 1,384 patients with histologically confirmed BC who underwent a mastectomy from 2011 to 2022, retrospectively. Patients were stratified into three groups according to the number of NLNs removed: (1) < 10, (2) 10-20, and (3) > 20. The primary endpoints were 5-year OS and RFS. Survival was assessed by Kaplan-Meier analysis using log-rank tests to compare survival curves, and Cox proportional hazards models were used to identify prognostic factors.

Results: At a mean follow-up of 54.6 months, the 5-year OS and RFS were estimated to be 65.5% and 54.2% respectively. Kaplan-Meier curves showed significantly improved survival in patients with ≥ 10 NLNs removed. Multivariate Cox regression demonstrated that the OS rate in patients with the number of NLNs removed > 20 was significantly better than in patients with the number of NLNs removed < 10 (HR: 0.69, 95% CI: 0.56, 0.86, P: 0.001). Also, the OS rate in patients with the number of NLNs removed between 10 and 20 was significantly better than in patients with the number of NLNs removed < 10 (HR: 0.85, 95% CI: 0.75, 0.96, P: 0.001). Additionally, age < 45, higher BMI, comorbidities, advanced tumor/nodal stage, high histologic grade, HER2 status, higher Ki-67, and higher lymph node ratio were independently associated with poorer OS and RFS.

Conclusion: The removal of a greater number of tumor-free lymph nodes was independently associated with improved 5-year OS and RFS in BC patients following surgery.

Background: Femoral artery pseudoaneurysms are a serious and increasingly common complication among intravenous drug users (IVDUs), often requiring urgent surgical intervention due to infection and hemorrhage. Despite numerous treatment approaches, the optimal surgical strategy remains uncertain, particularly regarding the balance between infection control and limb preservation.

Objectives: This study aimed to evaluate and compare the outcomes of ligation versus vessel repair in the surgical management of infected femoral pseudoaneurysms among IVDUs over a 20-year period at a single tertiary care center.

Methods: We conducted a retrospective review of 88 male patients with femoral pseudoaneurysms secondary to intravenous drug use, treated between 2000 and 2020. Patients underwent either ligation alone (Group A) or primary arterial reconstruction (Group B). Outcomes measured included postoperative complications, limb ischemia, need for secondary bypass, amputation, and mortality. Log-rank analysis and intergroup comparisons were performed.

Results: Ligation was performed in 70 patients (79%), and vessel repair in 18 patients (21%). Group A had a complication rate of 28%, with claudication (17%) and infection (7%) being most common; 11 patients required delayed bypass, and 2 underwent amputation. Group B experienced higher early infection rates (33%) and a comparable claudication rate (17%); 6 patients required secondary bypass, and 2 required amputation. No mortality occurred in Group B, while 2 deaths were recorded in Group A. Log-rank analysis indicated higher reintervention and infection rates in the revascularization group, without a statistically significant difference in limb salvage or survival.

Conclusion: Ligation remains a safe and effective first-line approach for managing infected femoral pseudoaneurysms in IVDUs, with low amputation and mortality rates. Vessel repair may be considered in selected cases but is associated with higher early complication rates. Delayed revascularization following initial infection control appears to be a prudent strategy for optimizing outcomes.