Surgical Oncology-Oxford最新文献_第2页

Effective factors on postoperative 30–90 and 360-day mortality in non-small cell lung cancer 影响非小细胞肺癌术后 30-90 天和 360 天死亡率的有效因素。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-27 DOI: 10.1016/j.suronc.2024.102149

Yunus Türk , Ahmet Üçvet

Purpose

Postoperative mortality and morbidity are serious problems, and the identification of risky patient groups will reduce mortality and morbidity rates. The aim of our study was to determine the mortality at 30, 90, and 360 days in patients who underwent surgical resection for non-small cell lung cancer (NSCLC).

Methods

In this single-center retrospective study, 935 patients who were operated on for NSCLC were included. Demographic characteristics, laboratory data, tumor characteristics, surgical method used, type of resection, postoperative complications, and the relationship between 30, 90, and 360-day mortality were analyzed.

Results

In-hospital mortality was observed in 21 (2.2 %) of the 935 patients; the 30-90-360-day mortality rate was respectively 3 %, 4.9 %, and 12.1 %. The 30- and 90-day mortality rates were close (3 %, 4.9 % respectively), and the only difference was the additional surgical procedure. The common factors that increased 30-, 90-, and 360-day mortality were advanced disease stage, additional surgical procedure, length of stay longer than 7 days, low % forced vital capacity (FVC), presence of comorbidities, presence of postoperative complications, and pneumonectomy.

Conclusion

In this study, 30-, 90-, and 360-day mortality rates and common and independent risk factors affecting mortality were determined. Although 30-day mortality is the most often utilized time period for assessing postoperative mortality, 90-day mortality can be used to predict postoperative mortality following a major surgical procedure. Preoperative mortality and morbidity are expected to decrease with more detailed preoperative examination of high-risk patients and special follow-up programs in the postoperative period.

目的：术后死亡率和发病率是严重的问题，识别高危患者群体将降低死亡率和发病率。我们的研究旨在确定非小细胞肺癌（NSCLC）手术切除患者在 30 天、90 天和 360 天的死亡率：在这项单中心回顾性研究中，共纳入了 935 名接受手术治疗的非小细胞肺癌患者。分析了人口统计学特征、实验室数据、肿瘤特征、手术方法、切除类型、术后并发症以及 30 天、90 天和 360 天死亡率之间的关系：935名患者中有21人（2.2%）出现院内死亡；30-90-360天死亡率分别为3%、4.9%和12.1%。30天和90天的死亡率接近（分别为3%和4.9%），唯一的区别是多了一个手术过程。增加30天、90天和360天死亡率的常见因素包括：疾病分期较晚、额外的外科手术、住院时间超过7天、用力肺活量（FVC）百分比较低、存在合并症、术后并发症和肺切除术：本研究确定了 30 天、90 天和 360 天死亡率以及影响死亡率的常见和独立风险因素。虽然 30 天死亡率是评估术后死亡率最常用的时间段，但 90 天死亡率也可用于预测大手术后的死亡率。通过对高危患者进行更详细的术前检查和术后特别随访计划，术前死亡率和发病率有望降低。

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引用次数: 0

Treatment strategies for patients over 80 years of age with oral squamous cell carcinoma 80 岁以上口腔鳞状细胞癌患者的治疗策略。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-26 DOI: 10.1016/j.suronc.2024.102146

Hideaki Hirai , Naoya Kinoshita , Naoto Nishii , Yu Oikawa , Takuma Kugimoto , Takeshi Kuroshima , Hirofumi Tomioka , Yasuyuki Michi , Yoshimasa Sumita , Kei Tomihara , Hiroyuki Harada

Objective

To analyze the clinical characteristics of patients with oral squamous cell carcinoma aged ≥80 years, focusing on surgical treatments.

Study design

We reviewed patients with oral squamous cell carcinoma aged ≥80 years who underwent surgery between 2005 and 2018. Basic information, comorbidities, multiple primary cancers, initial treatment, complications, and outcomes were evaluated.

Results

Of 197 patients aged ≥80 years, 119 patients underwent surgery (50 males, 69 females; mean age: 83.5 years). The gingiva was the most common primary tumor site (63 patients, 52.9 %). The stage classification was stage I in 35 patients (29.4 %), stage II in 44 (37 %), stage III in 16 (13.4 %), stage IVA in 22 (18.5 %), and stage IVB in 2 (1.7 %). Comorbidities were identified in 112 patients (94.1 %). Surgery was the initial treatment in 111 patients (93.3 %). Eight (6.7 %) patients received postoperative adjuvant chemotherapy/radiotherapy; 20 patients (16.8 %) underwent free tissue transplantation. Perioperative complications were observed in 36 patients (30.3 %). The cumulative 5-year and 10-year overall survival rates were 82 % and 68.3 %, respectively; the disease-specific survival rates were 90 %.

Conclusion

Good treatment outcomes were obtained with radical surgery. Surgery should be the first choice if quality of life is assured and there are no issues with surgical tolerance, regardless of age.

研究目的分析年龄≥80岁的口腔鳞状细胞癌患者的临床特征，重点关注手术治疗：我们回顾了 2005 年至 2018 年期间接受手术治疗的年龄≥80 岁的口腔鳞状细胞癌患者。对基本信息、合并症、多种原发癌、初始治疗、并发症和预后进行评估：在197名年龄≥80岁的患者中，119名患者接受了手术（男性50人，女性69人；平均年龄：83.5岁）。牙龈是最常见的原发肿瘤部位（63 名患者，52.9%）。35名患者（29.4%）分期为I期，44名患者（37%）分期为II期，16名患者（13.4%）分期为III期，22名患者（18.5%）分期为IVA期，2名患者（1.7%）分期为IVB期。112名患者（94.1%）有合并症。111名患者（93.3%）接受了手术治疗。8名患者（6.7%）接受了术后辅助化疗/放疗；20名患者（16.8%）接受了游离组织移植。36名患者（30.3%）出现了围手术期并发症。5年和10年累积总生存率分别为82%和68.3%；疾病特异性生存率为90%：结论：根治性手术取得了良好的治疗效果。如果患者的生活质量有保证，且不存在手术耐受性问题，无论年龄大小，都应首选手术治疗。

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引用次数: 0

Preoperative multiparametric magnetic resonance imaging based risk stratification system for predicting biochemical recurrence after radical prostatectomy 基于多参数磁共振成像的术前风险分层系统，用于预测根治性前列腺切除术后的生化复发。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-26 DOI: 10.1016/j.suronc.2024.102150

Cagri Akpinar , Digdem Kuru Oz , Alkan Oktar , Furkan Ozsoy , Eriz Ozden , Nuray Haliloglu , Muhammed Arif Ibis , Evren Suer , Sumer Baltaci

Background

Multiparametric magnetic resonance imaging (mpMRI) is used as a current marker in preoperative staging and surgical decision-making, but current evidence on predicting post-surgical oncological outcomes based on preoperative mpMRI findings is limited. In this study We aimed to develop a risk classification based on mpMRI and mpMRI-derived biopsy findings to predict early biochemical recurrence (BCR) after radical prostatectomy.

Methods

Between January 2017 and January 2023, the data of 289 patients who underwent mpMRI, transrectal ultrasound-guided cognitive and fusion targeted biopsies, and subsequent radical prostatectomy (RP) with or without pelvic lymph node dissection in a single center were retrospectively re-evaluated. BCR was defined as a prostate specific-antigen (PSA) ≥ 0.2 ng/mL at least twice after RP. Multivariate logistic regression models tested the predictors of BCR. The regression tree analysis stratified patients into risk groups based on preoperative mpMRI characteristics. Receiver operating characteristic (ROC)-derived area under the curve (AUC) estimates were used to test the accuracy of the regression tree–derived risk stratification tool.

Results

BCR was detected in 47 patients (16.2 %) at a median follow-up of 24 months. In mpMRI based multivariate analyses, the maximum diameter of the index lesion (HR 1.081, 95%Cl 1.015–1.151, p = 0.015) the presence of PI-RADS 5 lesions (HR 2.604, 95%Cl 1.043–6.493, p = 0.04), ≥iT3a stage (HR 2.403, 95%Cl 1.013–5.714, p = 0.046) and ISUP grade ≥4 on biopsy (HR 2.440, 95%Cl 1.123–5.301, p = 0.024) were independent predictors of BCR. In regression tree analysis, patients were stratified into three risk groups: maximum diameter of index lesion, biopsy ISUP grade, and clinical stage on mpMRI. The regression tree–derived risk stratification model had moderate-good accuracy in predicting early BCR (AUC 77 %)

Conclusion

Straightforward mpMRI and mpMRI-derived biopsy-based risk stratification for BCR prediction provide an additional clinical predictive model to the currently available pathological risk tools.

背景：多参数磁共振成像（mpMRI）是目前用于术前分期和手术决策的标志物，但目前根据术前 mpMRI 检查结果预测术后肿瘤结果的证据有限。在这项研究中，我们旨在根据 mpMRI 和 mpMRI 衍生的活检结果制定一种风险分类，以预测根治性前列腺切除术后的早期生化复发（BCR）：在2017年1月至2023年1月期间，回顾性重新评估了在一个中心接受mpMRI、经直肠超声引导的认知和融合靶向活检以及随后接受根治性前列腺切除术（RP）并进行或不进行盆腔淋巴结清扫的289名患者的数据。前列腺癌根治术后至少两次前列腺特异抗原（PSA）≥0.2纳克/毫升即为BCR。多变量逻辑回归模型检验了 BCR 的预测因素。回归树分析根据术前 mpMRI 特征将患者分为不同的风险组。接收者操作特征（ROC）得出的曲线下面积（AUC）估计值用于检验回归树衍生风险分层工具的准确性：结果：在中位随访 24 个月时，47 例患者（16.2%）被检测出 BCR。493，p = 0.04）、≥iT3a 分期（HR 2.403，95%Cl 1.013-5.714，p = 0.046）和活检时 ISUP 分级≥4（HR 2.440，95%Cl 1.123-5.301，p = 0.024）是 BCR 的独立预测因素。在回归树分析中，患者被分为三个风险组：指标病变最大直径、活检 ISUP 分级和 mpMRI 临床分期。回归树衍生的风险分层模型在预测早期 BCR 方面具有中等偏上的准确性（AUC 77 %）。

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引用次数: 0

The incidence of atypical fibroxanthoma and pleomorphic dermal sarcoma in Denmark from 2002 to 2022 2002 年至 2022 年丹麦非典型纤维黄瘤和多形性真皮肉瘤的发病率。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-26 DOI: 10.1016/j.suronc.2024.102147

Olivia Fruergaard, Mathias Ørholt, Peter Viktor Vester-Glowinski, David Hebbelstrup Jensen

Background

The purpose of this study was to assess trends in the incidence rates and overall survival of atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) in the Danish population from 2002 to 2022.

Methods

We included all patients diagnosed with AFX or PDS in the Danish National Pathology Register (DNPR) during the study period. We computed the age-adjusted incidence rate (AAIR) per 100,000 and the average annual percent change (AAPC) and developed an age-period-cohort (APC) model of incidence.

Results

We included a total of 1118 patients, 78.3 % of whom were men. The median age upon diagnosis for AFX and PDS was 77.6 and 78.4 years, respectively. 84.5 % of the 1118 patients received an AFX diagnosis, while 15.5 % received a PDS diagnosis. The AAIR rose from 0.2 per 100,000 individuals in 2002 to 0.5 per 100,000 by 2022, with a peak increase of 0.75 per 100,000 in 2014. The AAPC for both tumors was 5.3 (95 % CI 2.9 %–7.7 %). We found a significant difference in overall survival between AFX and PDS, with PDS having worse overall survival than AFX.

Conclusion

This study, which included the largest non-selected national population to date, found a significant increase in the incidence of AFX and PDS between 2002 and 2015, followed by a decrease.

背景：本研究旨在评估2002年至2022年丹麦人口中非典型纤维黄瘤（AFX）和多形性真皮肉瘤（PDS）的发病率和总生存率的变化趋势：我们纳入了研究期间丹麦国家病理登记册（DNPR）中所有确诊为AFX或PDS的患者。我们计算了每十万人的年龄调整发病率（AAIR）和年均百分比变化率（AAPC），并建立了发病率的年龄-时期-队列（APC）模型：我们共纳入了 1118 名患者，其中 78.3% 为男性。AFX和PDS的诊断年龄中位数分别为77.6岁和78.4岁。在 1118 名患者中，84.5% 被诊断为 AFX，15.5% 被诊断为 PDS。AAIR从2002年的每10万人中0.2人上升到2022年的每10万人中0.5人，2014年达到峰值，为每10万人中0.75人。两种肿瘤的 AAPC 均为 5.3（95 % CI 2.9 %-7.7%）。我们发现，AFX 和 PDS 的总生存率存在明显差异，PDS 的总生存率低于 AFX：这项研究包括了迄今为止最大的非选择性全国人口，发现2002年至2015年间AFX和PDS的发病率显著增加，随后有所下降。

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引用次数: 0

Review of definition and treatment of upper rectal cancer 上部直肠癌的定义和治疗回顾。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-23 DOI: 10.1016/j.suronc.2024.102145

Elias Karam , Fabien Fredon , Yassine Eid , Olivier Muller , Marie Besson , Nicolas Michot , Urs Giger-Pabst , Arnaud Alves , Mehdi Ouaissi

While the treatment of locally advanced lower and middle rectal cancer with total mesorectal excision (TME) after neoadjuvant therapy is now well defined, the treatment of locally advanced upper rectal cancer (LAURC) remains controversial. Although most teams and academic societies recommend upfront surgery (US) with partial mesorectal excision (PME), as this appears to be sufficient for these tumors, the literature remains conflicting regarding the additional use of neoadjuvant therapy and TME. Current recommendations for the treatment of LAURC do not reflect actual clinical practice. Notably, there is a paucity of published data specific to the treatment of LAURC since most of the data are from sub-analyses of different cohorts. Another important point responsible for the inconsistent data situation is the fact that the current definition of upper rectal cancer is based on anatomical criteria that are difficult to reproduce and therefore also differ between international professional societies.

The aim of this review is to provide a deeper insight into the issues surrounding the treatment of LAURC based on an analysis of the current literature, including anatomic and embryologic data.

虽然新辅助治疗后采用全直肠系膜切除术（TME）治疗局部晚期中下段直肠癌的方法现已明确，但局部晚期上段直肠癌（LAURC）的治疗方法仍存在争议。虽然大多数团队和学术团体都建议进行部分直肠系膜切除术（PME）的前期手术（US），因为这似乎足以治疗这些肿瘤，但关于是否额外使用新辅助治疗和 TME 的文献仍存在冲突。目前关于 LAURC 治疗的建议并不反映实际的临床实践。值得注意的是，由于大多数数据来自不同队列的子分析，因此专门针对 LAURC 治疗的已发表数据非常少。造成数据不一致的另一个重要原因是，目前上段直肠癌的定义是基于解剖学标准，而解剖学标准很难再现，因此不同国际专业协会的定义也不尽相同。本综述的目的是在分析现有文献（包括解剖学和胚胎学数据）的基础上，深入探讨有关 LAURC 治疗的问题。

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引用次数: 0

Pancreatoduodenectomy after Ivor-Lewis Santi oesophagectomy with gastric tube reconstruction. An European multicentre experience Ivor-Lewis Santi 食管切除术后的胰十二指肠切除术与胃管重建。欧洲多中心经验。

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-20 DOI: 10.1016/j.suronc.2024.102144

Alessandro D. Mazzotta , Pietro Addeo , Benedetto Ielpo , Michael Ginesini , Nicolas Regenet , Ugo Boggi , Philippe Bachellier , Olivier Soubrane

Background

Pancreaticoduodenectomy (PD) is the standard surgery to treat tumors and other conditions affecting the head of the pancreas. PD involves the division of the gastroduodenal artery (GDA) and its branches, to allow for complete dissection of lymph nodes. However, PD in patients with prior esophageal resection presents challenges due to altered anatomy and risks compromising gastric tube vascularization. GDA preservation becomes crucial to avoid ischemia, although this may pose oncological risks by potentially leaving behind regional lymph nodes. This article reviews European surgical center experiences and techniques for PD in patients with prior esophageal surgery, focusing on short-term outcomes.

Methods

We have collected all the experiences carried out in European surgical centers and evaluated the techniques applied for PD in patients who had prior esophageal surgery while analyzing short-term outcomes.

Results

Eight patients from 5 European centers were identified. Six patients were diagnosed with pancreatic adenocarcinoma, including one borderline case. Intraoperatively, the gastroduodenal artery (GDA) was preserved in all cases, with portal vein reconstruction required in only one instance due to tumor invasion. No ischemia or venous congestion of the gastric tube was observed during the surgical procedure. Post-operative complications that occurred included POPF type C in 1 (12.5 %), PPH type C in 1 (12.5 %). The median number of harvested lymph nodes was 21 [14–24]. with a median of 1.5 positive lymph nodes. R1 resection was present in 62.5 % of cases.

Conclusion

Performing pancreaticoduodenectomy subsequent to Ivor Lewis esophagectomy is a technical challenge, but seems feasiable and safe in selected patients. GDA-preserving pancreaticoduodenectomy emerges as a valuable and time-efficient variation of the conventional procedure, it can be considered oncologically appropriate, but studies confirming its long-term impact on radicality are still needed.

背景：胰十二指肠切除术（PD）是治疗影响胰腺头部的肿瘤和其他疾病的标准手术。胰十二指肠切除术包括分割胃十二指肠动脉（GDA）及其分支，以便彻底切除淋巴结。然而，由于解剖结构的改变和损害胃管血管的风险，对曾进行过食管切除术的患者进行胃十二指肠切除术是一项挑战。保留 GDA 对避免缺血至关重要，但这可能会遗留区域淋巴结，从而带来肿瘤风险。本文回顾了欧洲外科中心在食管手术前患者中进行胃十二指肠切除术的经验和技术，重点关注短期疗效：我们收集了欧洲外科中心的所有经验，并评估了对曾接受过食管手术的患者进行腹腔镜手术的技术，同时分析了短期疗效：我们确定了来自欧洲 5 个中心的 8 名患者。结果：来自欧洲 5 个中心的 8 名患者被确诊为胰腺癌，其中包括 1 例边缘病例。术中，所有病例都保留了胃十二指肠动脉（GDA），只有一例因肿瘤侵犯而需要重建门静脉。手术过程中未发现胃管缺血或静脉充血。术后并发症包括1例（12.5%）POPF C型和1例（12.5%）PPH C型。切除淋巴结的中位数为 21 [14-24]，阳性淋巴结的中位数为 1.5。62.5%的病例进行了R1切除：结论：在 Ivor Lewis 食管切除术后进行胰腺十二指肠切除术是一项技术挑战，但在选定的患者中似乎可行且安全。保留胰腺十二指肠的胰腺切除术是传统手术的一种有价值、省时的变体，在肿瘤学上可被认为是适当的，但仍需研究证实其对根治性的长期影响。

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引用次数: 0

Advances in the management of regionally metastatic melanoma 区域转移性黑色素瘤的治疗进展

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-20 DOI: 10.1016/j.suronc.2024.102143

Caitlyn Balsay-Patel , Michelle M. Dugan , Jonathan S. Zager

Despite numerous developments in systemic therapy, the prognosis for patients with locoregionally advanced melanoma remains poor. By delivering therapy directly to the targeted area via intralesional injections or intra-arterial isolated infusions, systemic side effects are minimized and oncolytic agents are delivered more directly and effectively to the melanoma. There has been significant progress in recent years with intralesional agents such as Talimogene laherparepvec (T-VEC), PV-10 and TAVOkinase/electrocorporation as well as advances in infusional therapies such as percutaneous hepatic perfusion (PHP) for hepatic metastasis of ocular melanoma. This review evaluates advances in intralesional and infusional therapies for melanoma while limiting discussion to those therapies currently approved and on trial.

尽管全身治疗取得了许多进展，但局部晚期黑色素瘤患者的预后仍然很差。通过区域内注射或动脉内分离输注将治疗直接送达靶区，可最大限度地减少全身副作用，并能更直接、更有效地将溶瘤药物送达黑色素瘤。近年来，Talimogene laherparepvec (T-VEC)、PV-10 和 TAVOkinase/electrocorporation 等区域内药物以及经皮肝灌注（PHP）等用于治疗眼部黑色素瘤肝转移的灌注疗法取得了重大进展。本综述评估了黑色素瘤腔内和输注疗法的进展，但讨论范围仅限于目前已获批准和正在试用的疗法。

引用次数: 0

“Prepectoral tissue expanders without mesh as a bridge to delayed autologous breast reconstruction: Experience at a single academic center” "无网眼的胸前组织扩张器作为延迟自体乳房重建的桥梁：单个学术中心的经验"

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-19 DOI: 10.1016/j.suronc.2024.102142

Daniel A. Curiel, Samyd S. Bustos, Vahe Fahradyan, Jorys Martinez-Jorge, Aparna Vijayasekaran

Acellular dermal matrix (ADM) is a useful adjunct in implant-based breast reconstruction. The benefits of using ADM with an expander as a temporary bridge to delayed autologous reconstruction are unknown. Placing prepectoral tissue expanders, without ADM, as a bridge to delayed autologous reconstruction could yield cost savings, shorten operating time and decrease complications. This investigation seeks to demonstrate the safety of placing prepectoral tissue expanders without ADM at the time of mastectomy as the first stage of autologous breast reconstruction. A retrospective, chart review was performed at our major academic institution between 2015 and 2020. Included were female patients, 18 years or older at the time of reconstruction, who underwent mastectomy with prepectoral tissue expander placement followed by autologous breast reconstruction at a delayed second stage. Excluded were patients of male gender, younger than 18, patients with lumpectomy only, subpectoral reconstruction, or immediate autologous reconstruction. Data on ADM, patient demographics, comorbidities, and cancer treatment were collected. There were 189 reconstructed breasts of which 56 (29.6 %) used ADM, 131 (69.3 %) did not use ADM, and 2 patients (1.1 %) of unknown ADM use. Expanders were in place for a mean time of 8.9±6.2 months. There was no statistically significant difference in complication rates between the ADM and no-ADM groups. Therefore, not wrapping prepectoral tissue expanders in ADM, at the time of mastectomy, has an equivalent rate of complications compared to ADM wrapping among patients who go on to have second stage autologous breast reconstruction.

细胞真皮基质（ADM）是假体乳房重建的有效辅助手段。将 ADM 与扩张器一起用作延迟自体重建的临时桥梁的益处尚不清楚。在不使用 ADM 的情况下放置胸前组织扩张器，作为延迟自体重建的桥梁，可以节约成本、缩短手术时间并减少并发症。本研究旨在证明在乳房切除术时放置胸前组织扩张器（不含 ADM）作为自体乳房重建第一阶段的安全性。我们的主要学术机构在 2015 年至 2020 年期间进行了一项回顾性病历审查。研究对象包括重建时年满 18 周岁的女性患者，她们在接受乳房切除术的同时植入胸前组织扩张器，然后在第二阶段延迟进行自体乳房重建。不包括性别为男性、年龄小于 18 岁、仅接受肿块切除术、胸膜下重建或立即进行自体乳房重建的患者。研究人员还收集了有关ADM、患者人口统计学、合并症和癌症治疗的数据。共有 189 例重建乳房，其中 56 例（29.6%）使用了 ADM，131 例（69.3%）未使用 ADM，还有 2 例患者（1.1%）不知道是否使用了 ADM。扩张器的平均植入时间为 8.9±6.2 个月。ADM 组和未使用 ADM 组的并发症发生率没有明显的统计学差异。因此，在乳房切除术时不使用 ADM 包裹胸前组织扩张器与使用 ADM 包裹进行第二阶段自体乳房重建的患者的并发症发生率相当。

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引用次数: 0

Safe and beneficial outcomes of pancreaticogastrostomy with endoscopic transgastric drainage for pancreatic fistula after pancreaticoduodenectomy 胰十二指肠切除术后胰腺瘘的胰胃造口术和内镜下经胃引流术的安全和有益效果

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-19 DOI: 10.1016/j.suronc.2024.102141

Norimitsu Okui , Kenei Furukawa , Yoshihiiro Shirai , Shinji Onda , Koichiro Haruki , Masafumi Chiba , Masayuki Kato , Yuichi Torisu , Takeshi Gocho , Toru Ikegami

Purposes

The optimal surgical technique and perioperative management to prevent postoperative pancreatic fistula (POPF) formation after pancreaticoduodenectomy have not yet been established. This study examined the perioperative outcomes of pancreaticogastrostomy with endoscopic transgastric drainage.

Methods

We performed a retrospective analysis of 191 patients who underwent pancreaticoduodenectomy between 2016 and 2023. They were divided into two groups: pancreaticojejunostomy group (n = 135) and pancreaticogastrostomy group (n = 56). We compared preoperative factors and postoperative outcomes. We performed endoscopic drainage only in the pancreaticogastrostomy group.

Results

Preoperative factors were similar between the two groups. Operative time [480 (404–542) vs. 382 (346–458) minutes], blood loss [505 (270–850) vs. 315 (145–535) g], pseudoaneurysm formation (7 % vs. 0 %), and postoperative hospital stay [28 (22–38) vs. 19 (17–24) days] were significantly lower in the pancreaticogastrostomy group. In the analysis of 41 patients with POPF, postoperative hospital stay [40 (23–108) vs. 27 (18–54) days] and hospital stay after POPF diagnosis [30 (10–99) vs. 15 (5–35) days] were significantly shorter in the pancreaticogastrostomy group. Endoscopic transgastric drainage was performed in 77 % of patients in the pancreaticogastrostomy group, and drainage was successfully completed in all patients.

Conclusion

Pancreaticogastrostomy with endoscopic transgastric drainage could be effective for the safe management of pancreaticoduodenectomy.

目的预防胰十二指肠切除术后胰瘘（POPF）形成的最佳手术技术和围手术期管理尚未确立。本研究探讨了胰十二指肠切除术与内镜下经胃引流术的围手术期结果。方法我们对2016年至2023年间接受胰十二指肠切除术的191例患者进行了回顾性分析。他们被分为两组：胰空肠吻合术组（n = 135）和胰胃造瘘术组（n = 56）。我们比较了术前因素和术后结果。结果两组患者的术前因素相似。胰胃造口术组的手术时间[480（404-542）分钟 vs. 382（346-458）分钟]、失血量[505（270-850）克 vs. 315（145-535）克]、假性动脉瘤形成（7% vs. 0%）和术后住院时间[28（22-38）天 vs. 19（17-24）天]均显著低于胰胃造口术组。在对 41 名 POPF 患者的分析中，胰胃造口术组的术后住院时间[40 (23-108) 天 vs. 27 (18-54) 天]和确诊 POPF 后的住院时间[30 (10-99) 天 vs. 15 (5-35) 天]明显较短。胰胃造口术组 77% 的患者进行了内镜下经胃引流，所有患者都成功完成了引流。

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引用次数: 0

Oncologic and functional outcomes following robot assisted radical prostatectomy: 15-Year experience in a Latin American referral center 机器人辅助根治性前列腺切除术后的肿瘤和功能结果：拉丁美洲转诊中心的 15 年经验

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2024-09-11 DOI: 10.1016/j.suronc.2024.102138

Agustin Romeo, Pablo Martinez, Martin Compagnucci, Ignacio Tobia, Carlos Giudice, Wenceslao Villamil

Background

Prostate cancer is the most common cancer in men with more than 52,000 cases diagnosed every year on average. With the introduction of robotic surgery, robotic assisted radical prostatectomy (RARP) has become a popular treatment option in recent years. Achieving oncological control, urinary continence and satisfactory erectile sexual function after RP is the main goal also known as “trifecta”. All these outcomes are highly influenced by surgical experience and caseload. The main objective of this study is to analyze oncological and functional outcomes in RARP after 15 years of experience.

Methods

From 2008 until December 2023, 1790 RARP for localized prostate cancer were performed. A retrospective analysis was conducted based on prospectively collected data correlated with electronic medical records.

Results

Subgroup analyses were conducted in order to evaluate oncological and functional outcomes (n: 1400). Red blood cell transfusion and conversion to open surgery rate was 1.9 % and 0.1 %, respectively. Mean surgical time was 194 min. Mean follow-up time was 69.5 months, 23.8 % patients experienced biochemical recurrence and 1 % died, primarily due to disease progression. Estimated 10-year recurrence-free survival was 68.7 % (95 % CI 67.2–72.2) while estimated 10-year overall survival was 97.9 % (95 % CI 96.3–99.4). Overall urinary continence rate at 2 years was 86.9 % while satisfactory erectile function rate at 18 months was 56.8 %.

Conclusions

Robotic-assisted radical prostatectomy has become a standard surgical technique in our urological practice for the management of clinically localized and locally advanced prostate tumors in selected cases. After 15 years since the inception of our robotic surgery program, we can conclude that our results are comparable to those published in the international literature, enabling patients to maintain satisfactory sexual function with a high continence rate within the first year of surgery.

背景前列腺癌是男性最常见的癌症，平均每年确诊 52,000 多例。近年来，随着机器人手术的引入，机器人辅助前列腺癌根治术（RARP）已成为一种流行的治疗方法。前列腺癌根治术后达到肿瘤控制、排尿通畅和满意的勃起性功能是主要目标，也被称为 "三连胜"。所有这些结果都受到手术经验和病例数量的很大影响。本研究的主要目的是分析 RARP 术后 15 年的肿瘤学和功能性结果。方法从 2008 年到 2023 年 12 月，共进行了 1790 例局部前列腺癌 RARP 术。结果为了评估肿瘤学和功能性结果，进行了分组分析（n：1400）。输红细胞和转为开放手术的比例分别为 1.9 % 和 0.1 %。平均手术时间为 194 分钟。平均随访时间为69.5个月，23.8%的患者出现生化复发，1%的患者死亡，主要原因是疾病进展。估计10年无复发生存率为68.7%（95% CI为67.2-72.2），估计10年总生存率为97.9%（95% CI为96.3-99.4）。结论机器人辅助前列腺癌根治术已成为我们泌尿外科治疗临床局部和局部晚期前列腺肿瘤的标准手术技术。我们的机器人手术项目开展 15 年后，我们可以得出结论，我们的结果与国际文献中发表的结果相当，使患者在术后第一年内就能保持满意的性功能和较高的尿失禁率。

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