Estimating the optimal timing of surgery by imputing potential outcomes

2021 ◽  
Author(s):  
Xiaofei Chen ◽  
Daniel F. Heitjan ◽  
Gerald Greil ◽  
Haekyung Jeon‐Slaughter
Keyword(s):  
Timing Of Surgery ◽  
Potential Outcomes ◽  
Optimal Timing

scholarly journals GCT-53. CASE OF INTRACRANIAL GROWING TERATOMA SYNDROME WITH DIFFICULTY IN TIMING OF RESECTION

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii339-iii339
Author(s):  
Hidenobu Yoshitake ◽  
Hideo Nakamura ◽  
Yuta Hamamoto ◽  
Yusuke Otsu ◽  
Jin Kikuchi ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Mature Teratoma ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Third Ventriculostomy ◽  
Mixed Tumor ◽  
Gland Tumor ◽  
Growing Teratoma Syndrome

Abstract BACKGROUND Intracranial Growing teratoma syndrome(iGTS) is a phenomenon in which a tumor with a teratoma component grows during treatment, and its pathological tissue is often a mature teratoma. Here we report a case of iGTS in which the timing of surgery was determined by tumor markers and changes in tumor size on MRI images. CASE-REPORT: 11-year-old boy with a short stature. He developed a headache and we found a pineal gland tumor on MRI. Due to obstructive hydrocephalus, an endoscopic third ventriculostomy and biopsy were performed. The pathological diagnosis was mature teratoma, but AFP was elevated at 104.2 ng/mL. Considering NGGCT, we started chemoradiation immediately. Despite the declining AFP, it gradually increased, at which point we suspected iGTS. Resection was considered, but at some point tumor growth had stopped, so radiation therapy and a second course of ICE therapy preceded the resection. Thereafter, the tumor was completely removed, and a third course of ICE therapy was performed. DISCUSSION The onset mechanism of iGTS has not been elucidated, and its prediction is difficult. Early resection of the tumor is required, but discontinuation of radiation therapy and side effects of chemotherapy also need to be considered. In our case, resection was performed after normalization of AFP and recovery of myelosuppression. The patient followed an uneventful course, but the timing of resection was controversial. CONCLUSION We experienced a case of iGTS in NGGCT, a mixed tumor with mature teratoma. The optimal timing of the resection was discussed and literature was reviewed.

scholarly journals Optimal Timing for Primary Early Endoscopic Dacryocystorhinostomy in Acute Dacryocystitis

2021 ◽  
Vol 10 (10) ◽  
pp. 2161
Author(s):  
Jae Yun Sung ◽  
Ju Mi Kim ◽  
Jae Yul Hwang ◽  
Kyoung Nam Kim ◽  
Jae Young Kim ◽  
...  
Keyword(s):  
Subgroup Analysis ◽  
Surgical Outcomes ◽  
Timing Of Surgery ◽  
Secondary Outcome ◽  
Control Group ◽  
Optimal Timing ◽  
Secondary Outcome Measure ◽  
Success Rates ◽  
Endoscopic Dacryocystorhinostomy ◽  
And Gender

Purpose: To evaluate the surgical outcomes of primary early endoscopic dacryocystorhinostomy (EnDCR) in acute dacryocystitis (AD) and to determine the optimal timing for surgery. Methods: A retrospective review of medical records was performed on consecutive patients who underwent primary early EnDCR (within 1 week) for AD between May 2010 and June 2020 (AD group) and an age- and gender-matched control group of NLDO patients who underwent EnDCR (non-AD group). The primary outcome measures were the surgical outcomes at the final follow-up examination. The secondary outcome measure was the clinical course of AD patients. Subgroup analysis was performed to determine the optimal timing of surgery by comparing the outcomes of very early EnDCR (within 3 days) and those of early EnDCR (between 4 and 7 days). Results: Forty-one patients were included in the AD group and 82 patients in the non-AD group. The anatomical and functional success rates were 87.8% and 82.9% in the AD group, and 91.5% and 84.1% in the non-AD group, which were not significantly different between the two groups (p = 0.532 and p = 0.863). In the AD group, the mean times for pain relief and resolution of swelling after surgery were 2.4 and 6.5 days after surgery, respectively. In the subgroup analysis according to the timing of surgery, the time for symptom resolution after diagnosis, the length of hospital stays, and the duration of antibiotic treatments were significantly shorter after very early EnDCR (all ps < 0.05), whereas the surgical outcomes were not different between the two groups (p = 1.000). Conclusions: Primary early EnDCR is a safe and effective procedure for the treatment of AD. In particular, very early EnDCR performed within 3 days leads to faster recovery and shortens the course of antibiotic treatment.

Estimating the optimal timing of surgery from observational data

Biometrics ◽  
2020 ◽  
Author(s):  
Xiaofei Chen ◽  
Daniel F. Heitjan ◽  
Gerald Greil ◽  
Haekyung Jeon‐Slaughter
Keyword(s):  
Observational Data ◽  
Timing Of Surgery ◽  
Optimal Timing

scholarly journals Midterm Outcomes of Early Versus Late Surgery for Infective Endocarditis with Neurologic Complications: A Meta-analysis

2020 ◽  
Author(s):  
Yujiro Yokoyama ◽  
Taichiro Goto
Keyword(s):  
Infective Endocarditis ◽  
Meta Analysis ◽  
Perioperative Period ◽  
Timing Of Surgery ◽  
Optimal Timing ◽  
Neurologic Complications ◽  
Recurrence Rates ◽  
Hazard Ratios ◽  
All Cause Mortality ◽  
Secondary Endpoints

Abstract Background: Cerebral infarction (CI) remains one of the most common and fatal complications of infective endocarditis (IE), and the timing of surgery for IE with neurologic complications is controversial. As outcomes beyond the perioperative period have not been assessed with a meta-analysis previously, we conducted a meta-analysis comparing mid- to long-term outcomes of early and late surgery in patients with IE and neurologic complications.Methods: All studies that investigated early and late surgery in patients with IE and neurologic complications were identified. The primary and secondary endpoints were all-cause mortality and recurrence, respectively. Hazard ratios (HRs) for all-cause mortality and recurrence were extracted from each study. Results: Our search identified five eligible studies, which were all observational studies consisting of a total of 624 patients with IE and neurologic complications. Pooled analyses demonstrated that all-cause mortality was similar between the early and late surgery groups (HR [95% confidence interval [CI]]=0.90 [0.49-1.64]; P=0.10; I2=49%). Similarly, the recurrence rates were similar between both groups (HR [95% CI]=1.86 [0.76-4.52]; P=0.43; I2=0%). Conclusions: Our meta-analysis showed similar mortality and recurrent rates between the early and late surgery groups. The optimal timing of surgery should be individualized on a case-to-case basis.

scholarly journals Surgical Repair of Mitral-Aortic Intervalvular Fibrosa Pseudoaneurysm in a High-Risk Patient 13 Years after Aortic Root Replacement

2019 ◽  
Vol 46 (2) ◽  
pp. 147-150
Author(s):  
Mirko Muretti ◽  
Walid Elmahdy ◽  
Iakovos Ttofi ◽  
David Mozalbat ◽  
Michael Murphy ◽  
...  
Keyword(s):  
Aortic Root ◽  
Watchful Waiting ◽  
Surgical Repair ◽  
High Risk Patient ◽  
Timing Of Surgery ◽  
Valve Surgery ◽  
Aortic Root Replacement ◽  
Optimal Timing ◽  
Aortic Valve Surgery ◽  
Life Threatening

Pseudoaneurysms of the mitral-aortic intervalvular fibrosa are rare complications that can develop after mitral or aortic valve surgery, endocarditis, or Takayasu arteritis. The optimal timing of surgery to avoid potentially life-threatening complications of pseudoaneurysms has not been established, and watchful waiting has been adopted in specific situations. We describe the case of a 50-year-old man in whom a pseudoaneurysm of the mitral-aortic intervalvular fibrosa developed after aortic root replacement with a homograft. After 13 years of watchful waiting, reoperation was deemed necessary because the pseudoaneurysm had grown to 48 mm and the aortic regurgitation caused by the degenerated homograft had become severe. This case highlights the need for increased awareness of mitral-aortic intervalvular fibrosa pseudoaneurysms and their management.

scholarly journals AB002. SOH21AS038. Optimal timing of surgery following breast cancer neoadjuvant chemotherapy: a systematic review and meta-analysis

2021 ◽  
Vol 5 ◽  
pp. AB002-AB002
Author(s):  
Carolyn M. Cullinane ◽  
Amber Shrestha ◽  
Ahmed Al Maksoud ◽  
Janice Walsh ◽  
Jane Rothwell ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Systematic Review ◽  
Neoadjuvant Chemotherapy ◽  
Meta Analysis ◽  
Timing Of Surgery ◽  
Optimal Timing
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