scholarly journals Short-term preoperative drainage is associated with improved postoperative outcomes compared to that of long-term biliary drainage in pancreatic surgery

2021 ◽  
Author(s):  
F. Oehme ◽  
S. Hempel ◽  
M. Pecqueux ◽  
B. Müssle ◽  
H. M. Hau ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Pancreatic Surgery ◽  
Cell Function ◽  
University Hospital ◽  
Recurrence Free Survival ◽  
Periampullary Carcinoma ◽  
Short Term ◽  
Free Survival ◽  
Perioperative Morbidity

Abstract Purpose The treatment of choice for patients presenting with obstructive cholestasis due to periampullary carcinoma is oncologic resection without preoperative biliary drainage (PBD). However, resection without PBD becomes virtually impossible in patients with obstructive cholangitis or severely impaired liver cell function. The appropriate duration of drainage by PBD has not yet been defined for these patients. Methods A retrospective analysis was conducted on 170 patients scheduled for pancreatic resection following biliary drainage between January 2012 and June 2018 at the University Hospital Dresden in Germany. All patients were deemed eligible for inclusion, regardless of the underlying disease entity. The primary endpoint analysis was defined as the overall morbidity (according to the Clavien-Dindo classification). Secondary endpoints were the in-hospital mortality and malignancy adjusted overall and recurrence-free survival rates. Results A total of 170 patients were included, of which 45 (26.5%) and 125 (73.5%) were assigned to the short-term (< 4 weeks) and long-term (≥ 4 weeks) preoperative drainage groups, respectively. Surgical complications (Clavien-Dindo classification > 2) occurred in 80 (47.1%) patients, with significantly fewer complications observed in the short-term drainage group (31.1% vs. 52%; p = 0.02). We found that long-term preoperative drainage (unadjusted OR, 3.386; 95% CI, 1.507–7.606; p < 0.01) and periampullary carcinoma (unadjusted OR, 5.519; 95% CI, 1.722–17.685; p-value < 0.01) were independent risk factors for postoperative morbidity, based on the results of a multivariate regression model. The adjusted overall and recurrence-free survival did not differ between the groups (p = 0.12). Conclusion PBD in patients scheduled for pancreatic surgery is associated with substantial perioperative morbidity. Our results indicate that patients who have undergone PBD should be operated on within 4 weeks after drainage.

scholarly journals Long-term recurrence-free survival in a patient with stage IVB uterine carcinosarcoma

2011 ◽  
Vol 22 (4) ◽  
pp. 292 ◽  
Author(s):  
Gun Yoon ◽  
Yong-Seok Kim ◽  
Byoung-Gie Kim ◽  
Duk-Soo Bae ◽  
Jeong-Won Lee
Keyword(s):  
Recurrence Free Survival ◽  
Uterine Carcinosarcoma ◽  
Free Survival ◽  
Stage Ivb

scholarly journals Impact of postoperative complications on long-term survival of hepatocellular carcinoma patients after liver resection

2021 ◽  
Author(s):  
Susumu Mochizuki ◽  
Hisashi Nakayama ◽  
Yutaka Midorikawa ◽  
Tokio Higaki ◽  
Masamichi Moriguchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Resection ◽  
Pleural Effusion ◽  
Postoperative Complications ◽  
Recurrence Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Long Term Survival

Objective The effect of postoperative complications including red blood transfusion (BT) on long-term survival for hepatocellular carcinoma (HCC) is unknown. The purpose of this study was to define the relationship between postoperative complications and long-term survival in patients with HCC. Methods Postoperative complications of 1251 patients who underwent curative liver resection for HCC were classified, and their recurrence-free survival (RFS) and cumulative overall survival (OS) were investigated. Results Any complications occurred in 503 patients (40%). Five-year RFS and 5-year OS in the complication group were 21% and 56%, respectively, significantly lower than the respective values of 32% ( p &lt; 0.001) and 68% ( p &lt; 0.001) in the no-complication group (n=748). Complications related to RFS were postoperative BT [Hazard ratio (HR): 1.726, 95% confidence interval (CI): 1.338–2.228, p &lt; 0.001], pleural effusion [HR: 1.434, 95% CI: 1.200–1.713, p &lt; 0.001] using Cox-proportional hazard model. Complications related to OS were postoperative BT [HR: 1.843, 95%CI: 1.380-2.462, p &lt; 0.001], ascites [HR: 1.562, 95% CI: 1.066–2.290 p = 0.022], and pleural effusion [HR: 1.421, 95% CI: 1.150–1.755, p = 0.001). Conclusions Postoperative complications were factors associated with poor long-term survival. Postoperative BT and pleural effusion, were noticeable complications that were prognostic factors for both recurrence-free survival and overall survival.

The role of surgical access in retroperitoneal sarcoma resection - a retrospective study

2021 ◽  
Author(s):  
Pauline Aeschbacher ◽  
Attila Kollár ◽  
Daniel Candinas ◽  
Guido Beldi ◽  
Anja Lachenmayer
Keyword(s):  
Local Recurrence ◽  
Medical Center ◽  
Retroperitoneal Sarcoma ◽  
University Hospital ◽  
Recurrence Free Survival ◽  
Tertiary Institution ◽  
Midline Laparotomy ◽  
Free Survival ◽  
Surgical Access ◽  
Tertiary Center

Abstract Background Retroperitoneal sarcoma (RPS) is a rare disease often requiring multi-visceral and wide margin resections. Midline incision seems to be the access of choice. Up to now there is no evidence for the best surgical access. This study aimed to analyze the oncological outcome according to the incision used for the resection. Methods All patients treated for RPS between 2007 and 2018 at the Department of Visceral Surgery and Medicine of the University Hospital Bern and receiving a RPS resection in curative intent were included. Patient- and treatment specific factors as well as local recurrence-free survival was analyzed in correlation with the type of surgical access used. Results Thirty-five patients were treated for RPS at our center. The majority received their primary RPS resection at a tertiary medical center (n = 23) the rest of the resection were performed in an external non-tertiary institution (n = 12). Median tumor size was 24 cm. Resections were performed via a midline laparotomy (MI = 31) or flank incision (FI = 4). All FI were performed at a non-tertiary center and received no multi-visceral resection. In ML the macroscopically complete resection (R0/1) rate was 83.9% and 25% in FI (p = 0.021). The local recurrence rate after R0/1 resection was 100% in FI and 61.5% in ML (p = 1.00). Early recurrence or local disease progression was present in 50% of FI compared to 0% in ML (p = 0.01). The median recurrence-free survival after R0/1 resection was lower in FI (p < 0.001) and in patients operated in a non-tertiary center (p = 0.27). Conclusions FI with limited exposure of the retroperitoneum and no access to the visceral organs as well as resection at a non-tertiary center are associated worse outcome in RPS surgery.

scholarly journals Long-Term Outcomes of Local Excision Following Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

2020 ◽  
Author(s):  
Lucrezia D’Alimonte ◽  
Quoc Riccardo Bao ◽  
Gaya Spolverato ◽  
Giulia Capelli ◽  
Paola Del Bianco ◽  
...  
Keyword(s):  
Local Excision ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Recurrence Free Survival ◽  
Long Term Outcomes ◽  
Relapse Free Survival ◽  
Free Survival

Abstract Background Local excision might represent an alternative to total mesorectal excision for patients with locally advanced rectal cancer who achieve a major or complete clinical response after neoadjuvant chemoradiotherapy. Methods Between August 2005 and July 2011, 63 patients with mid-low rectal adenocarcinoma who had a major/complete clinical response after neoadjuvant chemoradiotherapy were enrolled in a multicenter prospective phase 2 trial and underwent transanal full thickness local excision. The main endpoint of this study was to evaluate the 5- and 10-year overall, relapse-free, local, and distant relapse-free survival, which were calculated by applying the Kaplan–Meier method. The rate of patients with rectum preserved and without stoma were also calculated. Results Of 63 patients, 38 (60%) were male and 25 (40%) were female, with a median (range) age of 64 (25–82) years. At baseline, the following clinical stages were found: cT2, n = 21 (33.3%); cT3, n = 42 (66.6%), 39 (61.9%) patients were cN+. At a median (range) follow-up of 108 (32–166) months, the estimated cumulative 5- and 10-year overall survival, relapse-free survival, local recurrence-free survival, and distant recurrence-free survival were 87% (95% CI 76–93) and 79% (95% CI 66–87), 89% (95% CI 78–94) and 82% (95% CI 66–91), both 91% (95% CI 81–96), and 90% (95% CI 80–95) and 86% (95% CI 73–93), respectively. Overall, 49 (77.8%) patients had their rectum preserved, and 54 (84.1%) were stoma-free. Conclusion In highly selected patients, the local excision approach after neoadjuvant chemoradiotherapy is associated with excellent long-term outcomes, high rates of rectum preservation and absence of permanent stoma.

scholarly journals Long-term outcomes of upfront surgery in patients with resectable pathological N2 non-small-cell lung cancer

2020 ◽  
Vol 58 (1) ◽  
pp. 59-69 ◽  
Author(s):  
Jae Kwang Yun ◽  
Jin San Bok ◽  
Geun Dong Lee ◽  
Hyeong Ryul Kim ◽  
Yong-Hee Kim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Adjuvant Chemotherapy ◽  
Small Cell Lung Cancer ◽  
Clinical Outcomes ◽  
Small Cell ◽  
Recurrence Free Survival ◽  
Small Cell Lung ◽  
Free Survival ◽  
N2 Disease

Abstract OBJECTIVES Although the standard treatment for pathological N2 (pN2) non-small-cell lung cancer (NSCLC) patients is definitive chemoradiation, surgery can be beneficial for resectable pN2 disease. Herein, we report the long-term clinical outcomes of upfront surgery followed by adjuvant treatment for selected patients with resectable pN2 disease. METHODS We performed a retrospective analysis of clinical outcomes for patients with pN2 disease who underwent surgery as the first-line therapy. Multivariable Cox regression analysis was used to identify the significant factors for overall survival (OS) and recurrence-free survival. RESULTS From 2004 to 2015, a total of 706 patients with pN2 NSCLC underwent complete anatomical resection at our institution. The patients’ clinical N stages were cN0, 308 (43.6%); cN1, 123 (17.4%) and cN2, 275 (39.0%). Adjuvant chemotherapy, radiotherapy and chemoradiotherapy were administered to 169 (23.9%), 115 (17.4%) and 299 patients (42.4%), respectively. With a median follow-up of 40 months, the respective median time and 5-year rate of OS were 52 months and 44.7%. According to subdivided pN2 descriptors, the median OS time was 80, 53 and 37 months for patients with pN2a1, pN2a2 and pN2b, respectively. Adjuvant chemotherapy was a significant prognostic factor for both OS [hazard ratio (HR) 0.39, 95% confidence interval (CI) 0.28–0.52; P &lt; 0.001] and recurrence-free survival (HR 0.42, 95% CI 0.30–0.58; P &lt; 0.001). CONCLUSIONS Upfront surgery followed by adjuvant therapy for resectable N2 disease showed favourable outcomes compared to those reported in previous studies. Adjuvant chemotherapy is essential to improve the prognosis for patients undergoing upfront surgery for N2 disease.

Prognosis of Hepatocellular Carcinoma Patients Who Achieved Long-Term Recurrence-Free Survival After Curative Therapy: Impact of the ALBI Grade

2018 ◽  
Vol 22 (7) ◽  
pp. 1230-1238 ◽  
Author(s):  
Hajime Matsushima ◽  
Yuko Takami ◽  
Tomoki Ryu ◽  
Munehiro Yoshitomi ◽  
Masaki Tateishi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Curative Therapy
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