Clinical outcomes and functional analysis of third space robotic and endoscopic cooperative surgery versus laparoscopic wedge resection for gastric submucosal tumours: a propensity score-matched study

AbstractThird space robotic and endoscopic cooperative surgery (TS-RECS) is a novel minimally invasive surgery for resecting gastric submucosal tumours (GSMTs), which could accomplish the completely oncological curability and maximal functional preservation. This study investigated the clinical outcomes and gastrointestinal function after TS-RECS versus laparoscopic wedge resection (LWR) for GSMTs. This was a single-centre retrospective study that included 130 patients with GSMTs who underwent LWR or TS-RECS from 2013 to 2019. To overcome selection biases, we performed propensity score matching (1:1) using seven covariates that could impact the group assignment and outcomes. Then, the clinical outcomes and gastrointestinal function in the LWR and TS-RECS groups were compared in a matched cohort. Among the 130 enrolled patients, 96 patients underwent LWR, and 34 underwent TS-RECS and were matched into 30 patients for each group. There was no significant difference in the operation time between the two groups (P = 0.543). However, the TS-RECS group had significantly less blood loss (20,5–100 vs 95,10–310 ml, P < 0.0001) and better postoperative recovery in terms of time to oral intake (2,2–4 vs 3,2–6 days, P < 0.0001) and postoperative hospital stay (5,4–10 vs 8.5,5–16 days, P < 0.0001) than the LWR group. The severity and frequency scores of postoperative gastrointestinal symptoms in the TS-RECS group were significantly lower than those in the LWR group. The median follow-up period was 24 months (10–60 months) in the LWR group and 18 months (10–27 months) in the TS-RECS group, and there was in total a single recurrence in the LWR group. TS-RECS appears to be a technically safe and effective surgery with preservation of gastrointestinal function for resection of GSMT resection.

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A Comparative Study of Intralobar Sequestration and Extralobar Pulmonary Sequestration

10.21203/rs.3.rs-963651/v1 ◽

2021 ◽

Author(s):

Xiao Duqing ◽

Wang Gefei ◽

Liang Yalun ◽

Yu Gang ◽

Wu Zhaohong

Keyword(s):

Wedge Resection ◽

Operation Time ◽

Pulmonary Sequestration ◽

Postoperative Recovery ◽

Intralobar Sequestration ◽

Isolated Lung ◽

Microscopic Evaluation ◽

Significant Difference ◽

The Difference ◽

Pulmonary Wedge Resection

Abstract Objective: This study aims to identify the difference between patients who have been diagnosed with either intralobar sequestration (ILS) or extralobar sequestration (ELS).Methods: In this clinical study, 29 children with pulmonary sequestration (PS), diagnosed via physical examination and imaging at our hospital between January 2019 and January 2020, were enrolled. We compared whether statistical differences existed in the blood loss, operative time, and post-operative hospital stay between the two groups (ILS and ELS) after thoracoscopic pulmonary wedge resection.Results: There were no significant differences in gender, operative age, preoperative weight, and isolated lung position between the ILS and ELS groups (p > 0.05). There was significantly more intra-operative bleeding in children with ILS than those with ELS (p < 0.05), and the operation time and postoperative hospitalization times were significantly longer for those with ILS(p < 0.05). Upon microscopic evaluation after surgery, we found the appearance of ILS and ELS to be similar.Conclusion: Different types of congenital PS have different influences onnewborns during and after operation. For children with ILS, surgery is more difficult and the postoperative recovery is slower than for children with ELS. For this reason, we suggest that more attention should be paid to the clinical treatment of children with ILS. Although ILS and ELS present with different manifestations, we found no evidence of a significant difference in the postoperative microscopy of the two conditions.

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Procedural times in early non-intubated VATS program - a propensity score analysis

BMC Anesthesiology ◽

10.1186/s12871-021-01270-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Isabella Metelmann ◽

Johannes Broschewitz ◽

Uta-Carolin Pietsch ◽

Gerald Huschak ◽

Uwe Eichfeld ◽

...

Keyword(s):

Propensity Score ◽

Surgical Procedure ◽

Recovery Time ◽

Propensity Score Analysis ◽

Wedge Resection ◽

University Hospital ◽

Implementation Phase ◽

Score Analysis ◽

Significant Difference ◽

Procedural Time

Abstract Background Non-intubated video-assisted thoracic surgery (NiVATS) has been introduced to surgical medicine in order to reduce the invasiveness of anesthetic procedures and avoid adverse effects of intubation and one-lung ventilation (OLV). The aim of this study is to determine the time effectiveness of a NiVATS program compared to conventional OLV. Methods This retrospective analysis included all patients in Leipzig University Hospital that needed minor VATS surgery between November 2016 and October 2019 constituting a NiVATS (n = 67) and an OLV (n = 36) group. Perioperative data was matched via propensity score analysis, identifying two comparable groups with 23 patients. Matched pairs were compared via t-Test. Results Patients in NiVATS and OLV group show no significant differences other than the type of surgical procedure performed. Wedge resection was performed significantly more often under NiVATS conditions than with OLV (p = 0,043). Recovery time was significantly reduced by 7 min (p = 0,000) in the NiVATS group. There was no significant difference in the time for induction of anesthesia, duration of surgical procedure or overall procedural time. Conclusions Recovery time was significantly shorter in NiVATS, but this effect disappeared when extrapolated to total procedural time. Even during the implementation phase of NiVATS programs, no extension of procedural times occurs.

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Efficacy and factors affecting the choice of enucleation and liver resection for giant hemangioma: a retrospective propensity score-matched study

BMC Surgery ◽

10.1186/s12893-020-00935-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mingguang Ju ◽

Feng Xu ◽

Wenyan Zhao ◽

Chaoliu Dai

Keyword(s):

Liver Resection ◽

Propensity Score ◽

Operation Time ◽

Major Complication ◽

Hepatic Hemangioma ◽

Transfusion Rate ◽

Complication Rates ◽

Factors Affecting ◽

Multiple Tumors ◽

Significant Difference

Abstract Background Liver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial. This study aimed to explore the efficacy and the factors affecting the choice of open procedure for HH. Methods The data for patients with pathologically confirmed HH who underwent open surgery from April 2014 to August 2020 were analyzed retrospectively. Univariate and multivariate analyses with logistic regression were performed to disclose the factors associated with the choice of EN or LR. Propensity score matching (PSM) analysis was used to compare the efficacy of the two procedures. Results A total of 163 and 110 patients were enrolled in the EN and LR groups. Following 1:1 matching by PSM analysis, 66 patients were selected from each group. Centrally located lesions (OR: 0.131, 95% CI 0.070–0.244), tumors size > 12.1 cm (OR: 0.226, 95% CI 0.116–0.439) and multiple tumors (OR: 1.860, 95% CI 1.003–3.449) were independent factors affecting the choice of EN. There was no significant difference in the median operation time (156 vs. 195 min, P = 0.156), median blood loss (200 vs. 220 ml, P = 0.423), blood transfusion rate (33.3% vs. 33.3%, P = 1.000), mean postoperative feeding (3.1 vs. 3.3 d, P = 0.460), mean postoperative hospital stay (9.5 vs. 9.0 d, P = 0.206), or the major complication rates between the two groups. Conclusions Peripherally located lesions, tumors size ≤ 12.1 cm and multiple tumors were more inclined to receive EN. There was no significant difference in the efficacy of EN or LR.

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Gastric schwannoma: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060520957828 ◽

2020 ◽

Vol 48 (9) ◽

pp. 030006052095782

Author(s):

Changsheng Pu ◽

Keming Zhang

Keyword(s):

Wedge Resection ◽

Postoperative Recovery ◽

Postoperative Treatment ◽

Laparoscopic Wedge Resection ◽

Case Presentation ◽

Gastric Tumors ◽

Gastric Schwannoma ◽

History Of ◽

Upper Abdominal

Background Gastric schwannoma is a rarely seen gastric tumor accounting for only 0.2% of all gastric tumors. It is difficult to distinguish a gastric schwannoma from other gastric tumors preoperatively. Case presentation: A 30-year-old man with no significant medical history or physical examination findings presented with a 1-month history of right upper abdominal discomfort. The preoperative diagnosis was a gastrointestinal stromal tumor, but the postoperative pathologic and immunohistochemical examinations confirmed a gastric schwannoma. The patient underwent laparoscopic wedge resection of the stomach without additional postoperative treatment, and his postoperative recovery was uneventful. No recurrence or metastasis was found at the 2-year follow-up examination. Conclusion Although gastric schwannomas are usually not malignant, they are difficult to distinguish from other malignant stromal tumors preoperatively. Surgical resection should be recommended when a schwannoma is malignant or considered to be at risk of becoming malignant.

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Comparison of open and intracorporeal modified ureterosigmoidostomy (Mainz II) after laparoscopic radical cystectomy with bladder cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02148-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Duo Zheng ◽

Junyao Liu ◽

Gongjin Wu ◽

Shujun Yang ◽

Chuang Luo ◽

...

Keyword(s):

Radical Cystectomy ◽

Urinary Diversion ◽

Operation Time ◽

Progression Free Survival ◽

Postoperative Recovery ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Urinary Control

Abstract Objective To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC). Patients and methods We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019. The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by the Kaplan-Meier method. Results Overall, 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients, respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24 ± 3.91 days vs. 18.98 ± 7.41 days, P = 0.033), similar operation time (498.57 ± 121.44 vs. 462.24 ± 99.71, P = 0.175), similar estimated blood loss [400 (200–475) ml vs. 400 (200–700) ml, P = 0.095], and similar overall complication rate within 30 days (19.05% vs. 25.40%, P = 0.848) and 90 days (23.81% vs. 17.46%, P = 0.748). Complete urinary control rate was 87.3% (55/63) in the OMUUD group. In IMUUD, the complete urinary control rate was 90.5% (19/21). There was no significant difference in OS (χ2 = 0.015, P = 0.901) and PFS (χ2 = 0.107, P = 0.743) between the two groups. Conclusion IMUUD postoperative recovery is faster; other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

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P965Prevalence, management strategies and outcomes of patients with coronary chronic total occlusions

European Heart Journal ◽

10.1093/eurheartj/ehz747.0559 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

L Guo ◽

J Wu ◽

L Zhong ◽

R C Huang

Keyword(s):

Propensity Score ◽

Propensity Score Matching ◽

Clinical Outcomes ◽

Cardiac Death ◽

Cardiovascular Health ◽

Artery Bypass ◽

Management Strategies ◽

Chronic Total Occlusions ◽

Significant Difference

Abstract Background Percutaneous coronary intervention (PCI) for coronary chronic total occlusions (CTOs) remains among the biggest challenges in interventional cardiology. However, limited data exist regarding the clinical outcomes of the three potential therapeutic strategies of PCI, coronary artery bypass grafting (CABG), and medical therapy (MT). Aims The aim of this study was to compare the clinical outcomes of CTO patients according to the initial treatment strategy. Methods and results Consecutive patients with at least one coronary CTO from January 2007 to December 2016 in our center were included and categorized as managed either by PCI, CABG, or MT. Propensity-score matching was also performed to adjust for baseline characteristics. The primary outcome was a major adverse cardiac event (MACE), such as cardiac death, myocardial infarction (MI), or target vessel revascularization (TVR). A total of 1655 patients with 1944 CTOs were enrolled in this study. The overall CTO prevalence was 10.5%. A CTO was treated by MT in 800 (48.3%) patients and PCI in 734 (44.4%), while 121 (7.3%) underwent CABG. The median overall follow-up duration was 3.6 (interquartile range = 2.1 to 5.0) years. Patients referred for MT had a higher incidence of MACE (28.0% vs. 17.3% and 12.4%, respectively; all p<0.001) and TVR (16.9% vs. 10.6% and vs. 7.4%, respectively; p<0.001 and = 0.005, respectively) than those managed by PCI and CABG. After propensity-score matching analysis, the rate of PCI was lower than that of MACE (19.2% vs. 28.9%, hazard ratio [HR] = 0.62, 95% confidence interval [CI] = 0.45–0.85, p=0.003) and TVR (HR = 0.53, 95% CI = 0.35–0.79, p=0.002) when compared with MT. There was no significant difference in the prevalence of MACE (18.5% vs. 23.1%, HR = 0.76, 95% CI = 0.53–1.09, p=0.126) or cardiac death (0.51; 0.23–1.15, 0.098) between the successful PCI and MT groups. Conclusions As an initial management strategy for patients with CTOs, PCI or CABG reduced the risk of MACE (driven by TVR), as compared with MT alone on follow-up. However, successful PCI did not reduce the long-term risk of MACE or cardiac death, as compared with MT alone. Acknowledgement/Funding Beijing Municipal Science and Technology Project (Z1611ehz747.05590516139) and BeijingLisheng Cardiovascular Health Foundation (LHJJ20158521)

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A Comparative Study of Laparoscopic versus Open Pancreaticoduodenectomy for Ampulla of Vater Carcinoma

Journal of Clinical Medicine ◽

10.3390/jcm9072214 ◽

2020 ◽

Vol 9 (7) ◽

pp. 2214

Author(s):

Daegwang Yoo ◽

Ki Byung Song ◽

Jong Woo Lee ◽

Kyungyeon Hwang ◽

Sarang Hong ◽

...

Keyword(s):

Propensity Score ◽

Postoperative Morbidity ◽

Operation Time ◽

Ampulla Of Vater ◽

Oncologic Outcomes ◽

Promising Alternative ◽

Significant Difference ◽

Hospital Stays ◽

Grade Ii ◽

Open Pancreaticoduodenectomy

Several studies have compared laparoscopic pancreaticoduodenectomy (LPD) and open pancreaticoduodenectomy (OPD) in patients with periampullary carcinoma; however, only a few studies have made such a comparison on patients with ampulla of Vater cancer (AVC). We compared the perioperative and oncologic outcomes between LPD and OPD in patients with AVC using propensity-score-matched analysis. A total of 359 patients underwent PD due to AVC during the study period (76 LPD, 283 OPD). After propensity score matching, the LPD group showed significantly longer operation time than did the OPD group (400.2 vs. 344.6 min, p < 0.001). Nevertheless, the LPD group had fewer painkiller administrations (8.3 vs. 11.1, p < 0.049), fewer Grade II or more severe postoperative complications (15.9% vs. 34.8%, p = 0.012), and shorter postoperative hospital stays (13.7 vs. 17.3 days, p = 0.048), compared with the OPD group. There was no significant difference in recurrence-free outcomes and overall survival between the two groups (p = 0.754 and 0.768, respectively). Compared with OPD, LPD for AVC had comparative oncologic outcomes with less pain, less postoperative morbidity, and shorter hospital stays. LPD may serve as a promising alternative to OPD in patients with AVC.

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Comparison of sacroplasty with or without balloon assistance for the treatment of sacral insufficiency fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499018782575 ◽

2018 ◽

Vol 26 (2) ◽

pp. 230949901878257 ◽

Cited By ~ 5

Author(s):

Shih-Chieh Yang ◽

Tsung-Ting Tsai ◽

Hung-Shu Chen ◽

Chi-Jung Fang ◽

Yu-Hsien Kao ◽

...

Keyword(s):

Clinical Outcomes ◽

Operation Time ◽

Cement Leakage ◽

Insufficiency Fractures ◽

Radiographic Findings ◽

Injection Volume ◽

Cement Injection ◽

Lower Back ◽

Significant Difference ◽

Sacral Insufficiency Fractures

Purpose: Sacral insufficiency fractures (SIFs) can cause severe lower back pain and immobility, which have limited therapeutic options. No previous studies have compared clinical outcomes and radiographic findings of sacroplasty with or without balloon assistance for the treatment of SIFs. Methods: Forty-five patients with SIFs were divided into two groups. One group had 18 patients treated using sacroplasty with balloon assistance, and the other had 27 patients treated without balloon assistance. The operation time and cement injection volume were compared between these two groups. Clinical outcomes were evaluated using visual analog scale (VAS), Oswestry Disability Index (ODI), and Odom’s criteria. Cement leakage rate was examined by postoperative radiography and computed tomography. Results: Sacroplasty with balloon assistance was associated with significantly longer operative time ( p = 0.003) and larger cement injection volume ( p = 0.038). Cement leakages were found in 4 of 18 patients (22.2%) with balloon assistance and 15 of 27 patients (55.6%) without balloon assistance, which showed significant difference ( p = 0.027). No significant differences were observed between sacroplasty with and without balloon assistance with regard to clinical outcomes including improvement in VAS, ODI, and Odom’s criteria. Conclusions: Sacroplasty with balloon assistance was shown to achieve greater cement injection with longer operation time and can decrease the risk of cement leakage. Both sacroplasty with and without balloon assistance showed good-to-excellent clinical outcomes for the treatment of SIFs.

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Safety and effectiveness of mucosal traction using a snare combined with endoclips to assist the resection of esophageal intraepithelial neoplasia: a propensity score matching analysis

Diseases of the Esophagus ◽

10.1093/dote/doab018 ◽

2021 ◽

Author(s):

Qiang Zhang ◽

Zhou-yang Lian ◽

Jian-Qun Cai ◽

Yang Bai ◽

Zhen Wang

Keyword(s):

Postoperative Complications ◽

Propensity Score ◽

Propensity Score Matching ◽

Operation Time ◽

Intraepithelial Neoplasia ◽

R0 Resection ◽

En Bloc ◽

Propensity Score Matching Analysis ◽

Significant Difference ◽

Traction Group

Summary Currently, the reports on esophageal endoscopic submucosal dissection (ESD) assisted by traction with a snare are rare. Because a snare is a commonly used endoscopic accessory and is easily available, its application in mucosal traction is worth exploring. The present study aims to evaluate the safety and effectiveness of snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia. Cases of esophageal intraepithelial neoplasia resected using ESD in the Digestive Endoscopy Center of Guangzhou Nanfang Hospital, China from June 2013 to March 2019 were retrospectively analyzed. The procedure of snare-endoclip traction-assisted ESD was compared with nontraction-assisted ESD by using a propensity score matching analysis. Operation time, en bloc and R0 resection, intra- and postoperative complications, and surgery-related costs were mainly evaluated. Overall, 99 cases of esophageal intraepithelial neoplasia under tissue biopsy were included in the present study. Further, 22 exact matched pairs were obtained. There were no differences in en bloc and R0 resection rates, intra- and postoperative complications, and costs of disposable surgical accessories between the traction group and the nontraction group. However, median operation time showed a significant difference: traction group, 50.0 min (range, 20–100 min); nontraction group, 70.0 min (range, 35–133 min), P=0.012. In conclusion, snare-endoclip traction-assisted ESD for esophageal intraepithelial neoplasia was safe and shortened operation time in the study, thereby improving the efficiency of ESD. Despite the additional use of a snare and endoclips for traction, the total costs of endoscopic accessories seemed not to be increased.

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Postoperative Clinical Outcomes of Thoracoscopic Surgery under Local Anesthesia in Patients with Primary Spontaneous Pneumothorax

Applied Sciences ◽

10.3390/app11041468 ◽

2021 ◽

Vol 11 (4) ◽

pp. 1468

Author(s):

Eunji Kim ◽

Chi-Seung Lee ◽

Jeong Su Cho ◽

Hoseok I ◽

Yeong Dae Kim ◽

...

Keyword(s):

Surgical Technique ◽

Clinical Outcomes ◽

Local Anesthesia ◽

Spontaneous Pneumothorax ◽

Thoracoscopic Surgery ◽

Wedge Resection ◽

Operation Time ◽

Postoperative Recurrence ◽

Primary Spontaneous Pneumothorax ◽

Anesthetic Technique

(1) Background: since the technologies of anesthesia and surgery were advanced, video-assisted thoracic surgery (VATS) under local anesthesia (LA) has been widely carried out and is considered a robust surgical technique to prevent the recurrence of pneumothorax in patients with recurrent primary spontaneous pneumothorax (PSP). In this study, postoperative clinical outcomes were compared to evaluate the feasibility and efficacy of VATS under LA compared with general anesthesia (GA) in patients with PSP. (2) Methods: 255 patients underwent wedge resection underwent VATS for PSP in our hospital from January 2014 to June 2019. Of them, 30 patients underwent the operation under LA and the others underwent the operation under GA. Except for the anesthesia method, the same surgical technique was adopted for all patients. All medical records were retrospectively reviewed. (3) Results: the total operation time and total hospital days were relatively shorter, post-chest tube drainage was significantly shorter (0.04), and visual analog scale (VAS) scores in the outpatient clinic were significantly lower in the LA group than in the GA group (p = 0.01). The incidence of postoperative recurrence after discharge in the LA group (3.3%) was also lower than in the GA group (18.67%) (p = 0.001). In the LA group, there were no cases of conversion to intubation. (4) Conclusions: our results showed relatively better clinical outcomes in VATS under LA with sedation than under GA in the treatment of PSP. Hence, LA with sedation can be considered as a robust anesthetic technique for VATS and as applicable in the surgical treatment of PSP.

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