National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7 cm: Adherence to Changes in Guidelines May Improve Overall Survival

Studied herein are the long-term results after surgical treatment of stage cT1 kidney cancer. The study includes 278 surgeries for kidney tumors. Partial nephrectomy was performed in 199 (71.6%) cases and radical nephrectomy in 79 (28.4%). Surgeries were performed using the open, laparoscopic, and robotic approaches. Surgical treatment and long-term oncological results were studied. Open approach for partial nephrectomy was used in 2.01% of cases, laparoscopic in 27.64%, and robotic in 70.34%; and radical nephrectomy in 2.53%, 87.34%, and 10.13%, respectively. Incidence postoperative complications after partial and radical nephrectomy were 16.58% and 3.8%, respectively. Сomplications (Clavien Dindo 3) occurred in 11.56% and 3.8% cases, respectively. Positive surgical margin occurred after partial nephrectomy in 1.51%, whereas undetermined for radical nephrectomy. The 5-year disease-free survival for partial and radical nephrectomy was 94.98 1.77% vs. 86.96% 4.11%; 5-year overall survival was 96.2% 1.55% vs. 88.15% 3.96%; 10-year overall survival was 90.82% 4.19% vs. 76.32 6.1%; and 5-year cancer-specific survival was 99.16% 0.84% vs. 94.09% 2.87%, respectively. Our study demonstrates that partial nephrectomy is a safe and effective method for surgical treatment in stage cT1 kidney cancer. A minimally invasive approach is a priority. The nephron-sparring technique demonstrates superior long-term results compared with radical nephrectomy.

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Surgical management and prognostic factors in liver metastases from kidney cancer

Annaly khirurgicheskoy gepatologii = Annals of HPB surgery ◽

10.16931/1995-5464.2020118-26 ◽

2020 ◽

Vol 25 (1) ◽

pp. 18-26

Author(s):

I. S. Proskuryakov ◽

Yu. I. Patyutko ◽

A. G. Kotelnikov ◽

D. V. Podluzhny ◽

A. N. Polyakov ◽

...

Keyword(s):

Overall Survival ◽

Prognostic Factors ◽

Surgical Treatment ◽

Liver Metastases ◽

Kidney Cancer ◽

Univariate Analysis ◽

Hepatic Metastases ◽

Long Term Results ◽

Maximum Diameter

Aim. To evaluate short- and long-term results of surgical treatment of the liver metastases from kidney cancer, to identify prognostic factors.Materials and methods. The retrospective study included 67 patients who underwent surgical treatment for liver metastases from kidney cancer from 1990 to 2019. A total of 71 operations on the liver were performed (53 economical resections, 15 extensive resections, 3 radiofrequency thermoablation). Four of them were repeated for the development of metastases in the liver remant.Results. Postoperative morbidity was 30%. There was one (1,5%) intraoperative death. Within 90 days after surgery, all patients were alive. The 5-year overall survival was 64%, median was 73 months. Univariate analysis revealed factors that significantly worsened overall survival: stage III and IV kidney cancer at the time of nephrectomy; nonclear cell histological type of metastases; synchronous liver metastases; intraoperative blood loss more than 2000 ml. Gender, age (≥ 65 years) at the time of surgery, number of metastases, maximum diameter of the metastases, presence of extrahepatic disease and major liver resection did not have a statistically significant impact on overall survival.Conclusions. Surgical treatment allows to achieve long-term overall survival of patients with liver metastases from kidney cancer. Higher indicators of overall survival were noted in the clear-cell variant of kidney cancer, stage I–II, and the metachronic nature of hepatic metastases. Patients with large (≥4 cm) and multiple resectable liver metastases, having solitary and single metastases in other organs, provided that they are radically removed, can also be considered as candidates for surgical treatment.

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Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

The American Surgeon ◽

10.1177/0003134821995060 ◽

2021 ◽

pp. 000313482199506

Author(s):

Youngbae Jeon ◽

Kyoung-Won Han ◽

Won-Suk Lee ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Nonsurgical Treatment ◽

Perioperative Outcomes ◽

Rank Test ◽

Kaplan Meier ◽

Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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ASO Visual Abstract: Merkel Cell Carcinoma—Changing Practice Patterns and Impact on Recurrence-Free and Overall Survival at a Single Institution and Nationally

Annals of Surgical Oncology ◽

10.1245/s10434-021-10784-7 ◽

2021 ◽

Author(s):

Andrew Esposito ◽

Daniel Jacobs ◽

Stephan Ariyan ◽

Anjela Galan ◽

Harriet Kluger ◽

...

Keyword(s):

Overall Survival ◽

Cell Carcinoma ◽

Merkel Cell Carcinoma ◽

Practice Patterns ◽

Merkel Cell ◽

Single Institution ◽

Changing Practice

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Surgery for Parkinson disease in the United States, 1996 to 2000: practice patterns, short-term outcomes, and hospital charges in a nationwide sample

Journal of Neurosurgery ◽

10.3171/jns.2003.99.5.0863 ◽

2003 ◽

Vol 99 (5) ◽

pp. 863-871 ◽

Cited By ~ 60

Author(s):

Emad N. Eskandar ◽

Alice Flaherty ◽

G. Rees Cosgrove ◽

Leslie A. Shinobu ◽

Fred G. Barker

Keyword(s):

Surgical Treatment ◽

Parkinson Disease ◽

Practice Patterns ◽

The United States ◽

Hospital Charges ◽

Short Term ◽

Content Type ◽

The Us ◽

Fine Print ◽

Deep Brain

Object. The surgical treatment of Parkinson disease (PD) has undergone a dramatic shift, from stereotactic ablative procedures toward deep brain stimulaion (DBS). The authors studied this process by investigating practice patterns, mortality and morbidity rates, and hospital charges as reflected in the records of a representative sample of US hospitals between 1996 and 2000. Methods. The authors conducted a retrospective cohort study by using the Nationwide Inpatient Sample database; 1761 operations at 71 hospitals were studied. Projected to the US population, there were 1650 inpatient procedures performed for PD per year (pallidotomies, thalamotomies, and DBS), with no significant change in the annual number of procedures during the study period. The in-hospital mortality rate was 0.2%, discharge other than to home was 8.1%, and the rate of neurological complications was 1.8%, with no significant differences between procedures. In multivariate analyses, hospitals with larger annual caseloads had lower mortality rates (p = 0.002) and better outcomes at hospital discharge (p = 0.007). Placement of deep brain stimulators comprised 0% of operations in 1996 and 88% in 2000. Factors predicting placement of these devices in analyses adjusted for year of surgery included younger age, Caucasian race, private insurance, residence in higher-income areas, hospital teaching status, and smaller annual hospital caseload. In multivariate analysis, total hospital charges were 2.2 times higher for DBS (median $36,000 compared with $12,000, p < 0.001), whereas charges were lower at higher-volume hospitals (p < 0.001). Conclusions. Surgical treatment of PD in the US changed significantly between 1996 and 2000. Larger-volume hospitals had superior short-term outcomes and lower charges. Future studies should address long-term functional end points, cost/benefit comparisons, and inequities in access to care.

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PS01.184: ESOPHAGEAL CANCER SURGICAL TREATMENT IN BRAZILIAN NATIONAL CANCER INSTITUTE: 25 YEARS EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.184 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 102-102

Author(s):

Marco Antonio Guimaraes Filho ◽

Flávio Sabino ◽

Daniel Fernandes ◽

Carlos Eduardo Pinto ◽

Luis Felipe Pinto ◽

...

Keyword(s):

Overall Survival ◽

Esophageal Cancer ◽

Surgical Treatment ◽

Surgical Resection ◽

National Cancer Institute ◽

Conflicts Of Interest ◽

Morbidity Rate ◽

Surgical Mortality ◽

Surgical Morbidity ◽

Hospitalization Time

Abstract Background Esophageal cancer is the 8th most common cancer in the world. It is an lethal disease, responsible for almost 400.000 deaths by year. Surgical resection is considered the gold standard in esophageal cancer treatment, with a global 15–40% cure rate. In this study, the results of esophageal cancer surgical treatment at Brazilian National Cancer Institute, Abdominal-pelvic Surgical Section, is analyzed. Methods The medical records of 215 patients with esophageal cancer, treated with surgical resection (esophagectomy), between January 1999 and December 2015, were retrospectively studied. The endpoints analyzed in the study were: hospitalization time, operative complications and mortality, and overall survival. Results Esophageal cancer was predominant in male patients; median age was 58 years (27–78). Primary tumor location varied between 7,5 - 41 cm (median 32cm) and tumor extension 1 - 16cm (median 5cm). Median surgical time was 330 minutes (120–720); transhiatal esophagectomy with gastric tube reconstruction was the most used surgical approach. Tumors histopathological types were equaly distributed. ICU (Intensive Care Unit) stay median time was 5 days (1–87) and median hospitalization time was 15 days (5–166). Most common surgical complications were anastomotic leakage (25,5%) and pneumonia (20%), with a surgical morbidity rate of 61,8%. Surgical mortality rate was 12%, with 61% of these cases occuring in the 30 days after surgery. Median 2-year overall survival was 44,3 months. Conclusion Besides the high surgical morbidity, esophagectomy for esophageal cancer remains the standard treatment for patients with ressectable tumors and without clinical contraindications for surgery. Reduction of surgical mortality depends on rigorous patients selection, surgical team expertise and adequate perioperative and postoperative care. Disclosure All authors have declared no conflicts of interest.

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The Impact of Prolonged Mechanical Ventilation on Overall Survival in Patients With Surgically Treated Brain Metastases

Frontiers in Oncology ◽

10.3389/fonc.2021.658949 ◽

2021 ◽

Vol 11 ◽

Author(s):

Patrick Schuss ◽

Niklas Schäfer ◽

Christian Bode ◽

Valeri Borger ◽

Lars Eichhorn ◽

...

Keyword(s):

Mechanical Ventilation ◽

Overall Survival ◽

Surgical Treatment ◽

Brain Metastases ◽

Prolonged Mechanical Ventilation ◽

Postoperative Phase ◽

Significant Prognostic Factor ◽

Cancer Disease ◽

Definition Of ◽

The Impact

ObjectiveSurgical resection represents a common treatment modality in patients with brain metastasis (BM). Postoperative prolonged mechanical ventilation (PMV) might have an enormous impact on the overall survival (OS) of these patients suffering from advanced cancer disease. We therefore have analyzed our institutional database with regard to a potential impact of PMV on OS of patients who had undergone surgery for brain metastases.Methods360 patients with surgically treated brain metastases were included. The definition of PMV consisted of postoperative mechanical ventilation lasting for more than 48 hours. Analysis of survival incorporating established prognostic factors such as age, location of BM, and preoperative physical status was performed.Results14 of 360 patients with BM (4%) suffered from postoperative PMV after surgical treatment of BM. Patients with PMV presented in a significantly more impaired neurological condition preoperatively than patients without (p<0.0001). Multivariate analysis determined PMV to be a significant prognostic factor for OS after surgical treatment in patients with BM, independent of other predictive factors (p<0.0001).ConclusionsThe present study demonstrates postoperative PMV as significantly related to poor OS in patients with surgically treated BM. Postoperative PMV is a so far underestimated prognostic predictor, but might be utilized for optimized patient management early in the postoperative phase. For this purpose, the results of the present study should encourage the initiation of further scientific efforts.

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