Mo1384 Long Term Outcomes, Recurrence RATES and Complications of Endoscopic Ampullectomy for Ampullary Lesions

Abstract Aim High quality operations with low rates of tumour perforation and circumferential resection margin (CRM) positivity are associated with improved long-term outcomes following surgery for rectal cancer. Previous audit has demonstrated lower rates of tumour perforation and CRM positivity by a single surgeon compared to the published standards. Our aim is to re-audit this surgeons’ outcomes for curative rectal resections. Methods Data was collected retrospectively for all potentially curative rectal resections over a 5-year period performed by a single surgeon using a local database and electronic care records. The CRM status and tumour perforation status were considered. Other end points included the rate of local recurrence, survival and length of stay. Results Fifty-one patients underwent rectal resections with curative intent, with a median age of 67. Complete resection (R0) was achieved in 94.1% of cases; 3.92% were found to have nodes less than 1mm from the margin and 1.96% were found to have tumour deposit less than 1mm from the margin – these cases were considered to be an R1 resection. Tumour perforation was present in 3.92% of cases, all of which had occurred pre-operatively. Local recurrence was found in 5.88% of cases and 90-day mortality was 1.96%. Median length of hospital stay was 7 days. Conclusion Our data demonstrates sustained high quality surgical outcomes with low tumour perforation rates and CRM positivity rates which compare favourably with the published standards to date. Local recurrence rates are comparable to published standards and 90-day mortality continues to be low.

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Surgical Treatment of Chiari I Malformation—Analysis of Intraoperative Findings, Complications, and Outcome for 371 Foramen Magnum Decompressions

Neurosurgery ◽

10.1227/neu.0b013e31825c3426 ◽

2012 ◽

Vol 71 (2) ◽

pp. 365-380 ◽

Cited By ~ 98

Author(s):

Jörg Klekamp

Keyword(s):

Clinical Symptoms ◽

Foramen Magnum ◽

Chiari I Malformation ◽

Outcome Data ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Surgical Morbidity ◽

Suboccipital Craniectomy ◽

Chiari I

Abstract BACKGROUND: Foramen magnum decompression is widely accepted as the treatment of choice for Chiari I malformation. However, important surgical details of the procedure are controversial. OBJECTIVE: This study analyzes 371 decompressions focusing on intraoperative findings, analysis of complications, and long-term outcomes. METHODS: Among 644 patients between 1985 and 2010, 359 patients underwent 371 decompressions. Surgery for symptomatic patients consisted of suboccipital craniectomy, C1 laminectomy, arachnoid dissection, and duraplasty. Short-term results were determined after 3 months; long-term outcomes were evaluated with Kaplan-Meier statistics. RESULTS: The mean age was 40 ± 16 years; mean follow-up was 49 ± 56 months; 75.8% demonstrated syringomyelia. The complication rate was 21.8% with permanent surgical morbidity of 3.2% and surgical mortality of 1.3%. Of the patients, 73.6% reported improvement after 3 months; 21% were unchanged. Overall, 14.3% demonstrated a neurological deterioration within 5 years and 15.4% within 10 years. The severity of neurological symptoms correlated with the grade of arachnoid pathology. Outcome data correlated with the number of previous decompressions, severity of arachnoid pathology, handling of the arachnoid, type of duraplasty, and surgical experience. First-time decompressions with arachnoid dissection and an alloplastic duraplasty resulted in surgical morbidity for 2.0%, a 0.9% mortality rate, postoperative improvement after 3 months for 82%, and neurological recurrence rates of 7% after 5 years and 8.7% after 10 years. CONCLUSION: Arachnoid pathology in Chiari I malformation has an impact on clinical symptoms and postoperative results. Decompressions with arachnoid dissection and an alloplastic duraplasty performed by surgeons experienced with this pathology offer a favorable long-term prognosis.

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Two-center Analysis of Long-term Outcomes after High Ligation Inguinal Hernia Repair in Adolescents

The American Surgeon ◽

10.1177/000313481508101229 ◽

2015 ◽

Vol 81 (12) ◽

pp. 1260-1262 ◽

Cited By ~ 4

Author(s):

Alessandra C. Gasior ◽

E. Marty Knott ◽

Arielle Ranters ◽

Shawn D. Peter ◽

Todd A. Ponsky

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Recurrent Hernia ◽

High Ligation ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Hernia Sac ◽

Telephone Surveys ◽

Low Incidence

High ligation of the inguinal hernia sac is standard practice for many pediatric surgeons in post-pubertal adolescents. Most adult surgeons do not use this technique to repair indirect inguinal hernias because of concerns for higher recurrence rates compared with mesh repairs. Therefore, we examined long-term outcomes of adolescent high ligation hernia repair performed by pediatric surgeons. Telephone surveys were conducted on children over 12 years old at the time of repair, and patients and/or their parents were contacted 18 months postrepair. Patients were identified from two institutions between 1998 and 2010. The incidences of reoperation, recurrence, presence of bulge, chronic pain, or numbness were determined. A total of 210 patients (40.7% response rate) were available for phone interviews at 18.6 to 159.5 months postrepair. Mean age was 14.6 ± 1.8 (range: 12.0–19.0 years). Fourteen patients had pain (6.7%) and five had numbness (2.4%). There were four (1.9%) patients with a second operation, two of which confirmed a recurrent hernia. Three patients expressed concern about possible recurrence. Two report a bulge, but have not been evaluated. Pediatric hernia repair with high sac ligation appears effective in patients anatomically similar to adults with low recurrence rate and low incidence of chronic symptoms. These data suggest that prospective trials on the adequacy of high ligation in adults are warranted.

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Management of colorectal anastomotic stricture with multidiameter balloon dilation: long-term results

Techniques in Coloproctology ◽

10.1007/s10151-020-02318-2 ◽

2020 ◽

Vol 24 (12) ◽

pp. 1271-1276

Author(s):

R.-H. Chan ◽

S.-C. Lin ◽

P.-C. Chen ◽

W.-T. Lin ◽

C.-H. Wu ◽

...

Keyword(s):

Anastomotic Stricture ◽

Balloon Dilation ◽

Long Term Results ◽

Endoscopic Dilation ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Aggressive Management ◽

Anastomotic Strictures

Abstract Background Postoperative colorectal anastomotic strictures are quite common. As such, many techniques have been available to address such a problem, one of which is endoscopic dilation. The aim of the present study was to evaluate the long-term outcomes following endoscopic dilation using a multidiameter balloon. Methods A retrospective study was conducted on patients with postoperative anastomotic stenosis treated with endoscopic dilation using a multidiameter balloon at our institution, in January 2005–December 2019 were retrospectively reviewed, excluding those with tumor recurrence. Perioperative factors, complications, and recurrence rates were analyzed. Results There were 40 patients, (22 males and 18 females, mean age 64.6 ± 10.7 years, range 33–84 years). The median follow-up period was 56 months (interquartile range 22.5–99 months). Only 1 complication occurred, micro-perforation due to guided wire injury, which was managed conservatively. Five (12.5%) patients developed restenosis and underwent repeat balloon dilation. None of the five recurrences required more aggressive management, such as redo anastomosis. Conclusions Endoscopic multidiameter balloon dilation is a safe and effective method for treating benign colorectal anastomotic strictures.

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Enteroplication in cats with intussusception: a retrospective study (2001–2016)

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x18786599 ◽

2018 ◽

Vol 21 (6) ◽

pp. 488-494 ◽

Cited By ~ 1

Author(s):

Georg Haider ◽

Katharina Leschnik ◽

Nikola Katic ◽

Gilles Dupré

Keyword(s):

Medical Records ◽

Clinical Signs ◽

Long Term Outcomes ◽

Short Term ◽

Recurrence Rates ◽

Initial Surgery ◽

Duration Of Surgery ◽

Previously Treated ◽

Short And Long Term

Objectives The aim of this study was to report complications, as well as short- and long-term clinical outcomes of cats suffering from surgically reduced intussusception with and without enteroplication. Methods Medical records of cats presented at our institution with intussusception between 2001 and 2016 were reviewed. The following data were retrieved: signalment; history; physical examination; diagnostic imaging, surgical and histological findings; and outcomes. Animals were grouped as with or without enteroplication. Duration of surgery, survival, complication and recurrence rates, duration of hospitalisation, and short- and long-term outcomes were compared. Results Cats with intussusception presented with unspecific type and duration of clinical signs. Male or male castrated cats and Maine Coons were over-represented in both groups. Enteroplication was performed in 48% (10/21) of the cats. Cats in the enteroplication group were significantly younger than those in the non-enteroplication group ( P = 0.023). Duration of surgery, time of hospitalisation, complication rate and outcomes did not differ between the two groups. Two complications in the short term and one complication in the long term were possibly associated with enteroplication. A recurrence of intussusception was seen in 2/17 cats approximately 12 months after initial surgery, both previously treated with enteroplication. Conclusions and relevance Although the number of cases was limited, our results suggest that enteroplication should be cautiously performed in cats with intussusception as it may be associated with major complications in the short and long term, and its efficacy remains unclear. Based on this study, the need for enteroplication in cats following a correction of intussusception could be questioned.

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Long-Term Outcomes and Evaluation of Hepatocellular Carcinoma Recurrence after Hepatitis C Virus Eradication by Direct-Acting Antiviral Treatment: All Kagawa Liver Disease Group (AKLDG) Study

Cancers ◽

10.3390/cancers13092257 ◽

2021 ◽

Vol 13 (9) ◽

pp. 2257

Author(s):

Joji Tani ◽

Tomonori Senoh ◽

Akio Moriya ◽

Chikara Ogawa ◽

Akihiro Deguchi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Antiviral Treatment ◽

Survival Rates ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Virus Eradication ◽

Direct Acting Antiviral ◽

Direct Acting ◽

Hcc Recurrence

There are limited studies that have evaluated the long-term outcomes in patients with hepatocellular carcinoma (HCC) recurrence after direct-acting antiviral (DAA) treatment. In this retrospective study, we aimed to investigate the recurrence rates, recurrence factors, and prognosis of 130 patients who were treated with IFN-free DAA treatment after treatment for HCC. The median observation time was 41 ± 13.9 months after DAA treatment. The recurrence rates of HCC were 23.2%, 32.5%, 46.3%, and 59.4% at 6, 12, 24, and 36 months, respectively. A multivariate analysis showed that palliative treatment prior to DAA treatment (HR = 3.974, 95% CI 1.924–8.207, p = 0.0006) and alpha-fetoprotein at sustained virological response 12 (HR = 1.048, 95% CI 1.016–1.077, p = 0.0046) were associated with independent factors for HCC recurrence (HCC-R). The 12-, 24-, and 36-month overall survival rates were 97.6%, 94.0%, and 89.8%, respectively. The 12-, 24-, and 36-month survival rates of the non-recurrence and recurrence groups were 97.7%, 97.7%, and 94.1% and 97.6%, 92.3%, and 87.9%, respectively (p = 0.3404). The size of the main tumor lesion and the serological data were significantly improved at the time of HCC-R after DAA treatment. This study showed an improved prognosis regardless of recurrence rate, which suggests that DAA treatment in HCV patients should be considered.

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Long-Term Outcomes after Elective versus Emergency Surgery for Small Bowel Neuroendocrine Tumors

The American Surgeon ◽

10.1177/000313481808401006 ◽

2018 ◽

Vol 84 (10) ◽

pp. 1570-1574 ◽

Cited By ~ 4

Author(s):

Nicholas Manguso ◽

Alexandra Gangi ◽

Nicholas Nissen ◽

Attiya Harit ◽

Emily Siegel ◽

...

Keyword(s):

Small Bowel ◽

Lymph Nodes ◽

Neuroendocrine Tumors ◽

Emergency Surgery ◽

Disease Free Survival ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Elective Resection ◽

Significant Difference

Small bowel neuroendocrine tumors (SBNETs) are often indolent, but occasionally, patients present with acute symptoms requiring emergent operative intervention. Our aim was to determine whether emergency surgery for SBNETs affects long-term outcomes. An institutional database was reviewed to identify patients with SBNET diagnosed between 1990 and 2015. Need for emergency resection (ER) was compared with elective resection (ELR). One hundred and thirty-four patients met inclusion criteria. Median age was 59 years (range, 21–91), and median tumor size was 1.5 cm (range, 0.1–5). Median follow-up time was 5.5 years. One hundred (74.6%) patients had ELR, whereas 34 (25.4%) required ER. ELR had a higher number of lymph nodes resected (median 12.5 vs 8 ER, P = 0.04); however, there was no difference in the number of positive nodes (median 3 vs 2, P = 0.85). There were 45 (33.6%) recurrences (31 [31.0%] ELR vs 14 [41.7%] ER, P = 0.29) and 13 (9.7%) deaths (7 [7.0%] ELR; 6 [17.6%] ER). There was no significant difference in 5-year disease-free survival (ELR 72.6% vs ER 77.9%, P = 0.71) or overall survival (ELR 97.2% vs ER 96.6%, P = 0.81). Although patients undergoing ER have significantly fewer lymph nodes resected, they have comparable recurrence rates and long-term outcomes with those patients undergoing ER.

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An evaluation of long-term outcomes and recurrence rates in patients with morphea

International Journal of Dermatology ◽

10.1111/ijd.14401 ◽

2019 ◽

Vol 58 (4) ◽

pp. E90-E92 ◽

Cited By ~ 3

Author(s):

Noureddine Litaiem ◽

Takwa Bacha ◽

Haifa Drissi ◽

Faten Zeglaoui

Keyword(s):

Long Term Outcomes ◽

Recurrence Rates

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Remote magnetic navigation shows superior long-term outcomes in pediatric atrioventricular (nodal) tachycardia ablation compared to manual radiofrequency and cryoablation

EP Europace ◽

10.1093/europace/euab116.072 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

AME Noten ◽

JAE Kammeraad ◽

S Wijchers ◽

IM Van Beynum ◽

M Balinghaus ◽

...

Keyword(s):

Heart Disease ◽

Pediatric Patients ◽

Structural Heart Disease ◽

Complication Rates ◽

Magnetic Navigation ◽

Rf Ablation ◽

Long Term Outcomes ◽

Recurrence Rates ◽

Remote Magnetic Navigation

Abstract Funding Acknowledgements Type of funding sources: None. Introduction – Catheter ablation (CA) is a first-choice treatment for tachyarrhythmia in pediatric patients. The currently available CA techniques differ in manner of catheter steering technique and energy sources. There are no large studies comparing long-term outcomes between the available CA techniques in pediatric patients with atrioventricular reentry (also known as accessory pathway mediated) tachycardia (AVRT) or atrioventricular nodal reentry tachycardia (AVNRT) mechanisms. Objective – The aim of this study was to compare procedural parameters and outcomes of remote magnetic navigation-guided radiofrequency (RF) ablation (RMN), manual-guided RF ablation (MAN) and manual-guided cryoablation (CRYO). Methods – This single-center, retrospective study included all first consecutive CA procedures for AVRT or AVNRT mechanisms performed in pediatric patients with no structural heart disease from January 2008 until June 2019. Three study groups were defined by the ablation technique used: RMN, MAN or CRYO. Primary outcome was recurrence of tachyarrhythmia and/or pre-excitation on ECG. Baseline clinical parameters, procedure times and complication rates were also evaluated. Results – In total, we included 223 patients, aged 13.8 ± 2.8 years, with a mean weight of 55.6 ± 14 kilograms. In total, 108 procedures were performed using RMN, 76 using MAN and 39 using Cryo. RMN had the lowest recurrence rates at a mean follow-up of 5.5 ± 2.9 years (AVRT ablation: 4% vs. 16% vs. 55%, P < 0.001; AVNRT ablation: 8% vs. 8% vs. 36%, P = 0.008; for RMN vs. MAN vs. CRYO respectively). In AVRT ablation, procedure and fluor times were comparable between groups. However, in AVNRT ablation, RMN and MAN had significantly lower fluoroscopy times compared to Cryo (10 (IQR 7-14) vs. 9 (IQR 6-26) vs. 15 (IQR 10-22) minutes respectively, P = 0.040). Moreover, procedure times were shortest in MAN and second in RMN ablation (101 (IQR 87-121) vs. 88 (IQR 62-99) vs. 120 (IQR 88-143) minutes respectively, P = 0.018). We observed minor complications in 3 patients (1%), which were comparable between groups and no major complications. Conclusion – In pediatric patients with no structural heart disease who underwent their first AV(N)RT ablation, RMN has the most favorable long-term outcomes, in addition to favorable fluoroscopy and procedure times. Abstract Figure. AVRT and AVNRT ablation recurrence rates

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