Long-term outcomes of endoscopic endonasal conjunctivodacryocystorhinostomy with Jones tube placement: A thirteen-year experience

Background Parasellar invasion of pituitary adenomas (PAs) into the cavernous sinus (CS) is common. The management of the CS component of PA remains controversial. Objective The objective of this study was to analyze CS involvement in PA treated with endoscopic endonasal approaches, including incidence, surgical risks, surgical strategies, long-term outcomes, and our treatment algorithm. Methods We reviewed a series of 176 surgically treated PA with particular attention to CS involvement and whether the CS tumor was approached medial or lateral to the internal carotid artery. Results The median duration of follow-up was 36 months. Macroadenomas and nonfunctional adenomas represented 77 and 60% of cases, respectively. CS invasion was documented in 23% of cases. CS involvement was associated with a significantly diminished odds of gross total resection (47 vs. 86%, odds ratio [OR]: 5.2) and increased the need for subsequent intervention (4 vs. 40%, OR: 14.4). Hormonal remission was achieved in 15% of hormonally active tumors. Rates of surgical complication were similar regardless of CS involvement. Conclusion Our tailored strategy beginning with a medial approach and adding lateral exposure as needed resulted in good outcomes with low morbidity in nonfunctional adenomas. Functional adenomas involving the CS were associated with low rates of hormonal remission necessitating higher rates of additional treatment.

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Long-Term Outcomes Following Percutaneous Cholecystostomy Tube Placement for Treatment of Acute Calculous Cholecystitis

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-017-3375-4 ◽

2017 ◽

Vol 21 (5) ◽

pp. 761-769 ◽

Cited By ~ 28

Author(s):

Donna Marie L. Alvino ◽

Zhi Ven Fong ◽

Colin J. McCarthy ◽

George Velmahos ◽

Keith D. Lillemoe ◽

...

Keyword(s):

Tube Placement ◽

Percutaneous Cholecystostomy ◽

Long Term Outcomes ◽

Acute Calculous Cholecystitis ◽

Cholecystostomy Tube ◽

Percutaneous Cholecystostomy Tube ◽

Calculous Cholecystitis

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Image-Guided Cholecystostomy Tube Placement: Short- and Long-Term Outcomes of Transhepatic Versus Transperitoneal Placement

American Journal of Roentgenology ◽

10.2214/ajr.18.19669 ◽

2019 ◽

Vol 212 (1) ◽

pp. 201-204 ◽

Cited By ~ 6

Author(s):

Michael D. Beland ◽

Lakir Patel ◽

Sun H. Ahn ◽

David J. Grand

Keyword(s):

Tube Placement ◽

Long Term Outcomes ◽

Image Guided ◽

Short And Long Term ◽

Cholecystostomy Tube

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Long-term outcomes with concurrent carboplatin, paclitaxel, and radiation therapy in locally advanced, inoperable head and neck cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.6032 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 6032-6032

Author(s):

R. L. Ferris ◽

S. S. Agarwala ◽

E. Cano ◽

D. E. Heron ◽

J. Johnson ◽

...

Keyword(s):

Head And Neck ◽

External Beam Radiotherapy ◽

Objective Response ◽

Locally Advanced ◽

Tube Feeding ◽

Stage Iv ◽

Tube Placement ◽

Long Term Outcomes ◽

Brachytherapy Boost

6032 Background: Our goal was to evaluate long-term outcomes of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with carboplatin, paclitaxel, and radiotherapy. Methods: We conducted a phase II trial in inoperable patients with locally advanced SCCHN. Carboplatin 100 mg/m2 and paclitaxel 40 mg/m2 were administered intravenously once a week during external beam radiotherapy (once daily, 180 cGy/fraction) for 6–7 weeks. Interstitial brachytherapy was used as a boost in selected patients with primary malignancies of the oral cavity and the oropharynx. Results: 55 patients were enrolled. 52 patients (95%) had stage IV and 51 (93%) had technically unresectable disease; 62% had an oropharyngeal primary site. 21 patients underwent brachytherapy boost. Grade 3 or 4 mucositis occurred in 30% of patients. One death occurred during treatment; it was related to complications of gastrostomy tube (G-tube) placement. Forty of 50 evaluable patients (80%) had an objective response, with a complete response rate of 52%. With a median follow-up of 69 months years for surviving patients, the 5-year progression-free survival (PFS) was 36% and the 5-year overall survival (OS) was 35%. Two of the 18 long-term survivors of >50 months were G-tube feeding dependent. Patients undergoing brachytherapy boost (n=21) had similar outcomes compared with the rest of the patients. In multivariate analysis, baseline hemoglobin levels and N stage were predictive of survival. Conclusion: Treatment with concurrent carboplatin, paclitaxel and radiation is safe and offers curative potential for poor prognosis patients with locally advanced SCCHN. No significant financial relationships to disclose.

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The Feeding Access Consult

Surgical Palliative Care ◽

10.1093/med/9780190858360.003.0023 ◽

2019 ◽

pp. 284-292

Author(s):

Christine Toevs

Keyword(s):

Palliative Medicine ◽

Feeding Tube ◽

Tube Placement ◽

Long Term Outcomes ◽

Goals Of Care ◽

Financial Costs ◽

Short And Long Term ◽

Feeding Tube Placement

The feeding access consult is often the bane of every surgeon. We are either a technician or someone who delays the discharge for a goals-of-care discussion. This chapter gives the surgeon the resources necessary to understand when a feeding tube may be beneficial for the patient and when it is not indicated. This chapter reviews the complications of feeding tube placement and its role in dementia and cancer. This chapter also discusses comfort feeds, financial costs, and the role of palliative medicine in the feeding access consult. The information presented is useful for the surgeon for understanding the short- and long-term outcomes of placement of a feeding tube and guiding discussions with colleagues, patients, and families about the realities of feeding access.

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