A third decade's experience with the gastric pull-up operation for hypopharyngeal carcinoma: changing patterns of use

1999 ◽  
Vol 113 (3) ◽  
pp. 241-243 ◽  
Author(s):  
B. E. J. Hartley ◽  
I. D. Bottrill ◽  
D. J. Howard
Keyword(s):  
Soft Tissues ◽  
Survival Rates ◽  
Free Flaps ◽  
Hypopharyngeal Carcinoma ◽  
Term Survival ◽  
Palliative Procedure ◽  
Patterns Of Use ◽  
Kaplan Meier ◽  
Gastric Transposition ◽  
Changing Patterns

AbstractGastric transposition has been used extensively in this department since 1965 for reconstruction following pharyngolaryngoesophagectomy (PLO). A previous report by Harrison and Thompson in 1986 detailed our experience with 101 cases dating back to 1965. Here we review our experience between 1986–1996.Medical records of 41 cases were examined. The primary site and stage of tumour and associated lymph nodes, patient demographics, complications, in-patient mortality and survival as demonstrated by the Kaplan-Meier method were recorded.Gastric transposition is now used for more extensive tumours: 70 per cent T4 (83 per cent pathologically T4) compared to 21 per cent in the previous report. A high proportion of ‘radiation failures’ remains (54 per cent). The in-hospital mortality has fallen from 11 per cent to seven per cent. The five-year-survival calculated using the Kaplan-Meier method is 11 per cent.This procedure is increasingly being used as a palliative procedure aiming to restore swallowing in the relatively young patient who has very extensive hypopharyngeal carcinoma. Long-term survival rates specific to this operation have fallen. This is attributed to patient selection for the procedure with the vast majority having disease extending into bone, cartilage or soft tissues (T4). The defect created by the resection of less extensive tumours are now increasingly reconstructed with jejunal free flaps and musculocutaneous flaps.

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

scholarly journals Lymphadenectomy in the Treatment of Colon Cancer: A Survival Nalysis

2019 ◽  
Vol 4 (12) ◽  
Author(s):  
Romualdo Silva Corrêa ◽  
Luciana Ayres de Oliveira Lima ◽  
Isa Maryana Araújo Bezerra de Macedo ◽  
Amália Cinhtia Meneses Rêgo ◽  
Irami Araújo-Filho
Keyword(s):  
Colon Cancer ◽  
Lymph Nodes ◽  
Medical Records ◽  
Survival Rates ◽  
Primary Treatment ◽  
Term Survival ◽  
Kaplan Meier ◽  
The Impact ◽  
Radiotherapy Treatment

Colon cancer is a curable disease when restricted to the bowel and colectomy, the primary treatment. However, the presence and number of resected lymph nodes influence the therapeutic approach and prognosis of the patient. To evaluate the impact of the number of resected lymph nodes on the overall survival of patients treated for colon cancer at the League of Cancer Hospital - Natal - State of Rio Grande do Norte (RN) - Northeast Brazil. A retrospective observational study of 80 patients with colon cancer from Dr. Luiz Antônio Hospital (Natal-RN / Brazil), considering the period 2007-2014. Data were collected through medical records review. Survival rates were calculated and compared using the non-parametric Kaplan-Meier and Wilcoxon tests, respectively. All patients underwent radical surgical treatment associated or not with chemotherapy and/or radiotherapy treatment. The median survival time for the group of patients who had 12 or more resected lymph nodes was 9.4 years, in contrast to the 3.3 years of those who had less than 12 lymph nodes. Conclusion: It was concluded that a total of 12 or more resected lymph nodes confirmed by histopathology is associated with increased long-term survival in patients with colon cancer undergoing radical colectomy with or without chemotherapy and radiotherapy.

Extended ray resection for sarcoma of the hand: long-term survival and functional results

2019 ◽  
Vol 45 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Farhad Farzaliyev ◽  
Hans-Ulrich Steinau ◽  
Halil-Ibrahim Karadag ◽  
Alexander Touma ◽  
Lars Erik Podleska
Keyword(s):  
Soft Tissue ◽  
Survival Rates ◽  
Soft Tissue Sarcomas ◽  
Functional Results ◽  
Contralateral Side ◽  
Level Of Evidence ◽  
Term Survival ◽  
Kaplan Meier

In this retrospective study, we analysed the long-term oncological and functional results after extended ray resection for sarcoma of the hand. Recurrence-free and overall survivals were calculated using the Kaplan–Meier method. The function of the operated hand was assessed with the Michigan Hand Questionnaire and compared with the contralateral side. Extended ray resection was performed in 25 out of 168 consecutive patients with soft-tissue and bony sarcomas of the hand. The overall 5- and 10-year, disease-specific survival rates were 86% and 81%, respectively. Local recurrences were observed in two patients. The Michigan Hand Questionnaire score for the affected hand at follow-up in nine patients was 82 points versus 95 for the healthy contralateral hands. We conclude that extended ray resection of osseous sarcomas breaking through the bone into the soft tissue or for soft tissue sarcomas invading bone is a preferable alternative to hand ablation when excision can be achieved with tumour-free margins. Level of evidence: III

Abstract 2840: An Impedance Threshold Device Improves 24 Hour Survival in a Spontaneously Breathing Pediatric Porcine Model of Hemorrhagic Shock

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Anja Metzger ◽  
Brad Marino ◽  
Tim Matsuura ◽  
Carly Alexander ◽  
Margot Herman ◽  
...  
Keyword(s):  
Hemorrhagic Shock ◽  
Sham Group ◽  
Survival Rates ◽  
Term Survival ◽  
Kaplan Meier ◽  
Threshold Device ◽  
Short And Long Term ◽  
Spontaneously Breathing ◽  
Impedance Threshold Device

Introduction: Traumatic injury and hypovolemic shock are leading causes of death in children worldwide. We previously demonstrated that augmentation of negative intrathoracic pressure generated by spontaneously breathing through an impedance threshold device (ITD) improves blood pressure and cardiac output in a pediatric porcine model of hemorrhagic shock. However, the optimal method to restore intravascular volume, prevent secondary organ damage, and prevent progression of reversible shock to irreversible circulatory collapse after severe blood loss in children is not known. Hypothesis: Breathing through an ITD for 90 min prior to fluid resuscitation will safely increase short and long-term survival rates. Methods: Seventeen spontaneously breathing female piglets (12.4 ± 0.1 kg), anesthetized with propofol, were subjected to a 40% bleed and randomized in a prospective, blinded manner to either a sham or active ITD (cracking pressure of -7 cmH2O, Advanced Circulatory Systems, Minneapolis, MN) for 90 min. Shed blood was then reinfused. Work of breathing (WOB), 90 minute and 24 hour survival were evaluated. Survival analysis was performed using the Wilcoxon Rank Sum Test, Fischer’s Exact Test, and Kaplan-Meier Methods. Results: Baseline and post-bleed heart rate, blood pressure, lactate levels, and arterial blood gas parameters were similar between groups. Piglets treated with the active ITD had significantly improved survival compared to the piglets treated with the sham ITD at 90 min (8/9 vs. 3/8, p=0.04). At 24 hours, Kaplan-Meier curve analysis revealed improved survival with the active ITD (6/9 vs. 2/8, p=0.04). The 3 animals in the active ITD group that did not survive died at a median time of 280 minutes (82–580), and the 6 animals in the sham group that did not survive, died at a median time of 69 minutes (24 –101) after bleed (p=0.11). The WOB at 45 min (J/L) was 73% higher in the active ITD group than the sham group (1.18 ± 0.07 vs. 0.68 ± 0.07, p= 0.001). The piglets safely tolerated the active ITD therapy. Conclusion: In this spontaneously breathing, anesthetized piglet model of hemorrhagic shock, treatment with an active ITD for 90 min without supplemental fluid resuscitation significantly improved short and long-term survival rates.

scholarly journals Long-term survival rates of gravity-assisted, adjustable differential pressure valves in infants with hydrocephalus

2016 ◽  
Vol 17 (5) ◽  
pp. 544-551 ◽  
Author(s):  
Anna-Felicitas Gebert ◽  
Matthias Schulz ◽  
Karin Schwarz ◽  
Ulrich-Wilhelm Thomale
Keyword(s):  
Survival Rates ◽  
Differential Pressure ◽  
Older Children ◽  
Term Survival ◽  
Kaplan Meier ◽  
Single Center Study ◽  
Gravitational Unit ◽  
Shunt Survival ◽  
Flexible Application

OBJECTIVE The use of adjustable differential pressure valves with gravity-assisted units in shunt therapy of children with hydrocephalus was reported to be feasible and promising as a way to avoid chronic overdrainage. In this single-center study, the authors' experiences in infants, who have higher rates of shunt complications, are presented. METHODS All data were collected from a cohort of infants (93 patients [37 girls and 56 boys], less than 1 year of age [mean age 4.1 ± 3.1 months]) who received their first adjustable pressure hydrocephalus shunt as either a primary or secondary implant between May 2007 and April 2012. Rates of valve and shunt failure were recorded for a total of 85 months until the end of the observation period in May 2014. RESULTS During a follow-up of 54.2 ± 15.9 months (range 26–85 months), the Kaplan-Meier rate of shunt survival was 69.2% at 1 year and 34.1% at 85 months; the Kaplan-Meier rate of valve survival was 77.8% at 1 year and 56% at 85 months. Survival rates of the shunt were significantly inferior if the patients had previous shunt surgery. During follow-up, 44 valves were exchanged in cases of infection (n = 19), occlusion (n = 14), dysfunction of the adjustment unit (n = 10), or to change the gravitational unit (n = 1). CONCLUSIONS Although a higher shunt complication rate is observed in infant populations compared with older children, reasonable survival rates demonstrate the feasibility of using this sophisticated valve technology. The gravitational unit of this valve is well tolerated and its adjustability offers the flexible application of opening pressure in an unpredictable cohort of patients. This may adequately address overdrainage-related complications from early in treatment.

scholarly journals P-OGC10 Long-term survival is not affected by complications after oesophagectomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Edward J Nevins ◽  
Jakub Chmelo ◽  
Joshua Brown ◽  
Pooja Prasad ◽  
Alexander W Phillips
Keyword(s):  
Survival Rates ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Kaplan Meier ◽  
Operative Complications ◽  
Short Term Mortality ◽  
Index Hospital ◽  
Post Operative Complications

Abstract Background Outcomes following oesophagectomy for oesophageal cancer continue to improve, but complications are common and can result in significant morbidity. Post-operative complications are known to impact upon peri-operative and short-term survival but the effect on long-term survival remains unclear. The aim of this study is to investigate the effect of post-operative complications on long-term survival following oesophagectomy. Methods A contemporaneously maintained database from a single centre was reviewed. All patients who underwent oesophagectomy between January 2010 and January 2019 were included. Patients were separated into three groups, those who experienced no or very minor complications (Clavien-Dindo 0 or 1), minor complications (Clavien-Dindo 2), and major complications (Clavien-Dindo 3-4). Those who died during the index hospital admission were excluded to correct for short-term mortality effects. Overall survival was analysed using Kaplan-Meier and log rank testing. Results Seven hundred and twenty-three patients underwent oesophagectomy during this time. Seventeen (2.4%) died during their index hospital stay, and were excluded from the survival analysis. The 30- and 90- day mortality was 1.1% (8/723) and 2.4% (17/723) respectively. There were 43.2% (305/706), 30.2% (213/706) and 26.6% (188/706) in the Clavien-Dindo 0-1, Clavien-Dindo 2, and Clavien-Dindo 3-4 group respectively. Median survival across the three groups was equivalent (50, 57 and 51 months). Across all three groups, overall long-term survival rates were equivalent at 1 (87.5%, 84.9%, 83.5%), 5 (44.2%, 48.9%, 44.7%) and 10 years (36.7%, 36.0%, 36.7%) (p = 0.730). Conclusions Long term survival is not affected by complications, irrespective of severity, following oesophagectomy.

Clinical Course and Surgical Prognosis of 33 Cases of Intracranial Epidermoid Tumors

Neurosurgery ◽  
1989 ◽  
Vol 24 (4) ◽  
pp. 568-573 ◽  
Author(s):  
Kenta Yamakawa ◽  
Nobuyuki Shitara ◽  
Shigeru Genka ◽  
Shinya Manaka ◽  
Kintomo Takakura
Keyword(s):  
Survival Rates ◽  
Clinical Manifestations ◽  
Recurrence Rates ◽  
Term Survival ◽  
Kaplan Meier ◽  
Suprasellar Region ◽  
Initial Symptoms ◽  
Long Term Follow Up ◽  
Intracranial Epidermoid

ABSTRACT Thirty-three cases of intracranial epidermoid tumors treated during the past 25 years were analyzed with regard to clinical manifestations, recurrence rates related to the extent of surgery, and long-term survival rates. Epidermoid tumors caused various symptoms, especially in the cerebellopontine angle (15 cases), of which a transient remission of symptoms was observed in 4 cases (23.5%). The average time from initial symptoms to surgery was much shorter in suprasellar region and third ventricular locations (average of 11 months) than in other locations (average of 7 years). In 28 patients (84.9%), the tumor was removed totally or subtotally. Most of the patients could lead an independent and useful life after operation (93.1%). Among the 29 patients in a long-term follow-up survey, seven tumors recurred after an average interval of 8 years and 10 months (from the first to second operation) and 12 years and 6 months (from the second to third operation). Patients with recurrent tumors were successfully treated, and excellent functional prognosis was observed even after the second or third operation. The 20-year survival rate was 92.8% (Kaplan-Meier method).

Free Jejunal Autograft Reconstruction of the Pharyngoesophagus: Review of a 10-year experience

1987 ◽  
Vol 97 (4) ◽  
pp. 369-375 ◽  
Author(s):  
Merrill A. Biel ◽  
Robert H. Maisel
Keyword(s):  
Squamous Cell Carcinoma ◽  
Survival Rate ◽  
Postoperative Complications ◽  
Stage Iii ◽  
Hypopharyngeal Carcinoma ◽  
Term Survival ◽  
Palliative Procedure ◽  
Ablative Surgery ◽  
Cervical Esophageal Carcinoma

Seventeen patients underwent free jejunal autograft reconstruction of the pharyngoesophagus after ablative surgery for Stage III and IV squamous cell carcinoma of the cervical esophagus and hypopharynx. Postoperative complications included three perioperative deaths, three graft failures, six transient fistulas, and two early and one late fistula. The 5-year survival rate of patients with Stage III and IV hypopharyngeal carcinoma was 20% (one of five). The 4-year survival rate for patients with cervical esophageal carcinoma was 33% (one of three). This method of reconstruction is advocated as a reliable palliative procedure for patients with a dismal long-term survival.

Új lehetőségek a refrakter és relabált Hodgkin-lymphomás betegek kezelésében

2015 ◽  
Vol 156 (45) ◽  
pp. 1824-1833 ◽  
Author(s):  
Árpád Illés ◽  
Ádám Jóna ◽  
Zsófia Simon ◽  
Miklós Udvardy ◽  
Zsófia Miltényi
Keyword(s):  
Stem Cell ◽  
Hodgkin Lymphoma ◽  
Treatment Options ◽  
Survival Rates ◽  
Relapse Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Novel Treatment ◽  
Refractory Hodgkin Lymphoma

Introduction: Hodgkin lymphoma is a curable lymphoma with an 80–90% long-term survival, however, 30% of the patients develop relapse. Only half of relapsed patients can be cured with autologous stem cell transplantation. Aim: The aim of the authors was to analyze survival rates and incidence of relapses among Hodgkin lymphoma patients who were treated between January 1, 1980 and December 31, 2014. Novel therapeutic options are also summarized. Method: Retrospective analysis of data was performed. Results: A total of 715 patients were treated (382 men and 333 women; median age at the time of diagnosis was 38 years). During the studied period the frequency of relapsed patients was reduced from 24.87% to 8.04%. The numbers of autologous stem cell transplantations was increased among refracter/relapsed patients, and 75% of the patients underwent transplantation since 2000. The 5-year overall survival improved significantly (between 1980 and 1989 64.4%, between 1990 and 1999 82.4%, between 2000 and 2009 88.4%, and between 2010 and 2014 87.1%). Relapse-free survival did not change significantly. Conclusions: During the study period treatment outcomes improved. For relapsed/refractory Hodgkin lymphoma patients novel treatment options may offer better chance for cure. Orv. Hetil., 2015, 156(45), 1824–1833.

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