scholarly journals Meta-analysis of the effect of the pringle maneuver on long-term oncological outcomes following liver resection

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Elias Khajeh ◽  
Saeed Shafiei ◽  
Sadeq Ali-Hasan Al-Saegh ◽  
Ali Ramouz ◽  
Ahmed Hammad ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Liver Resection ◽  
Meta Analysis ◽  
Survival Rates ◽  
Pringle Maneuver ◽  
Free Survival ◽  
Oncological Outcomes ◽  
Overall Survival Rates

AbstractHepatic pedicle clamping reduces intraoperative blood loss and the need for transfusion, but its long-term effect on survival and recurrence remains controversial. The aim of this meta-analysis was to evaluate the effect of the Pringle maneuver (PM) on long-term oncological outcomes in patients with primary or metastatic liver malignancies who underwent liver resection. Literature was searched in the Cochrane Central Register of Controlled Trials (CENTRAL), Medline (via PubMed), and Web of Science databases. Survival was measured as the survival rate or as a continuous endpoint. Pooled estimates were represented as odds ratios (ORs) using the Mantel–Haenszel test with a random-effects model. The literature search retrieved 435 studies. One RCT and 18 NRS, including 7480 patients who underwent liver resection with the PM (4309 cases) or without the PM (3171 cases) were included. The PM did not decrease the 1-year overall survival rate (OR 0.86; 95% CI 0.67–1.09; P = 0.22) or the 3- and 5-year overall survival rates. The PM did not decrease the 1-year recurrence-free survival rate (OR 1.06; 95% CI 0.75–1.50; P = 0.75) or the 3- and 5-year recurrence-free survival rates. There is no evidence that the Pringle maneuver has a negative effect on recurrence-free or overall survival rates.

scholarly journals SIMULTANEOUS AND STAGED RESECTIONS FOR SYNCHRONOUS COLORECTAL LIVER METASTASES: META-ANALYSIS

2017 ◽  
pp. 6-21 ◽  
Author(s):  
A. A. Ponomarenko ◽  
Yu. A. Shelygin ◽  
E. G. Rybakov ◽  
S. I. Achkasov
Keyword(s):  
Colorectal Cancer ◽  
Liver Resection ◽  
Liver Metastases ◽  
Colorectal Liver Metastases ◽  
Meta Analysis ◽  
Survival Rates ◽  
Mortality Rates ◽  
Synchronous Colorectal Liver Metastases ◽  
Overall Survival Rates

AIM. To analyze the short-term and long-term outcomes two alternative surgical strategies: 1) simultaneous resections for colorectal cancer and synchronous colorectal liver metastases;2) conventional surgery for the primary tumor during the initial operation. After time, the liver resection is performed at a second operation METHODS. Meta-analysis was performed to compare outcomes simultaneous resections for colorectal cancer and synchronous colorectal liver metastases and staged surgery. Tumor localization, spread and number of metastasis, extent of operation, blood loss, length of hospital stay, postop mortality, complication rates, overall survival rates were analyzed. RESULTS. Twenty-nine studies with 5518 patients were included in meta-analysis. Multiple (р=0,007) and bilobed (р=0,0004) metastasis were more often in patients in group ofstaged resections. Major hepatectomy was also performed more often in group of staged resections. There were no significant differences in blood loss and postopirative mortality rates (p>0,05). Complication rate in group of simultaneous resections was lower than in group of staged resections (0R=0,8, 95 %CI: 0,7-1.0, p=0,048). 3- and 5-year overall survival rates were similar in both groups: 54% vs 55 %, and 37% vs 38%, respectively (р=0,007). CONCLUSION. Simultaneous resection of the primary tumor and the minor liver resection or extended hepatectomy in selected patients didn’t adversely affect on complications and mortality rates in equivalent long-term survival compared to staged liver resection. An important limitation of the present study is the bias and heterogeneity in compared groups due to retrospective data over the 20-year period.

Long-Term Survival Results of a Randomized Trial Comparing Gemcitabine Plus Cisplatin, With Methotrexate, Vinblastine, Doxorubicin, Plus Cisplatin in Patients With Bladder Cancer

2005 ◽  
Vol 23 (21) ◽  
pp. 4602-4608 ◽  
Author(s):  
Hans von der Maase ◽  
Lisa Sengelov ◽  
James T. Roberts ◽  
Sergio Ricci ◽  
Luigi Dogliotti ◽  
...  
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Locally Advanced ◽  
Survival Rates ◽  
Progression Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Visceral Metastases ◽  
Overall Survival Rates

Purpose To compare long-term survival in patients with locally advanced or metastatic transitional cell carcinoma (TCC) of the urothelium treated with gemcitabine/cisplatin (GC) or methotrexate/vinblastine/doxorubicin/cisplatin (MVAC). Patients and Methods Efficacy data from a large randomized phase III study of GC versus MVAC were updated. Time-to-event analyses were performed on the observed distributions of overall and progression-free survival. Results A total of 405 patients were randomly assigned: 203 to the GC arm and 202 to the MVAC arm. At the time of analysis, 347 patients had died (GC arm, 176 patients; MVAC arm, 171 patients). Overall survival was similar in both arms (hazard ratio [HR], 1.09; 95% CI, 0.88 to 1.34; P = .66) with a median survival of 14.0 months for GC and 15.2 months for MVAC. The 5-year overall survival rates were 13.0% and 15.3%, respectively (P = .53). The median progression-free survival was 7.7 months for GC and 8.3 months for MVAC, with an HR of 1.09. The 5-year progression-free survival rates were 9.8% and 11.3%, respectively (P = .63). Significant prognostic factors favoring overall survival included performance score (> 70), TNM staging (M0 v M1), low/normal alkaline phosphatase level, number of disease sites (≤ three), and the absence of visceral metastases. By adjusting for these prognostic factors, the HR was 0.99 for overall survival and 1.01 for progression-free survival. The 5-year overall survival rates for patients with and without visceral metastases were 6.8% and 20.9%, respectively. Conclusion Long-term overall and progression-free survival after treatment with GC or MVAC are similar. These results strengthen the role of GC as a standard of care in patients with locally advanced or metastatic TCC.

scholarly journals Cryoablation of renal tumors: long-term follow-up from a multicenter experience

2021 ◽  
Author(s):  
Fulvio Stacul ◽  
Camilla Sachs ◽  
Fabiola Giudici ◽  
Michele Bertolotto ◽  
Michele Rizzo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Tumor Size ◽  
Treatment Efficacy ◽  
Survival Rates ◽  
Oncologic Outcomes ◽  
Renal Tumors ◽  
Recurrence Free Survival ◽  
Free Survival ◽  
Overall Survival Rates

Abstract Purpose To retrospectively investigate long-term outcomes of renal cryoablation from a multicenter database. Methods 338 patients with 363 renal tumors underwent cryoablation in 4 centers in North-Eastern Italy. 340/363 tumors (93.7%) were percutaneously treated with CT guidance. 234 (68.8%) were treated after conscious sedation, 76 (22.3%) under local lidocaine anesthesia only and 30 (8.8%) under general anesthesia. Treatment efficacy and complication rate considered all procedures. Oncologic outcomes considered a subset of 159 patients with 159 biopsy proven renal cell carcinoma. Results Mean tumor size was 2.53 cm. Technical success was achieved in 355/363 (97.8%) treatments. Treatment efficacy after the first treatment was achieved in 348/363 (95.9%) tumors. Statistical analysis revealed a significant lower treatment efficacy for ASA score >3, Padua score >8, tumor size >2.5 cm, use of >2 cryoprobes, presence of one single kidney. In the subset of 159 patients, recurrence-free survival rates were 90.5% (95% CI 83.0%, 94.9%) at 3 years and 82.4% (95% CI 72.0%, 89.4%) at 5 years; overall survival rates were 96.0% (95% CI 90.6%, 98.3%) at 3 years and 91.0% (95% CI 81.7%, 95.7%) at 5 years; no patient in this subset developed metastatic disease. Clavien-Dindo >1 complications were recorded in 14/369 procedures (3.8%) and were related to age >70 years, tumor size >4 cm and use of >2 cryoprobes. Conclusion Cryoablation performed across four different centers in a large cohort of predominantly small renal tumors showed that this technique provides good recurrence-free survival rates and overall survival rates at three- and five-year with very low major complications rate.

scholarly journals Long-term outcomes of synchronous splenectomy and hepatectomy or radiofrequency ablation for hepatocellular carcinoma and esophagogastric variceal bleeding

2021 ◽  
Author(s):  
Jia-li Ma ◽  
Li Jiang ◽  
Ping Li ◽  
Ling-ling He ◽  
Hong-shan Wei
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Variceal Bleeding ◽  
Survival Rates ◽  
Recurrence Free Survival ◽  
Long Term Outcomes ◽  
Survival Curves ◽  
Free Survival ◽  
Overall Survival Rates

Abstract Aim: This study aimed to compare the long-term outcomes of hepatectomy and radiofrequency ablation (RFA) combined with pericardial devascularization (PCDV) plus splenectomy for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding.Materials and Methods: Between October 2008 and March 2018, 46 patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding for portal hypertension were included in this study. The overall survival curves, recurrence-free survival curves, and rebleeding-free survival curves were plotted using Kaplan–Meier analysis. The log-rank test was used to compare time-to-event curves between groups.Results: The median follow-up time was 38 months. Among 20 patients undergoing RFA, the 1-, 3-, and 5-year overall survival rates were 95.00%,60.00%, and 35.00%, respectively. The 1-, 3- and 5-year recurrence-free survival rates were 35.00%, 25.00%, and 10.00%, respectively. The 1,3- and 5-year rebleeding-free survival rates were 85.00%, 60.00%, and 40.00%, respectively. Among 26 patients undergoing hepatectomy, the 1-, 3-, and 5-year overall survival rates were 96.15%,50.00%, and 34.62%, respectively. The 1-, 3-, and 5-year recurrence-free survival rates were 65.38%, 19.23%, and 11.54%, respectively. The 1-, 3-, and 5-year rebleeding-free survival rates were 73.08%, 42.31%, and 26.92%, respectively. No significant differences were found in overall, recurrence-free, and rebleeding-free survival rates.Conclusions: Hepatectomy or RFA with PCDV plus splenectomy might be a safe and effective treatment for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding. “Hepatectomy first” strategy may be considered due to its lower and later recurrence. More attention should be paid to background liver diseases after surgery.

scholarly journals The Anti-PD-1/PD-L1 Immunotherapy for Gastric Esophageal Cancer: A Systematic Review and Meta-Analysis and Literature Review

2021 ◽  
Vol 28 ◽  
pp. 107327482199743
Author(s):  
Ke Chen ◽  
Xiao Wang ◽  
Liu Yang ◽  
Zheling Chen
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rate ◽  
Meta Analysis ◽  
Response Rates ◽  
Control Group ◽  
Term Survival ◽  
Long Term Survival ◽  
And Control

Background: Treatment options for advanced gastric esophageal cancer are quite limited. Chemotherapy is unavoidable at certain stages, and research on targeted therapies has mostly failed. The advent of immunotherapy has brought hope for the treatment of advanced gastric esophageal cancer. The aim of the study was to analyze the safety of anti-PD-1/PD-L1 immunotherapy and the long-term survival of patients who were diagnosed as gastric esophageal cancer and received anti-PD-1/PD-L1 immunotherapy. Method: Studies on anti-PD-1/PD-L1 immunotherapy of advanced gastric esophageal cancer published before February 1, 2020 were searched online. The survival (e.g. 6-month overall survival, 12-month overall survival (OS), progression-free survival (PFS), objective response rates (ORR)) and adverse effects of immunotherapy were compared to that of control therapy (physician’s choice of therapy). Results: After screening 185 studies, 4 comparative cohort studies which reported the long-term survival of patients receiving immunotherapy were included. Compared to control group, the 12-month survival (OR = 1.67, 95% CI: 1.31 to 2.12, P < 0.0001) and 18-month survival (OR = 1.98, 95% CI: 1.39 to 2.81, P = 0.0001) were significantly longer in immunotherapy group. The 3-month survival rate (OR = 1.05, 95% CI: 0.36 to 3.06, P = 0.92) and 18-month survival rate (OR = 1.44, 95% CI: 0.98 to 2.12, P = 0.07) were not significantly different between immunotherapy group and control group. The ORR were not significantly different between immunotherapy group and control group (OR = 1.54, 95% CI: 0.65 to 3.66, P = 0.01). Meta-analysis pointed out that in the PD-L1 CPS ≥10 sub group population, the immunotherapy could obviously benefit the patients in tumor response rates (OR = 3.80, 95% CI: 1.89 to 7.61, P = 0.0002). Conclusion: For the treatment of advanced gastric esophageal cancer, the therapeutic efficacy of anti-PD-1/PD-L1 immunotherapy was superior to that of chemotherapy or palliative care.

scholarly journals Impact of postoperative complications on long-term survival of hepatocellular carcinoma patients after liver resection

2021 ◽  
Author(s):  
Susumu Mochizuki ◽  
Hisashi Nakayama ◽  
Yutaka Midorikawa ◽  
Tokio Higaki ◽  
Masamichi Moriguchi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Overall Survival ◽  
Liver Resection ◽  
Pleural Effusion ◽  
Postoperative Complications ◽  
Recurrence Free Survival ◽  
Term Survival ◽  
Free Survival ◽  
Long Term Survival

Objective The effect of postoperative complications including red blood transfusion (BT) on long-term survival for hepatocellular carcinoma (HCC) is unknown. The purpose of this study was to define the relationship between postoperative complications and long-term survival in patients with HCC. Methods Postoperative complications of 1251 patients who underwent curative liver resection for HCC were classified, and their recurrence-free survival (RFS) and cumulative overall survival (OS) were investigated. Results Any complications occurred in 503 patients (40%). Five-year RFS and 5-year OS in the complication group were 21% and 56%, respectively, significantly lower than the respective values of 32% ( p &lt; 0.001) and 68% ( p &lt; 0.001) in the no-complication group (n=748). Complications related to RFS were postoperative BT [Hazard ratio (HR): 1.726, 95% confidence interval (CI): 1.338–2.228, p &lt; 0.001], pleural effusion [HR: 1.434, 95% CI: 1.200–1.713, p &lt; 0.001] using Cox-proportional hazard model. Complications related to OS were postoperative BT [HR: 1.843, 95%CI: 1.380-2.462, p &lt; 0.001], ascites [HR: 1.562, 95% CI: 1.066–2.290 p = 0.022], and pleural effusion [HR: 1.421, 95% CI: 1.150–1.755, p = 0.001). Conclusions Postoperative complications were factors associated with poor long-term survival. Postoperative BT and pleural effusion, were noticeable complications that were prognostic factors for both recurrence-free survival and overall survival.

scholarly journals Comparison of prognosis between emergency and scheduled hemodialysis

2019 ◽  
Vol 47 (3) ◽  
pp. 1221-1231 ◽  
Author(s):  
Zhixiang Bian ◽  
Huiyi Gu ◽  
Peihua Chen ◽  
Shijian Zhu
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Mortality Rate ◽  
Serum Creatinine ◽  
Survival Rates ◽  
Overall Survival Rate ◽  
Short Term ◽  
Term Survival ◽  
Renal Replacement Therapies

Background The survival rate of patients undergoing hemodialysis and other renal replacement therapies has been extensively studied, but comparative studies of emergency and scheduled hemodialysis are limited. Methods This study included 312 patients who underwent emergency hemodialysis and 274 who received scheduled hemodialysis. We investigated the prognostic differences between these two groups of patients, including the short-term and long-term survival rates. Results The overall survival rate was significantly better among the patients in the scheduled hemodialysis group than emergency hemodialysis group. The mortality rate within 3 months of emergency hemodialysis was 4.8%, while that within 3 months of scheduled hemodialysis was 1.1%. Conclusions Significant differences were present between emergency and scheduled hemodialysis, especially the levels of serum creatinine and hemoglobin.

A literature review of the role of brachytherapy in the management of early-stage breast cancer

2019 ◽  
Vol 19 (3) ◽  
pp. 281-290
Author(s):  
Rebecca Thorpe ◽  
Heather Drury-Smith
Keyword(s):  
Quality Of Life ◽  
Overall Survival ◽  
Local Recurrence ◽  
Literature Review ◽  
Survival Rates ◽  
External Beam Radiation ◽  
Recurrence Rates ◽  
Overall Survival Rates

AbstractBackground:This review evaluates whether brachytherapy can be considered as an alternative to whole breast irradiation (WBI) using criteria such as local recurrence rates, overall survival rates and quality of life (QoL) factors. This is an important issue because of a decline in local recurrence rates, suggesting that some women at very low risk of recurrence may be incurring the negative long-term side effects of WBI without benefitting from a reduction in local recurrence and greater overall survival. As such, the purpose of this literature review is to evaluate whether brachytherapy is a credible alternative to external beam radiation with a particular focus on the impact it has on patient QoL.Methods:The search terms used were devised by using the Population Intervention Comparison Outcome framework, and a literature search was carried out using Boolean connectors and Medical Subject Headings in the PubMed database. The resultant articles were manually assessed for relevance and appraised using the Scottish Intercollegiate Guidelines Network tool. Additional papers were sourced from the citations of articles found using the search strategy. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence website. This process resulted in a total of 30 sources being included as part of the review.Results:Three types of brachytherapy were the foundation for the majority of the papers found: interstitial multi-catheter brachytherapy, intra-cavity brachytherapy and permanent seed implantation. The key themes that arose from the literature were that brachytherapy is equivalent to WBI both in terms of 5-year local recurrence rates and overall survival rates at 10–12 years. The findings showed that brachytherapy was superior to WBI for some QoL factors such as being less time-consuming and equal in terms of others such as breast cosmesis. The results did also show that brachytherapy does come with its own local toxicities that could impact upon QoL such as the poor breast cosmesis associated with some brachytherapy techniques.Conclusion:In conclusion, brachytherapy was deemed a safe or acceptable alternative to WBI, but there is a need for further research on the long-term local recurrence rates, survival rates and quality of life issues as the volume of evidence is still significantly smaller for brachytherapy than for WBI. Specifically, there needs to be further investigation as to which patients will benefit from being offered brachytherapy and the influence that factors such as co-morbidities, performance status and patient choice play in these decisions.

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