Recurrence rates and form of recurrence after endoluminal ablation of the great saphenous vein – A comparison of laser ablation (EVLA) 1470 nm, radio frequency (RFITT and ClosureFast) and superheated steam with an average follow-up time of 3.8 years

Abstract Objectives In addition to combined crossectomy and stripping or pure sclerotherapy, various endovenous thermal procedures are now available for treatment, which are compared in the present study. Methods Between 2009 and 2013, the GSV was ablated in 297 patients using one of four methods: EVLA 1470 nm, ClosureFast, RFITT or superheated steam. The recurrence rate after treatment was defined as the primary endpoint. Follow-up examinations with duplex ultrasound took place 14 days, 3 months and 1 year post-operatively, and thereafter annually with average follow-up time of 3.8 years and a follow-up rate of 81 %. Results At the time of the last follow-up examination, the following complete closure rates of treated GSV were found: ClosureFast 95 %, EVLA 97 %, RFITT 79 % and superheated steam 71 %. Serious complications occurred only with superheated steam (necrosis at the puncture site). The median pain intensity recorded 14 days post-operatively was 1–3 on a scale of 1–10. Both the CIVIQ score and the VCSS were significantly improved by all endovenous thermal methods. In 5–12 % of cases, reflux was found in the previously non-refluxive AASV. Conclusions EVLA and ClosureFast are indicated for the treatment of GSV incompetence with high success rates, comparable to the results with crossectomy and stripping. The RFITT and superheated steam methods present significantly lower closure rates. Particular attention should be paid to the presence of an initially non-refluxive AASV. Since there was an increased recurrence rate over this vein, it seems reasonable to treat the AASV primarily.

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The Progression of Peripheral Anterior Synechia after Combined Phacoemulsification with Goniosynechialysis Under an Ophthalmic Endoscope: A Three-Year Study

10.21203/rs.3.rs-962744/v1 ◽

2021 ◽

Author(s):

Xinyi Liu ◽

Yau Kei Chan ◽

Lin Fu ◽

Yunhe Song ◽

Junhua Li ◽

...

Keyword(s):

Recurrence Rate ◽

Early Postoperative Period ◽

Angle Closure ◽

Success Rates ◽

Recurrence Rates ◽

Primary Angle Closure Glaucoma ◽

Nasal Side ◽

Temporal Side

Abstract Aim To investigate the long-term changes of peripheral anterior synechia (PAS) after phacoemulsification with goniosynechialysis under an ophthalmic endoscope (Phaco-OE-GSL) in primary angle-closure glaucoma (PACG) assisted with viscoelastics alone or viscoelastics combined with iris repositor (viscoelastics-repositor). Method A retrospective study was conducted. Thirty-nine eyes of 31 PACG patients were included. The follow-up period was 36 months. The main outcomes of the study included the changes of PAS, intraocular pressure (IOP), and the success rate.Results Phaco-OE-GSL was performed assisted with viscoelastics-alone on 20 eyes, and viscoelastics-repositor on 19 eyes. The total recurrence rates of PAS were 62.5% in viscoelastics-alone group and 87.5% in viscoelastics-repositor group. In particular, the recurrence rate of PAS at the same location at which were separated intraoperatively were 37.3% and 75.0% respectively (P=0.033). The recurrence of PAS was observed in 2 eyes in viscoelastics-alone group and 12 eyes in viscoelastics-repositor group within 1-month follow-up (P<0.001). In addition, comparing any two follow-ups 6 months after surgery, there are not significant differences in the extent of re-PAS in total eyes (P>0.05). The extent of postoperative PAS at final follow-up was positively correlated with the range of PAS preoperatively (P=0.036, r=0.356). The complete success rates were 85.0% and 89.5% of viscoelastics-alone group and viscoelastics-repositor group at 36-month follow-up respectively. Both the preoperative and postoperative distribution of PAS are mainly concentrated on the upper (84.6% and 95.8%) and nasal side (74.4% and 62.5%), followed by the inferior side, and the least on the temporal side. Conclusion In summary, although the recurrence rate of PAS was high in early postoperative period, the progression of PAS was rapidly resolved after 6 months postoperatively, and Phaco-OE-GSL is an eﬀective treatment for the long-term control of IOP of PACG patients especially with large range of PAS (> 180°). Both preoperative and postoperative PAS are mainly concentrated on the upper and nasal side. Besides, our results suggested that mechanical separation may be easier to promote the progression of postoperative PAS than viscoelastics-alone separation.

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Outcome of endoscopic vs microsurgical transsphenoidal resection for Cushing’s disease

Endocrine Connections ◽

10.1530/ec-17-0312 ◽

2018 ◽

Vol 7 (1) ◽

pp. R26-R37 ◽

Cited By ~ 4

Author(s):

Nidan Qiao

Keyword(s):

Recurrence Rate ◽

Cushing’S Disease ◽

Meta Analysis ◽

Cushing's Disease ◽

Recurrence Rates ◽

Microscopic Surgery ◽

Significant Difference ◽

Comprehensive Search ◽

Definition Of

Introduction It is unclear whether the proportions of remission and the recurrence rates differ between endoscopic transsphenoidal surgery (TS) and microscopic TS in Cushing’s disease (CD); thus, we conducted a systematic review and meta-analysis to evaluate studies of endoscopic TS and microscopic TS. Methods We conducted a comprehensive search of PubMed to identify relevant studies. Remission and recurrence were used as outcome measures following surgical treatment of CD. Results A total of 24 cohort studies involving 1670 adult patients were included in the comparison. Among these studies, 702 patients across 9 studies underwent endoscopic TS, and 968 patients across 15 studies underwent microscopic TS. Similar baseline characteristics were observed in both groups. There was no significant difference in remission between the two groups: 79.7% (95% CI: 73.1–85.0%) in the endoscopic group and 76.9% (95% CI: 71.3–81.6%) in the microscopic group (P = 0.485). It appears that patients who underwent endoscopic surgery experience recurrence less often than patients who underwent microscopic surgery, with recurrence proportions of 11.0% and 15.9%, respectively (P = 0.134). However, if follow-up time is taken into account, both groups had a recurrence rate of approximately 4% per person per year (95% CI: 3.1–5.4% and 3.6–5.1%, P = 0.651). Conclusions We found that remission proportion and recurrence rate were the same in patients who underwent endoscopic TS as in patients who underwent microscopic TS. The definition of diagnosis, remission and recurrence should always be considered in the studies assessing therapeutic efficacy in CD.

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Inferior selective crossectomy for great saphenous vein incompetence: Our experience

Vascular ◽

10.1177/1708538120947251 ◽

2020 ◽

pp. 170853812094725

Author(s):

Maurizio Pagano ◽

Giovanna Passaro ◽

Roberto Flore ◽

Paolo Tondi

Keyword(s):

Saphenous Vein ◽

Varicose Vein ◽

Great Saphenous Vein ◽

Duplex Ultrasound ◽

Venous Disease ◽

Recurrence Rates ◽

Saphenofemoral Junction

Objective To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2–C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Results Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

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Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

Journal of Clinical Medicine ◽

10.3390/jcm10194372 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4372

Author(s):

Ioanna Sfakianaki ◽

Paris Binos ◽

Petros Karkos ◽

Grigorios G. Dimas ◽

George Psillas

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Recurrence Rate ◽

Benign Paroxysmal Positional Vertigo ◽

Female Gender ◽

Recurrence Rates ◽

Positional Vertigo ◽

Risk Factors For Recurrence ◽

Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

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Extent of resection of epidermoid tumors and risk of recurrence: case report and meta-analysis

Journal of Neurosurgery ◽

10.3171/2019.4.jns19598 ◽

2020 ◽

Vol 133 (2) ◽

pp. 291-301

Author(s):

Brian M. Shear ◽

Lan Jin ◽

Yawei Zhang ◽

Wyatt B. David ◽

Elena I. Fomchenko ◽

...

Keyword(s):

Recurrence Rate ◽

Meta Analysis ◽

Systemic Review ◽

Benign Tumors ◽

Recurrence Rates ◽

Mixed Effect ◽

Risk Of Recurrence ◽

Epidermoid Tumor ◽

Cranial Nerve Palsies

OBJECTIVEIntracranial epidermoid tumors are slow-growing, histologically benign tumors of epithelial cellular origin that can be symptomatic because of their size and mass effect. Neurosurgical resection, while the treatment of choice, can be quite challenging due to locations where these lesions commonly occur and their association with critical neurovascular structures. As such, subtotal resection (STR) rather than gross-total resection (GTR) can often be performed, rendering residual and recurrent tumor potentially problematic. The authors present a case of a 28-year-old man who underwent STR followed by aggressive repeat resection for regrowth, and they report the results of the largest meta-analysis to date of epidermoid tumors to compare recurrence rates for STR and GTR.METHODSThe authors conducted a systemic review of PubMed, Web of Science, and the Cochrane Collaboration following the PRISMA guidelines. They then conducted a proportional meta-analysis to compare the pooled recurrence rates between STR and GTR in the included studies. The authors developed fixed- and mixed-effect models to estimate the pooled proportions of recurrence among patients undergoing STR or GTR. They also investigated the relationship between recurrence rate and follow-up time in the previous studies using linear regression and natural cubic spline models.RESULTSOverall, 27 studies with 691 patients met the inclusion criteria; of these, 293 (42%) underwent STR and 398 (58%) received GTR. The average recurrence rate for all procedures was 11%. The proportional meta-analysis showed that the pooled recurrence rate after STR (21%) was 7 times greater than the rate after GTR (3%). The average recurrence rate for studies with longer follow-up durations (≥ 4.4 years) (17.4%) was significantly higher than the average recurrence rate for studies with shorter follow-up durations (< 4.4 years) (5.7%). The cutoff point of 4.4 years was selected based on the significant relationship between the recurrence rate of both STR and GTR and follow-up durations in the included studies (p = 0.008).CONCLUSIONSSTR is associated with a significantly higher rate of epidermoid tumor recurrence compared to GTR. Attempts at GTR should be made during the initial surgery with efforts to optimize success. Surgical expertise, as well as the use of adjuncts, such as intraoperative MRI and neuromonitoring, may increase the likelihood of completing a safe GTR and decreasing the long-term risk of recurrence. The most common surgical complications were transient cranial nerve palsies, occurring equally in STR and GTR cases when reported. In all postoperative epidermoid tumor cases, but particularly following STR, close follow-up with serial MRI, even years after surgery, is recommended.

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SURGERY FOR CONVEXITY MENINGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000310692.80289.28 ◽

2008 ◽

Vol 63 (3) ◽

pp. 427-434 ◽

Cited By ~ 48

Author(s):

Andrew P. Morokoff ◽

Jacob Zauberman ◽

Peter M. Black

Keyword(s):

Recurrence Rate ◽

Malignant Tumors ◽

Surgical Techniques ◽

Senior Author ◽

Neurological Deficits ◽

Complication Rates ◽

Recurrence Rates ◽

Complete Excision ◽

Image Guided

ABSTRACT OBJECTIVE Meningiomas that occur over the convexity of the brain are the most common meningiomas, but little has been published about their contemporary management. We aimed to analyze a large series of convexity meningiomas with respect to surgical technique, complication rates, and pathological factors leading to recurrence. METHODS We retrospectively reviewed 163 cases of convexity meningiomas operated on in our institution by the senior author (PMB) between 1986 and 2005. The median follow-up time was 2.3 years (range, 1–13 yr). RESULTS Convexity tumors represented 22% of all meningiomas operated on. There was a female:male ratio of 2.7:1. Median age was 57 years (range, 20–89 yr). Image-guided surgery was used on all cases in the last 5 years. The 30-day mortality rate was 0%. The incidence of new neurological deficits was 1.7%, and the overall complication rate was 9.4%. The pathology of the tumors was benign in 144 (88.3%), atypical in 16 (9.8%), and anaplastic/malignant in 3 (1.8%). In six of the cases designated “benign,” there were borderline atypical features. The 5-year recurrence rate for benign meningiomas was 1.8%, atypical meningiomas 27.2%, and anaplastic meningiomas 50%. The two cases of benign tumor recurrences involved tumors with borderline atypia and high MIB-1 indices. The borderline atypical cases had a 5-year recurrence-free survival rate of only 55.9%, more closely approximating that of tumors designated “atypical.” CONCLUSION Convexity meningiomas can be safely removed using modern image-guided minimally invasive surgical techniques with a very low operative mortality. Benign convexity meningiomas having a Simpson Grade I complete excision have a very low recurrence rate. The recurrence rates of atypical and malignant tumors are significantly higher, and borderline atypical tumors should be considered to behave more like atypical rather than benign lesions. Longer-term follow-up data are needed to more accurately determine the recurrence rates of benign meningiomas.

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Outcomes of Various Interventions for First-Time Perianal Abscesses in Children

BioMed Research International ◽

10.1155/2016/9712854 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Alexander Juth Karlsson ◽

Martin Salö ◽

Pernilla Stenström

Keyword(s):

Recurrence Rate ◽

Surgical Procedures ◽

Retrospective Review ◽

Perianal Abscess ◽

Recurrence Rates ◽

Incision And Drainage ◽

Younger Patients ◽

First Time

Introduction. In children treated surgically for first-time perianal abscesses, discovery and excision of concomitant fistulas may also be warranted.Aim. To evaluate children of varying age after incision and drainage of first-time perianal abscesses, examining recurrences rates with and without search for a fistula.Method. A retrospective review was conducted, analyzing children (ages 0–15 years) treated for first-time perianal abscesses at a tertiary pediatric surgical center, with a minimum follow-up of 6 months.Results. A total of 104 patients subjected to 112 treatments for first-time perianal abscesses were eligible. Surgical procedures constituted 84 (75%) of treatments, searching for fistulas in 49 (58%). In 34 (69%), fistulas were confirmed and treated. In the surgically treated subset, the recurrence rate was higher if no attempt was made to exclude a fistula (46%), as opposed to confirmed absence of a fistula (27%) or concurrent fistulotomy (9%;p=0.02). Younger patients showed a higher recurrence rate (12/26; 46%), compared with older counterparts (11/58; 19%) (p=0.002).Conclusion. In children surgically treated for first-time perianal abscess, recurrence rates appear to be lowered by locating and treating coexisting fistulas.

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Olfactory Groove Meningiomas: Clinical Outcome and Recurrence Rates after Tumor Removal Through the Frontolateral and Bifrontal Approach

Neurosurgery ◽

10.1227/01.neu.0000255453.20602.80 ◽

2007 ◽

Vol 60 (5) ◽

pp. 844-852 ◽

Cited By ~ 92

Author(s):

Makoto Nakamura ◽

Melena Struck ◽

Florian Roser ◽

Peter Vorkapic ◽

Madjid Samii

Keyword(s):

Clinical Outcome ◽

Recurrence Rate ◽

Tumor Resection ◽

Surgical Removal ◽

Tumor Removal ◽

Recurrence Rates ◽

Olfactory Groove ◽

Total Tumor Removal ◽

Frontolateral Approach

Abstract OBJECTIVE Olfactory groove meningiomas account for 8 to 13% of all intracranial meningiomas. Surgical removal is often performed through the bifrontal, unilateral subfrontal (frontolateral), or pterional approach. We report on the clinical outcome and recurrence rate after surgical treatment of olfactory groove meningiomas in our neurosurgical department. METHODS A retrospective study was conducted by analyzing the charts of the patients, including surgical records, discharge letters, histological records, follow-up records, and imaging studies. RESULTS A total of 1800 meningiomas were operated on between 1978 and 2002 in our department. There were 82 patients with olfactory groove meningiomas, including 63 women and 19 men with a mean age of 57.8 years (age range, 33–91 yr). Most patients presented with mental disturbance. Tumors were operated through the bifrontal (n = 46), frontolateral (n = 34), and pterional (n = 2) approaches. Total tumor removal (Simpson Grade 1 or 2) was achieved in most cases (91.2% frontolateral, 93.5% bifrontal). Perioperative mortality was 4.9% (four out of 82 patients, all operated through the bifrontal approach). The overall recurrence rate was 4.9%, with four patients requiring surgery. The mean follow-up period was 63.4 months (range, 4–270 mo). CONCLUSION Olfactory groove meningiomas were removed mainly through two different surgical approaches. Even in large tumors, high rates of total tumor resection could also be achieved with low recurrence rates using the simple and minimally invasive frontolateral approach. In recent years, we have preferred to use the frontolateral approach, which provides quick access to the tumor with less brain exposure while still enabling total tumor removal with a low morbidity rate and no mortality.

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Recurrence Rates of Dorsal Wrist Ganglion Cysts After Arthroscopic Versus Open Surgical Excision: A Retrospective Comparison

Hand ◽

10.1177/15589447211003184 ◽

2021 ◽

pp. 155894472110031

Author(s):

Matthew W. Konigsberg ◽

Liana J. Tedesco ◽

John D. Mueller ◽

Jacob R. Ball ◽

Chia H. Wu ◽

...

Keyword(s):

Recurrence Rate ◽

Surgical Excision ◽

Recurrence Time ◽

Recurrence Rates ◽

Lower Recurrence Rate ◽

Ganglion Cysts ◽

Cyst Recurrence ◽

Dorsal Ganglion ◽

Dorsal Wrist Ganglion

Background This study directly compares the recurrence rates of dorsal wrist ganglion cysts in patients treated via open surgical excision versus arthroscopic surgical excision. We hypothesized that there would be no difference between recurrence rates with these 2 surgical options. Methods We retrospectively reviewed the charts of all patients with a dorsal ganglion cyst undergoing either open or arthroscopic surgical excision at a single academic center with 3 fellowship-trained attending hand surgeons from 2012 to 2017. Charts were identified using Current Procedural Terminology codes and were reviewed using postoperative office notes for preoperative and postoperative symptoms, episodes of recurrence, time at which recurrence occurred, subsequent operations, and outcome at final follow-up. Results The charts of 172 patients undergoing either arthroscopic or open dorsal ganglion excision were reviewed. Nine of 54 (16.7%) arthroscopic excisions resulted in cyst recurrence, while 8 of 118 (6.8%) open excisions resulted in cyst recurrence ( P = .044). Two of 9 (22%) recurrences after arthroscopic ganglion excision versus 2 of 8 (25%) recurrences after open ganglion excision underwent repeat surgical intervention. Time to recurrence, as well as final follow-up, was not statistically different between groups. Conclusions Dorsal wrist ganglion cysts are the most common benign soft tissue mass of the upper extremity, but it remains unknown whether arthroscopic or open surgical excision leads to lower recurrence rate. Scant literature exists directly comparing these 2 methods of surgical excision. This study suggests that open excision of dorsal wrist ganglia leads to a lower recurrence rate than does arthroscopic excision.

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Substantial risk of recurrence even after 5 recurrence-free years in early-stage hepatocellular carcinoma patients

Clinical and Molecular Hepatology ◽

10.3350/cmh.2020.0016 ◽

2020 ◽

Vol 26 (4) ◽

pp. 516-528

Author(s):

Jihye Kim ◽

Wonseok Kang ◽

Dong Hyun Sinn ◽

Geum-Youn Gwak ◽

Yong-Han Paik ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Radiofrequency Ablation ◽

Recurrence Rate ◽

Early Stage ◽

Cancer Staging ◽

High Recurrence Rate ◽

Recurrence Rates ◽

Substantial Risk ◽

Hcc Recurrence

Background/Aims: Although hepatocellular carcinoma (HCC) is notorious for its high recurrence rate, some patients do not experience recurrence for more than 5 years after resection or radiofrequency ablation for early-stage HCC. For those with five recurrence-free period, the risk of HCC recurrence within the next 5 years remains unknown.Methods: A total of 1,451 consecutive patients (median, 55 years old; males, 79.0%; hepatitis B virus-related, 79.3%) with good liver function (Child-Pugh class A) diagnosed with early-stage HCC by Barcelona Clinic Liver Cancer Staging and received radiofrequency ablation or resection as an initial treatment between 2005 and 2010 were analyzed.Results: During a median follow-up period of 8.1 years, 961 patients (66.2%) experienced HCC recurrence. The cumulative recurrence rates increased to 39.7%, 60.3%, and 71.0% at 2, 5, and 10 years, respectively, and did not reach a plateau. Five years after HCC diagnosis, 487 patients were alive without experiencing a recurrence. Among them, during a median of 3.9 additional years of follow-up (range, 0.1–9.0 years), 127 patients (26.1%) experienced recurrence. The next 5-year cumulative recurrence rate (5–10 years from initial diagnosis) was 27.0%. Male sex, higher fibrosis-4 scores, and alpha-fetoprotein levels at 5 years were associated with later HCC recurrence among patients who did not experience recurrence for more than 5 years.Conclusions: The HCC recurrence rate following 5 recurrence-free years after HCC treatment was high, indicating that HCC patients warrant continued HCC surveillance, even after 5 recurrence-free years.

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