Surgical Treatment of Esthesioneuroblastoma: Major Complication Rates, Progression Free and Overall Survival

OBJECTIVE: We sought to develop an algorithm for surgical approaches to the sphenoid sinus. STUDY DESIGN AND SETTING: Retrospective review was conducted of all patients who underwent a sphenoid sinusotomy by the senior author between July 1994 and August 2001. RESULTS: The study population consisted of 141 patients, in whom 5 different surgical approaches were used: transseptal (47 (33.3%)), transnasal (19 (13.5%)), transethmoid (72 (51.1%)), transmaxillary (2 (1.42%)), and external (1 (0.7%)). Of the 47 transseptal approaches, 43 (91.5%) were for extirpation of a neoplasm. In contrast, 60 of 72 (83.3%) transethmoid procedures were for infectious/inflammatory disorders. An endoscopic approach was used for 7 of 8 (87.5%) skull base repairs. Four transsphenoid optic nerve decompressions were performed. The minor and major complication rates were 2.1% and 0.71%, respectively. CONCLUSIONS: The anatomic location of the pathologic process can guide the surgeon in selecting the most appropriate technique. SIGNIFICANCE: Surgical treatment of sphenoid pathology can be safely and successfully performed through a variety of approaches.

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Surgical Treatment of Olfactory Neuroblastoma: Major Complication Rates, Progression Free and Overall Survival

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1605593 ◽

2017 ◽

Vol 79 (02) ◽

pp. 151-155 ◽

Cited By ~ 3

Author(s):

Aileen Wertz ◽

Todd Hollon ◽

Lawrence Marentette ◽

Stephen Sullivan ◽

Jonathan McHugh ◽

...

Keyword(s):

Overall Survival ◽

Major Complication ◽

Olfactory Neuroblastoma ◽

Csf Leak ◽

Complication Rates ◽

Care Hospital ◽

Open Approach ◽

Major Complications ◽

Grading Systems ◽

Significant Difference

Objective We aimed to compare major complication rates in patients undergoing open versus endoscopic resection of olfactory neuroblastoma (ONB) and to determine the prognostic utility of the Kadish staging and Hyams grading systems with respect to progression-free survival (PFS) and overall survival (OS). Methods It is a retrospective review of experience in treating ONB at a single tertiary care hospital from 1987 through 2015. Major complications were defined as cerebrospinal fluid (CSF) leak, meningitis, osteomyelitis, tracheostomy, and severe neurologic injury. Results Forty-one patients were included. An open approach was used in 34 (83%), endoscopic in 6 (15%), and combined in 1 (2%) case. Rates of major complications by surgical approach were 17% after endoscopic versus 31% after open (p = 0.65). There was no significant difference in PFS or OS based on Kadish B versus C (PFS, p = 0.28; OS, p = 0.11) or Hyams grade 1 and 2 versus Hyams grade 3 and 4 (PFS, p = 0.53; OS, p = 0.38). Conclusions There was no significant difference in major complications between open and endoscopic approaches for the treatment of ONB. Patient stratification using the Kadish staging and Hyams grading systems did not show significant differences in PFS or OS. Further research is needed to determine if a different staging system would better predict patient outcomes.

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Association between CT-Based Preoperative Sarcopenia and Outcomes in Patients That Underwent Liver Resections

Cancers ◽

10.3390/cancers14010261 ◽

2022 ◽

Vol 14 (1) ◽

pp. 261

Author(s):

David Martin ◽

Yaël Maeder ◽

Kosuke Kobayashi ◽

Michael Schneider ◽

Joachim Koerfer ◽

...

Keyword(s):

Overall Survival ◽

Clinical Outcomes ◽

Lumbar Vertebra ◽

Length Of Hospital Stay ◽

Major Complication ◽

Complication Rates ◽

Survival Times ◽

Skeletal Muscle Index ◽

Liver Resections ◽

Preoperative Ct

This retrospective observational study aimed to evaluate whether preoperative sarcopenia, assessed by CT imaging, was associated with postoperative clinical outcomes and overall survival in patients that underwent liver resections. Patients operated on between January 2014 and February 2020 were included. The skeletal muscle index (SMI) was measured at the level of the third lumbar vertebra on preoperative CT scans. Preoperative sarcopenia was defined based on pre-established SMI cut-off values. The outcomes were postoperative morbidity, length of hospital stay (LOS), and overall survival. Among 355 patients, 212 (59.7%) had preoperative sarcopenia. Patients with sarcopenia were significantly older (63.5 years) and had significantly lower BMIs (23.9 kg/m2) than patients without sarcopenia (59.3 years, p < 0.01, and 27.7 kg/m2, p < 0.01, respectively). There was no difference in LOS (8 vs. 8 days, p = 0.75), and the major complication rates were comparable between the two groups (11.2% vs. 11.3%, p = 1.00). The median overall survival times were comparable between patients with sarcopenia and those without sarcopenia (15 vs. 16 months, p = 0.87). Based on CT assessment alone, preoperative sarcopenia appeared to have no impact on postoperative clinical outcomes or overall survival in patients that underwent liver resections. Future efforts should also consider muscle strength and physical performance, in addition to imaging, for preoperative risk stratification.

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Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

The Journal of Knee Surgery ◽

10.1055/s-0040-1712100 ◽

2020 ◽

Author(s):

Antonio Klasan ◽

Sven Edward Putnis ◽

Wai Weng Yeo ◽

Darli Myat ◽

Brett Andrew Fritsch ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Patient Selection ◽

Knee Arthroplasty ◽

Major Complication ◽

The Elderly ◽

Complication Rates ◽

Bilateral Total Knee Arthroplasty ◽

Proper Patient Selection ◽

Patient Reported ◽

Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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Outcomes of Surgical and Nonsurgical Treatment for Colorectal Cancer in Nonagenarian Patients

The American Surgeon ◽

10.1177/0003134821995060 ◽

2021 ◽

pp. 000313482199506

Author(s):

Youngbae Jeon ◽

Kyoung-Won Han ◽

Won-Suk Lee ◽

Jeong-Heum Baek

Keyword(s):

Colorectal Cancer ◽

Overall Survival ◽

Surgical Treatment ◽

Postoperative Complications ◽

Postoperative Mortality ◽

Nonsurgical Treatment ◽

Perioperative Outcomes ◽

Rank Test ◽

Kaplan Meier ◽

Number Of Patients

Purpose This study is aimed to evaluate the clinical outcomes of surgical treatment for nonagenarian patients with colorectal cancer. Methods This retrospective single-center study included patients diagnosed with colorectal cancer at the age of ≥90 years between 2004 and 2018. Patient demographics were compared between the operation and nonoperation groups (NOG). Perioperative outcomes, histopathological outcomes, and postoperative complications were evaluated. Overall survival was analyzed using Kaplan-Meier methods and log-rank test. Results A total of 31 patients were included (16 men and 15 women), and the median age was 91 (range: 90‐96) years. The number of patients who underwent surgery and who received nonoperative management was 20 and 11, respectively. No statistical differences in baseline demographics were observed between both groups. None of these patients were treated with perioperative chemotherapy or radiotherapy. Surgery comprised 18 (90.0%) colectomies and 2 (10.0%) transanal excisions. Short-term (≤30 days) and long-term (31‐90 days) postoperative complications occurred in 7 (35.0%) and 4 (20.0%) patients, respectively. No complications needed reoperation, such as anastomosis leakage or bleeding. No postoperative mortality occurred within 30 days: 90-day postoperative mortality occurred in two patients (10.0%), respectively. The median overall survival of the operation group was 31.6 (95% confidence interval: 26.7‐36.5) and that of NOG was 12.5 months (95% CI: 2.4‐22.6) ( P = 0.012). Conclusion Surgical treatment can be considered in carefully selected nonagenarian patients with colorectal cancer in terms of acceptable postoperative morbidity, with better overall survival than the nonsurgical treatment.

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Lateral Ankle Instability Surgical Treatment

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000347 ◽

2017 ◽

Vol 2 (3) ◽

pp. 2473011417S0003

Author(s):

Bahman Sahranavard ◽

Cesar de Cesar Netto ◽

Ashish Shah ◽

Parke Hudson ◽

Ibukunoluwa Araoye ◽

...

Keyword(s):

Surgical Treatment ◽

Revision Surgery ◽

Surgical Repair ◽

Ankle Instability ◽

Primary Repair ◽

P Value ◽

Complication Rates ◽

Suture Anchors ◽

Lateral Ankle ◽

Lateral Ankle Instability

Category: Ankle, Sports Introduction/Purpose: Lateral ankle instability is a common cause of disability in the active population. Although the majority of patients can be treated conservatively, surgical repair of the ligaments, with or without reinforcement, represents an excellent option for refractory cases. Failed primary surgical repair, recurrence of the ankle instability and need for revision surgery can rarely happen and is probably affected by multiple variables. That includes patient’s characteristics such as BMI and comorbidities and surgical aspects such as the use of suture anchors and soft-tissue reinforcement. The purpose of this study was to compare patient’s characteristics and complication rates of primary repair and revision procedures. Methods: We retrospectively reviewed 231 patients (160 Female, 71 Male) who underwent surgical treatment for lateral ankle instability between 2010-2016. Thirty-two were revision cases (14.2%), including 24 females and 8 males, and 199 were primary direct repairs (85.8%). The mean age at the time of the surgery was 39 (19-65)years, and average follow-up was 9 (2-55) months. The procedures were performed by four different surgeons. All cases were reviewed based on age, gender, BMI, procedure type and number of incisions, comorbidities, and complications. Data found was compared between the two groups (primary repair and revision surgery) by T-test. A p-value <0.05 was considered significant. Results: The Brostrom-Gould procedure was used in 69.5% of the primary repairs and 63.6% of the revision cases. The use of suture anchors was also similar in both groups (51%). Repair of the calcaneofibular ligament was performed in 68% of primary repairs and 81.8% of the revisions. We didn’t find significant differences regarding comorbidities between two groups: smoking (23.4% x 27.2%, p-value 0.371); diabetes (6.8% x 6%, p-value 0.951) and body mass index above 30 (28.5% x 24.2%, p-value 0.347). We found significant difference in the complication rate of the procedures, with a higher incidence in the revision group (48.4%) when compared to the primary repair group (24%). That included: sural neuritis (15.1% x 3.4%), superficial peroneal neuritis (12.1% x 4.5%), skin problems (9% x 7.4%). Conclusion: Our study of 231 patients that underwent surgical treatment for lateral ankle instability found significant higher incidence of complications in patients who had revision procedures when compared to primary repair. No differences regarding smoking status, diabetes and BMI were found.

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National Norwegian Practice Patterns for Surgical Treatment of Kidney Cancer Tumors ≤7 cm: Adherence to Changes in Guidelines May Improve Overall Survival

European Urology Oncology ◽

10.1016/j.euo.2018.04.001 ◽

2018 ◽

Vol 1 (3) ◽

pp. 252-261 ◽

Cited By ~ 1

Author(s):

Karin M. Hjelle ◽

Tom B. Johannesen ◽

Leif Bostad ◽

Lars A.R. Reisæter ◽

Christian Beisland

Keyword(s):

Overall Survival ◽

Surgical Treatment ◽

Kidney Cancer ◽

Practice Patterns

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Absence of Association between Preoperative Estimated Glomerular Filtration Rates and Postoperative Outcomes following Elective Gastrointestinal Surgeries: A Prospective Cohort Study

Anesthesiology Research and Practice ◽

10.1155/2018/5710641 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Sivesh K. Kamarajah ◽

Behrad Barmayehvar ◽

Mustafa Sowida ◽

Amirul Adlan ◽

Christina Reihill ◽

...

Keyword(s):

Risk Stratification ◽

Glomerular Filtration ◽

Elective Surgery ◽

Gastrointestinal Surgery ◽

Major Complication ◽

Postoperative Outcomes ◽

Queen Elizabeth Hospital ◽

Complication Rates ◽

Significant Difference ◽

The Impact

Background. Preoperative risk stratification and optimising care of patients undergoing elective surgery are important to reduce the risk of postoperative outcomes. Renal dysfunction is becoming increasingly prevalent, but its impact on patients undergoing elective gastrointestinal surgery is unknown although much evidence is available for cardiac surgery. This study aimed to investigate the impact of preoperative estimated glomerular filtration rate (eGFR) and postoperative outcomes in patients undergoing elective gastrointestinal surgeries. Methods. This prospective study included consecutive adult patients undergoing elective gastrointestinal surgeries attending preassessment screening (PAS) clinics at the Queen Elizabeth Hospital Birmingham (QEHB) between July and August 2016. Primary outcome measure was 30-day overall complication rates and secondary outcomes were grade of complications, 30-day readmission rates, and postoperative care setting. Results. This study included 370 patients, of which 11% (41/370) had eGFR of <60 ml/min/1.73 m2. Patients with eGFR < 60 ml/min/1.73 m2 were more likely to have ASA grade 3/4 (p<0.001) and >2 comorbidities (p<0.001). Overall complication rates were 15% (54/370), with no significant difference in overall (p=0.644) and major complication rates (p=0.831) between both groups. In adjusted models, only surgery grade was predictive of overall complications. Preoperative eGFR did not impact on overall complications (HR: 0.89, 95% CI: 0.45–1.54; p=0.2). Conclusions. Preoperative eGFR does not appear to impact on postoperative complications in patients undergoing elective gastrointestinal surgeries, even when stratified by surgery grade. These findings will help preassessment clinics in risk stratification and optimisation of perioperative care of patients.

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Morbidity and mortality of pelvic exenteration for cervical cancer at a German referral center.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17505 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17505-e17505

Author(s):

Jelena Boekhoff ◽

Luisa terGlane ◽

Uwe Wagner ◽

Axel Hegele

Keyword(s):

Cervical Cancer ◽

Overall Survival ◽

Pelvic Exenteration ◽

Survival Rates ◽

Operation Time ◽

Previous Treatment ◽

University Hospital ◽

Treatment Modalities ◽

Complication Rates ◽

Recurrent Cervical Cancer

e17505 Background: The purpose of this study was to evaluate data regarding the outcome of pelvic exenteration (PE) when performed for advanced or recurring cervical cancer. Methods: A total of 24 patients underwent PE for cervical cancer at the University Hospital Marburg between 2011 and 2016. Their data were retrospectively assessed and statistically analyzed. Survival was evaluated using the Kaplan-Meyer method. Results: Mean age was 52.2 years (29.7 to 72.6 years), mean BMI was 23.4 kg/m2. Most common indication was squamous cell carcinoma, whereas 3 patients underwent PE for adenocarcinoma. The majority of the tumors (62.5%) were stage pT4. Negative margins could be achieved in 70.8%. Lymph nodes could be assessed in 55% and were tumor-afflicted in 20.8%. 45.8% were treated for recurrent cancer; median recurrence free time between previous treatment and PE was 16 months. Up-front PE was performed in 20.8%. Another 79.2% received treatment prior to PE: 20.8% received all 3 treatment modalities whereas 37.5% had two treatments before (29.2% underwent chemo- and radiotherapy, 8.3% had surgery and radiotherapy) and 20.8% underwent one type of treatment. Anterior PE (APE) and total PE (TPE) were performed in 62.5% and 37.5%, respectively. Median operation time was 324min. Blood products were administered perioperatively in 75%; 37.5% needed 2 or more. Median hospital stay was 25 days. Major complications (Clavien Dindo≥3) were observed in 41.7% and 16.7% had no complications. Overall Survival (OS) was 29.2%; median overall survival was 19.1 months. 2- and 3-year survival rates for curative PE were 50% and 35% respectively. 4 patients underwent PE with palliative intent. Overall survival correlated significantly with R1- (p = 0.012), N1- (p = 0.047) and M1-status p < 0.01), TPE (p = 0.034) and surgical time > 6 h (p = 0.003). Conclusions: In cases of advanced or recurrent cervical cancer gynecologists struggle to find suitable therapeutic options, especially since most patients have already received radio- and/or chemotherapy. PE is a valid option for selected patients that may represent a cure with tolerable complication rates.

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Results of surgical treatment of massive localized lymphedema in severely obese patients

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/s0100-69912014000100005 ◽

2014 ◽

Vol 41 (1) ◽

pp. 018-022 ◽

Cited By ~ 4

Author(s):

Wilson Cintra Júnior ◽

Miguel Luiz Antonio Modolin ◽

Rodrigo Itocazo Rocha ◽

Thadeu Rangel Fernandes ◽

Ariel Barreto Nogueira ◽

...

Keyword(s):

Quality Of Life ◽

Morbid Obesity ◽

Surgical Treatment ◽

Lymphatic Vessels ◽

Complication Rates ◽

Blood Capillaries ◽

Tissue Edema ◽

Severely Obese

OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

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