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

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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The clinical profile, management, and outcome of febrile neutropenia in acute myeloid leukemia from resource constraint settings

Therapeutic Advances in Infectious Disease ◽

10.1177/20499361211036592 ◽

2021 ◽

Vol 8 ◽

pp. 204993612110365

Author(s):

Kundan Mishra ◽

Suman Kumar ◽

Sandeep Ninawe ◽

Rajat Bahl ◽

Ashok Meshram ◽

...

Keyword(s):

Overall Survival ◽

Acute Myeloid Leukemia ◽

Febrile Neutropenia ◽

Burkholderia Cepacia ◽

Myeloid Leukemia ◽

Tertiary Care ◽

Care Hospital ◽

Significant Difference ◽

The Mean ◽

Acute Myeloid

Introduction: Acute myeloid leukemia (AML) is the commonest leukemia in adults. Mortality in thew first 30-days ranges from 6% to 43%, while infections account for 30–66% of early deaths. We aim to present our experience of infections in newly-diagnosed AML. Method: This prospective, observational study, was undertaken at a tertiary care hospital in Northern India. Patients with confirmed AML (bone marrow morphology and flow cytometry) and who had developed febrile neutropenia (FN), were included. Result: A total of fifty-five patients were included in the study. The median age of the patients was 47.1 years (12–71) and 28 (50.9%) were males. Fever (33, 60%) was the commonest presentation at the time of diagnosis. One or more comorbid conditions were present in 20 patients (36.36%). Infection at presentation was detected in 17 patients (30.9%). The mean duration to develop febrile neutropenia since the start of therapy was 11.24 days. With each ten-thousand increase in white blood cell (WBC) count, the mean number of days of FN development decreased by 0.35 days ( p = 0.029). Clinical and/or radiological localization was possible in 23 patients (41.81%). Thirty-four blood samples (34/242, 14.04%) from 26 patients (26/55, 47.3%) isolated one or more organisms. Gram negative bacilli (GNB) were isolated in 24 (70.58%) samples. Burkholderia cepacia (8/34, 23.52%) was the commonest organism. The number of days required to develop febrile neutropenia was inversely associated with overall survival (OS). However, when compared, there was no statistically significant difference in OS between patients developing fever on day-10 and day-25 ( p = 0.063). Thirteen patients (23.63%) died during the study period. Discussion: Low percentage of blood culture positivity and high incidence of MDR organisms are a matter of concern. Days to develop febrile neutropenia were inversely associated with overall survival (OS), emphasizing the importance of preventive measures against infections. Conclusion: Infections continues to be a major cause of morbidity and mortality among AML patients.

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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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Comparison of Open and Endoscopic Approaches in the Resection of Esthesioneuroblastoma

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420939582 ◽

2020 ◽

pp. 000348942093958

Author(s):

Gregory L. Barinsky ◽

Monica C. Azmy ◽

Suat Kilic ◽

Jordon G. Grube ◽

Soly Baredes ◽

...

Keyword(s):

Overall Survival ◽

Endoscopic Surgery ◽

Olfactory Neuroblastoma ◽

Endoscopic Approach ◽

Surgical Approaches ◽

Open Approach ◽

Chi Square ◽

Kaplan Meier ◽

Open Versus ◽

Chi Square Analysis

Background: Olfactory neuroblastoma, or esthesioneuroblastoma (ENB), is an uncommon sinonasal malignancy arising from olfactory neuroepithelium that is optimally treated with surgical resection. The objective of this study is to determine preoperative predictors of undergoing open versus endoscopic approach for ENB and to investigate significant postoperative survival outcomes between the two surgical approaches. Methods: The National Cancer Database (NCDB) was queried for cases of ENB histology that were treated surgically from 2010 to 2015. Groups were stratified into open or endoscopic approach cohorts. Patient demographics, tumor characteristics, treatment modality, and 5-year overall survival were compared between the two groups using Chi-Square analysis and Kaplan-Meier survival analysis. Cases were classified as Kadish stage A, B, C, or D based on the “Collaborative Stage-Extension” codes in NCDB. Results: Of 533 patients meeting inclusion criteria, 276 (51.8%) patients underwent open, and 257 (48.2%) patients underwent endoscopic surgical approaches. Patients undergoing endoscopic surgery were more likely to be Kadish stages A and B and less likely to be stages C and D ( P = .020). Those undergoing endoscopic approach overall had a shorter mean hospital stay postoperatively (3.8 vs. 7.0 days, P < .001). Endoscopic cases had a greater 5-year overall survival (81.9% vs. 75.6%, P = .030); after multivariate regression, there was a trend toward survival benefit to endoscopic surgery that did not reach clinical significance (HR 0.644, [0.392-1.058], P = .083). Conclusion: Although not statistically significant, there is a trend toward increased overall survival with an endoscopic approach in patients undergoing surgery for ENB as compared to an open approach, regardless of Kadish stage. An endoscopic approach is an adequate alternative to an open approach for the surgical treatment of ENB.

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Audit of Complications in an Otolaryngology Led Skull-Base Surgical Practice

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1676793 ◽

2018 ◽

Vol 80 (06) ◽

pp. 586-592

Author(s):

Uma Patnaik ◽

Smriti Panda ◽

Alok Thakar

Keyword(s):

Skull Base ◽

Surgical Complications ◽

Skull Base Surgery ◽

Major Complication ◽

Anterior Skull Base ◽

Complication Rates ◽

Permanent Disability ◽

Lateral Skull Base ◽

Significant Difference ◽

Surgical Complexity

Objective This study was aimed to classify and study complications of surgery of the cranial base, primarily from an otorhinolaryngology perspective. Design This study was designed with consecutive cohort of skull base surgical cases. Setting Tertiary referral academic center. Participants Patients having skull-base surgery at a otorhinolaryngology based skull-base unit, from 2002 to 2015. Main Outcome Measures Enumeration of complications is the main outcome of this study. Surgical procedures, categorized for complexity as per a unified system, are applicable to endoscopic and open procedures. Complications were categorized as per the British Association of Otolaryngologists coding of surgical complications. Complication classified as major if life-threatening, causing permanent disability, or compromising the result of surgery. Results A total of 342 patients (n = 342) were operated; 13 patients' records were excluded due to < 6 months posttreatment follow-up. The study group constituted 204 anterior skull-base (endoscopic, 120; open/external, 84) and 125 lateral skull-base procedures. Complication rates noted to increase in both groups with increasing complexity of surgical intervention. Anterior skull-base surgery (total complications, 11%; major, 3%; death, 0.5%) noted to have significantly less surgical complications than lateral skull-base surgery (total complications, 33%; major, 15%; death, 1.6%; p < 0.001). Among the anterior procedures no significant difference noted among endoscopic and external approaches when compared across similar surgical complexity. Conclusion Despite improvement in surgical and perioperative care, the overall major complication rate in a contemporary otolaryngology led, primarily extradural, skull-base practice is noted at 8%. Perioperative mortality, though rare, was encountered in 1%. A standard method for categorization of surgical complexity and the grade of complications as reported here is recommended.

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Efficacy and factors affecting the choice of enucleation and liver resection for giant hemangioma: a retrospective propensity score-matched study

BMC Surgery ◽

10.1186/s12893-020-00935-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mingguang Ju ◽

Feng Xu ◽

Wenyan Zhao ◽

Chaoliu Dai

Keyword(s):

Liver Resection ◽

Propensity Score ◽

Operation Time ◽

Major Complication ◽

Hepatic Hemangioma ◽

Transfusion Rate ◽

Complication Rates ◽

Factors Affecting ◽

Multiple Tumors ◽

Significant Difference

Abstract Background Liver resection (LR) and enucleation (EN) are the main surgical treatment for giant hepatic hemangioma (HH), but how to choose the type of surgery is still controversial. This study aimed to explore the efficacy and the factors affecting the choice of open procedure for HH. Methods The data for patients with pathologically confirmed HH who underwent open surgery from April 2014 to August 2020 were analyzed retrospectively. Univariate and multivariate analyses with logistic regression were performed to disclose the factors associated with the choice of EN or LR. Propensity score matching (PSM) analysis was used to compare the efficacy of the two procedures. Results A total of 163 and 110 patients were enrolled in the EN and LR groups. Following 1:1 matching by PSM analysis, 66 patients were selected from each group. Centrally located lesions (OR: 0.131, 95% CI 0.070–0.244), tumors size > 12.1 cm (OR: 0.226, 95% CI 0.116–0.439) and multiple tumors (OR: 1.860, 95% CI 1.003–3.449) were independent factors affecting the choice of EN. There was no significant difference in the median operation time (156 vs. 195 min, P = 0.156), median blood loss (200 vs. 220 ml, P = 0.423), blood transfusion rate (33.3% vs. 33.3%, P = 1.000), mean postoperative feeding (3.1 vs. 3.3 d, P = 0.460), mean postoperative hospital stay (9.5 vs. 9.0 d, P = 0.206), or the major complication rates between the two groups. Conclusions Peripherally located lesions, tumors size ≤ 12.1 cm and multiple tumors were more inclined to receive EN. There was no significant difference in the efficacy of EN or LR.

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Complications of thermal ablation of hepatic tumors: Comparison of radiofrequency and microwave techniques.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e15040 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e15040-e15040 ◽

Cited By ~ 1

Author(s):

Xiang Jing ◽

Jianmin Ding ◽

Jibin Liu ◽

Yandong Wang ◽

Fengmei Wang ◽

...

Keyword(s):

Liver Cancer ◽

Thermal Ablation ◽

Liver Tumors ◽

Major Complication ◽

Mortality Rates ◽

Complication Rates ◽

Hepatic Tumors ◽

Ablation Therapy ◽

Liver Cancers ◽

Significant Difference

e15040 Background: The efficacy and safety of radiofrequency ablation (RFA) have been reported in the literatures, which are considered as frontline choice for treatment of liver cancer. Recently, microwave ablation (MWA) has emerged and gained great attention over RFA. However, in comparison to RFA, the safety of MWA for treatment of liver cancer has not been fully reported in the literatures. Studies with large clinical data sets are still needed to understand the technique and avoid the complications. The objective of this study was to retrospectively investigate the common complications of thermal ablations of liver tumors using both RFA and MWA techniques, and compare the safety between these two procedures. Methods: This retrospective study protocol was approved by our institutional ethics committee to allow investigators to review the existing patient’s medical records. A total of 879 patients with hepatic tumors underwent thermal ablation. There were 323 cases having the RFA procedures and 556 cases having MWA procedures. The complications of thermal ablations of liver tumors were compared using both RFA and MWA techniques. Results: A total of 1,030 thermal ablation sessions was performed in 879 patients with a total of 1,652 tumors. There were 323 patients with 562 tumors received a total of 376 RFA with averaged 1.16±0.48 sessions per patient. The other 556 patients with 1,090 tumors received a total of 654 MWA with averaged1.18±0.51 sessions per patient. The mortality rates were 0.31% (1/323) and 0.36% (2/556) in RFA and MWA group. In RFA and MWA group, the major complication rates were 3.5% (13/376) and 3.1% (20/654) (Table 1), meanwhile the minor complication rates were 5.9% (22/376) and 5.7% (37/654). There was no statistical significant difference for the mortality rates, the major complications, the minor complications between the RFA and MWA groups (P>0.05). Conclusions: Thermal ablation therapy in the treatment of liver cancers is relatively safe with low mortality and low incidence of serious complications. The types and incidences of complications caused by RFA and MWA are similar and comparable for safety consideration in clinical settings.

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Evaluation of CO2 Laser Surgery for Early Carcinoma Larynx

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1066 ◽

2011 ◽

Vol 2 (3) ◽

pp. 125-129

Author(s):

Vijay K Sharma ◽

Ajith Nilakantan

Keyword(s):

Laser Surgery ◽

Tertiary Care ◽

Major Complication ◽

Functional Results ◽

Laryngeal Edema ◽

Care Hospital ◽

Patient Acceptability ◽

Carcinoma Larynx ◽

Significant Difference ◽

Malignant Lesions

ABSTRACT Objective To evaluate the effectiveness of transoral endoscopic laser surgery in the treatment of early laryngeal cancers in comparison to external radiotherapy. Method: The patients included in the study were those who reported to the ENT department of a tertiary care hospital with early malignant lesions of the larynx. Result Our study revealed a local recurrence rate of 15% in the radiotherapy arm but only 10% in the CO2 laser arm; however, this difference was not statistically significant. The only parameter in the analysis of voice which showed a statistically significant difference between the two arms was roughness which was better in the radiotherapy arm at 6 months. The major complication following transoral CO2 laser surgery was persistent hoarseness which was seen in six patients and it resolved completely on continuation of conservative measures. Severe laryngeal edema following treatment was seen in two patients. Statistically significant difference was noted in patient acceptability in favor of CO2 laser. Conclusion Endoscopic CO2 laser surgery in early laryngeal cancer leads to similar control of the disease as with the traditional methods, with better patient acceptability, low morbidity and good functional results.

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Complications of cochlear implantation surgery in Zagazig University Hospitals

The Egyptian Journal of Otolaryngology ◽

10.1186/s43163-021-00136-3 ◽

2021 ◽

Vol 37 (1) ◽

Author(s):

Alaa Eldin M. Elfeky ◽

Adly A. Tantawy ◽

Asmaa M. Ibrahim ◽

Ibrahim M. Saber ◽

Said Abdel-Monem

Keyword(s):

Facial Nerve ◽

Cochlear Implant ◽

Cochlear Implantation ◽

Csf Leak ◽

Facial Nerve Paralysis ◽

Complication Rates ◽

Chorda Tympani Nerve ◽

University Hospitals ◽

Nerve Paralysis ◽

Major Complications

Abstract Background Cochlear implantation (CI) has been established worldwide as the surgical treatment for individuals with bilateral severe to profound hearing loss. Complications due to surgery are minimal and are often encountered in cases with congenital anomalies of the temporal bone and inner ear. Complications in CI are related to malfunctioning of the device or the process of wound healing. In most cochlear implant centers, as the surgeon’s skill and clinical expertise in managing various cochlear implant cases improve with years of experience, the complication rates ideally come down over time. This article is intended to describe the most common surgical complications of cochlear implantation in Zagazig University Hospitals. This retrospective study included 130 patients who underwent cochlear implantation in Zagazig University Hospitals from 2016 to 2018. The patients were 61 males and 69 females; their ages ranged between 2 and 6 years old with a mean age of 4.3. This study aims to provide feedback on the common complications of CI surgery at our institution to help the reduction of its incidence in the future. Results One hundred thirty cases of cochlear implants were performed in our department between 2016 and 2018. Sixty complications were recorded, including 27 cases of minor and 21 cases of major complications. Minor complications were flap wound infection in 4 cases (3.1%), chorda tympani nerve injury in 7 cases (5.4%), postoperative vertigo and vomiting in 3 cases (2.3%), injury of EAC in 7 cases (5.4%), wound seroma/hematoma in 4 cases (3.1%), and facial nerve twitching in 2 cases (1.5%). Major complications were electrode extrusion in 2 cases (1.5%), CSOM in 1 case (0.8%), CSF leak in 8 cases (6.1%), magnet migration in 3 cases (2.3%), total facial nerve paralysis in 5 cases (3.8%), and device failure in 2 cases (1.5%). Conclusion The overall incidence of major complications is low. The majority of minor complications can be effectively managed with conservative measures. Cochlear implantation remains a safe and effective surgical procedure.

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Determining the optimal timing for radical cystectomy after neoadjuvant chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.339 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 339-339

Author(s):

Chinedu O. Mmeje ◽

Cooper Benson ◽

Graciela M. Nogueras-Gonzalez ◽

Isuru Sampath Jayaratna ◽

Neema Navai ◽

...

Keyword(s):

Multivariate Analysis ◽

Lymph Node ◽

Lymph Node Metastasis ◽

Neoadjuvant Chemotherapy ◽

Radical Cystectomy ◽

Major Complication ◽

Complication Rates ◽

Surgical Time ◽

Node Metastasis ◽

Major Complications

339 Background: We present the largest series reviewing complications and pathologic outcomes following neoadjuvant chemotherapy (NAC) and radical cystectomy (RC), to determine whether the interval between chemotherapy and surgery (ICS) affects 90-day post-operative morbidity and lymph node metastasis. Methods: We analyzed 338 patients treated with NAC followed by RC from January 1995 through December 2013. The association of ICS with 90-day surgical morbidity, incidence of major complication, 90-day readmission, and lymph node metastasis was determined. Generalized linear models were used to determine potential predictors of each endpoint. Patients were stratified into four groups by ICS days (18 – 42; 43 – 64; 64 – 85; > 85). Complications were classified using the Clavien system. Results: The overall morbidity of the cohort was 59%, with 66% being minor, and 34% being major complications. The median ICS was 46 days (18 – 199 days). There was no difference in the overall morbidity, readmission, or major complication rates among the four groups. Patients with an ICT > 85 days had the highest incidence of lymph node metastasis (40%), though this was not found to be significant (p = 0.1). On multivariate analysis including predictors of perioperative morbidity, extravesical (pT3 – 4) disease (OR = 1.97; p = 0.01) was an independent predictor of overall morbidity, while age at cystectomy (OR = 1.05; p = 0.004), and surgical time ≥ 7 hrs (OR = 2.87; p = 0.001) were independent predictors of major complications. Only surgical time ≥ 7 hrs (OR = 2.24; p = 0.006) was found to be a predictor of readmission. In a separate multivariate analysis that included risk factors for pathological node positivity, the predictors for lymph node metastasis included variant histology (OR = 2.06; p = 0.026) and extravesical disease (OR = 2.76; p = 0.002). Patients with an ICT > 85 days had a higher risk of node metastasis though this was not significant. Conclusions: Patients can undergo RC anytime between 2.5 – 12 weeks after NAC with no difference in risk of surgical complications or nodal metastasis.

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Patient-reported outcome scores underestimate the impact of major complications in patients undergoing spine surgery for degenerative conditions

Journal of Neurosurgery Spine ◽

10.3171/2017.3.spine161400 ◽

2017 ◽

Vol 27 (4) ◽

pp. 397-402 ◽

Cited By ~ 7

Author(s):

Borys V. Gvozdyev ◽

Leah Y. Carreon ◽

Christopher M. Graves ◽

Stephanie A. Riley ◽

Katlyn E. McGraw ◽

...

Keyword(s):

Health Status ◽

Spine Surgery ◽

General Health ◽

Major Complication ◽

Adverse Outcomes ◽

General Health Status ◽

Major Complications ◽

Significant Difference ◽

Patient Reported ◽

The Impact

OBJECTIVEPatient-reported outcomes (PROs) such as the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) are widely used to evaluate treatment outcomes following spine surgery for degenerative conditions. The goal of this study was to use the Charlson Comorbidity Index (CCMI) as a measure of general health status, for comparison with standard PROs.METHODSThe authors examined serial CCMI scores, complications, and PROs in 371 patients treated surgically for degenerative lumbar spine conditions who were enrolled in the Quality and Outcomes Database from a single center. The cohort included 152 males (41%) with a mean age of 58.7 years. Patients with no, minor, or major complications were compared at baseline and at 1 year postoperatively.RESULTSMinor complications were observed in 177 patients (48%), and major complications in 34 (9%). There were no significant differences in preoperative ODI, EQ-5D, or CCMI among the 3 groups. At 1 year, there was a significantly greater deterioration in CCMI in the major complication group (1.03) compared with the minor (0.66) and no complication groups (0.44, p < 0.006), but no significant difference in ODI or EQ-5D.CONCLUSIONSDespite equivalent improvements in PROs, patients with major complications actually had greater deterioration in their general health status, as evidenced by worse CCMI scores. Because CCMI is predictive of medical and surgical risk, patients who sustained a major complication now carry a greater likelihood of adverse outcomes with future interventions, including subsequent spine surgery. Although PRO scores are a key metric, they fail to adequately reflect the potential long-term impact of major perioperative complications.

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