Choledochal Cyst and Malignancy: A Plea for Lifelong Follow-Up

2017 ◽  
Vol 29 (02) ◽  
pp. 143-149 ◽  
Author(s):  
Thomas Wirth ◽  
Joachim Kuebler ◽  
Claus Petersen ◽  
Benno Ure ◽  
Omid Madadi-Sanjani
Keyword(s):  
Choledochal Cyst ◽  
Abdominal Ultrasound ◽  
Current Data ◽  
Elevated Risk ◽  
Long Term Outcomes ◽  
Cyst Excision ◽  
Before And After ◽  
Risk Of Malignancy

AbstractPrevious research has confirmed that patients with choledochal cyst have an elevated risk of cholangiocarcinoma and gallbladder carcinoma. Current data suggest a risk of malignancy of 6 to 30% in adults with choledochal cyst. Malignancy has also occasionally been identified in children and adolescents. Multiple factors, including the age of the patient, cyst type, histological findings, and localization, have an impact on the prognosis. Information on long-term outcomes after cyst excision is limited. However, recent data suggest a lifelong elevated risk of up to 4% of cancer development following operation. This paper presents a review of the literature on cancer in patients with choledochal cyst before and after excision. A postoperative follow-up concept that consists of annual controls of CA19–9 and abdominal ultrasound is introduced.

Long-term outcomes after hepaticojejunostomy for choledochal cyst: a 10- to 27-year follow-up

2010 ◽  
Vol 45 (2) ◽  
pp. 376-378 ◽  
Author(s):  
Shigeru Ono ◽  
Shigehisa Fumino ◽  
Shinichi Shimadera ◽  
Naomi Iwai
Keyword(s):  
Choledochal Cyst ◽  
Long Term Outcomes

scholarly journals Comparison of Clinical Outcomes in Patients Selected for Infra-Popliteal Bypass or Plain Balloon Angioplasty for Chronic Limb Threatening Ischemia Between 2009 and 2013

2020 ◽  
Vol 55 (1) ◽  
pp. 26-32
Author(s):  
Matthew A. Popplewell ◽  
Huw O. B. Davies ◽  
Lewis Meecham ◽  
Gareth Bate ◽  
Andrew W. Bradbury
Keyword(s):  
Clinical Outcomes ◽  
Balloon Angioplasty ◽  
Group Analysis ◽  
Current Data ◽  
Index Admission ◽  
Long Term Outcomes ◽  
Vein Bypass ◽  
Best Medical Therapy

Introduction: A published subgroup analysis of the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL)-1 trial suggests that, in patients with chronic limb threatening ischemia (CLTI) due to infra-popliteal (IP) disease, clinical outcomes are better following vein bypass surgery (BS) than after plain balloon angioplasty (PBA). The aim of the present study is to determine if clinical outcomes following IP revascularization in our unit are concordant with those found in BASIL-1. Methods: We analyzed prospectively gathered data pertaining to 137 consecutive CLTI patients undergoing IP PBA or BS between 2009 and 2013. We compared 30-day morbidity and mortality, days in hospital (index admission and out to 12-months), amputation free survival (AFS), overall survival (OS), limb salvage (LS), and freedom from arterial re-intervention (FFR). Patient outcomes were censored on 1 February 2017, providing a minimum 3 years follow-up. Results: Patients undergoing BS (73/137, 47%) tended to be younger, have less comorbidity, and were more likely to be on best medical therapy (BMT). BS patients spent more days in hospital during the index admission (median 9 vs 5, p = .003), but not out to 12 months (median 15 vs 13, NS). BS patients suffered more 30-day morbidity (36% vs 10%, p < .001), mainly due to infective complications, but not mortality (3.1% vs 6.8%, NS). AFS (p = .001) and OS (p < .001), but not LS or FFR, were better after BS. Conclusions: CLTI patients selected for revascularization by means of IP BS had better long-term outcomes in terms of AFS and OS, but not FFR or LS. Although we await the results of the BASIL-2 trial, current data support the BASIL-1 sub-group analysis which suggests that patients requiring revascularization for IP disease should have BS where possible and that PBA should usually be reserved for patients who are not suitable for BS.

scholarly journals Type IVA Choledochal Cyst: Is Hepatic Resection Necessary?

HPB Surgery ◽  
1996 ◽  
Vol 10 (1) ◽  
pp. 61-63 ◽  
Author(s):  
Russell Strong
Keyword(s):  
Hepatic Resection ◽  
Choledochal Cyst ◽  
Study Design ◽  
Operative Management ◽  
Late Complications ◽  
Long Term Results ◽  
Cyst Excision ◽  
Percutaneous Transhepatic Cholangioscopy

Background: This study concerns patients who have choledochal cyst with intrahepatic and extrahepatic involvement (type IVA cyst). The extent of excision and the necessity of hepatectomy, including the intrahepatic cyst in these patients have not been clarified.Study design: We have performed excision of the extrahepatic cyst with hepaticojejunostomy upon 13 patients with type IVA cyst during a 16 year period. The present study was done to examine the size of the anastomotic opening by direct cholangiography two weeks postoperatively. The long-term results were assessed to find the appropriate operative management for patients with type IVA cysts.Results: Intrahepatic cysts were present in both hepatic lobes in 11 patients (85 percent). None of the patients had carcinoma after excision of extrahepatic cyst during the follow-up period, which ranged from two months to 16 years. Postoperative late complications occurred in three patients (23 percent), hepatolithiasis in two and cholangitis in one. The anastomotic opening of hepaticojejunostomy was 13.3±4.5 mm in diameter two weeks postoperatively, which was not significantly different when compared with that in ten patients without late complications (13.4±4.9 mm). The late complications were successfully treated with either antibiotics or percutaneous transhepatic cholangioscopy, and none required a reoperation.Conclusions: The results suggest that additional hepatectomy is not required because carcinoma has rarely occurred from the intrahepatic cyst. Excision of an extrahepatic cyst with a wide hepaticojejunostomy is an acceptable operative management for patients with type IVA cysts.

scholarly journals P-BN25 Redo-Antireflux surgery long term quality of life retrospective study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Hesham Mohamed ◽  
Martin Kawabata ◽  
Cicely Culmer ◽  
Keerthanaa Veerapatherar ◽  
Sanjoy Basu
Keyword(s):  
Quality Of Life ◽  
Retrospective Study ◽  
Antireflux Surgery ◽  
P Value ◽  
Long Term Outcomes ◽  
Before And After ◽  
Related Quality

Abstract Background Gastro-oesophageal reflux disease (GORD) can have a significant effect on patients quality of life, especially in sever cases. Laparoscopic Antireflux surgery is the most common approach which offers promising long-term outcomes. However, Failure of antireflux procedures are reported in 5% to 10% of the patients who might require a redo-antireflux surgery (Redo-ARS). This study aims to assess the long-term outcomes of Redo-Antireflux surgeries regarding symptoms control and patient satisfaction. Methods Retrospective study for patients who underwent Redo-ARS with a single consultant in the south of England. Follow up was done using The GORD Health-Related Quality-of-Life (GORD-HRQL) scale and patients reported their scores before and after the redo-surgery.   Exclusion criteria included follow up less than one year and failure of contacting the patient. Results All patients who underwent Redo-ARS between 2009-2019 were enlisted and 18 -out of the identified 22- were included in the study. Overall, There was a significant decrease in heartburn severity after the redo operation with a median reported severity of 4.5 preoperatively which decreased to 2 after the operation with a P value of 0.00062. This was observed in assessment of heartburn symptoms severity during sleep, laying flat, standing and after meals which all showed improvement after the operation with P values &lt;0.005. There was no statistically significant improvement of dysphagia, odynophagia or bloating. The median follow up was 5 years. Conclusions Redo laparoscopic antireflux operations are technically challenging, however, significant heartburn symptoms control is feasible. Further evaluation of types of surgeries and patient selection can guide decisions regarding further management and guidelines.

Intraoperative endoscopy during choledochal cyst excision: extended long-term follow-up compared with recent cases

2010 ◽  
Vol 45 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Tsubasa Takahashi ◽  
Akihiro Shimotakahara ◽  
Tadaharu Okazaki ◽  
Hiroyuki Koga ◽  
Go Miyano ◽  
...  
Keyword(s):  
Choledochal Cyst ◽  
Intraoperative Endoscopy ◽  
Cyst Excision ◽  
Long Term Follow Up

Periprocedural risk and long-term outcome of intracranial angioplasty based on a single-centre experience

VASA ◽  
2013 ◽  
Vol 42 (4) ◽  
pp. 264-274
Author(s):  
Dagmar Krajíčková ◽  
Antonín Krajina ◽  
Miroslav Lojík ◽  
Martina Mulačová ◽  
Martin Vališ
Keyword(s):  
Death Rate ◽  
Long Term Outcomes ◽  
Single Centre ◽  
Intracranial Atherosclerotic Stenosis ◽  
Atherosclerotic Stenosis ◽  
Angioplasty And Stenting ◽  
Aggressive Medical Management ◽  
Stroke Death

Background: Intracranial atherosclerotic stenosis is a major cause of stroke and yet there are currently no proven effective treatments for it. The SAMMPRIS trial, comparing aggressive medical management alone with aggressive medical management combined with intracranial angioplasty and stenting, was prematurely halted when an unexpectedly high rate of periprocedural events was found in the endovascular arm. The goal of our study is to report the immediate and long-term outcomes of patients with ≥ 70 % symptomatic intracranial atherosclerotic stenosis treated with balloon angioplasty and stent placement in a single centre. Patients and methods: This is a retrospective review of 37 consecutive patients with 42 procedures of ballon angioplasty and stenting for intracranial atherosclerotic stenosis (≥ 70 % stenosis) treated between 1999 and 2012. Technical success (residual stenosis ≤ 50 %), periprocedural success (no vascular complications within 72 hours), and long-term outcomes are reported. Results: Technical and periprocedural success was achieved in 90.5 % of patients. The within 72 hours periprocedural stroke/death rate was 7.1 % (4.8 % intracranial haemorrhage), and the 30-day stroke/death rate was 9.5 %. Thirty patients (81 %) had clinical follow-up at ≥ 6 months. During follow-up, 5 patients developed 6 ischemic events; 5 of them (17 %) were ipsilateral. The restenosis rate was 27 %, and the retreatment rate was 12 %. Conclusions: Our outcomes of the balloon angioplasty/stent placement for intracranial atherosclerotic stenosis are better than those in the SAMMPRIS study and compare favourably with those in large registries and observational studies.

Risk scoring by CHADS2 and CHA2DS2-VASc as predictors for long-term outcomes after surgical ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Lauritzen ◽  
H.J Vodstrup ◽  
T.D Christensen ◽  
M Onat ◽  
R Christensen ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Isolation Procedure ◽  
Survival Times ◽  
Long Term Outcomes ◽  
Surgical Ablation ◽  
Follow Up Study ◽  
Risk Scoring

Abstract Background Following catheter ablation for atrial fibrillation (AF), CHADS2 and CHA2DS2-VASc have utility in predicting long-term outcomes. However, it is currently unknown if the same holds for patients undergoing surgical ablation. Purpose To determine whether CHADS2 and CHA2DS2-VASc predict long-term outcomes after surgical ablation in concomitance with other cardiac surgery. Methods In this prospective, follow-up study, we included patients who underwent biatrial ablation - or pulmonary vein isolation procedure concomitantly with other cardiac surgery between 2004 and 2018. CHADS2 and CHA2DS2-VASc scores were assessed prior to surgery and categorized in groups as 0–1, 2–4 or ≥5. Outcomes were death, AF, and AF-related death. Follow-up was ended in April 2019. Results A total of 587 patients with a mean age of 68.7±0.4 years were included. Both CHADS2 and CHA2DS2-VASc scores were predictors of survival p=0.005 and p&lt;0.001, respectively (Figure). For CHADS2, mean survival times were 5.9±3.7 years for scores 0–1, 5.0±3.0 years for scores 2–4 and 4.3±2.6 years for scores ≥5. For CHA2DS2-VASc mean survival times were 7.3±4.0 years for scores 0–1, 5.6±2.9 years for scores 2–4 and 4.8±2.1 years for scores ≥5. The incidence of death was 20.1% for CHADS2 0–1, 24.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.186. The incidence of AF was 50.2% for CHADS2 0–1, 47.9% for CHADS2 2–4, and 76.5% for CHADS2 ≥5, p=0.073. The incidence of AF related death was 13.0% for CHADS2 0–1, 16.8% for CHADS2 2–4, and 35.3% for CHADS2 ≥5, p=0.031. The incidence of death was 16.8% for CHA2DS2-VASc 0–1, 26.2% for CHA2DS2-VASc 2–4, and 45.0% for CHA2DS2-VASc ≥5, p=0.001. The incidence of AF was 49.6% for CHA2DS2-VASc 0–1, 52.5% for CHA2DS2-VASc 2–4, and 72.5% for CHA2DS2-VASc ≥5, p=0.035. The incidence of AF related death was 12.2% for CHA2DS2-VASc 0–1, 16.0% for CHA2DS2-VASc 2–4, and 42.5% for CHA2DS2-VASc ≥5, p&lt;0.001. Conclusion Both CHADS2 and CHA2DS2-VASc scores predict long-term outcomes after surgical ablation for AF. However, CHA2DS2-VASc was superior in predicting death, AF, and AF-related death. Survival curves Funding Acknowledgement Type of funding source: None

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