Surgical Treatment of Bilateral Lung Cancers: Long-Term Outcomes and Prognostic Factors

2019 ◽  
Vol 68 (07) ◽  
pp. 646-651
Author(s):  
Francesco Petrella ◽  
Samuele Frassoni ◽  
Vincenzo Bagnardi ◽  
Monica Casiraghi ◽  
Daniela Brambilla ◽  
...  
Keyword(s):  
Pulmonary Resection ◽  
Survival Rates ◽  
Staging System ◽  
Patient Characteristics ◽  
Tumor Stage ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Lung Cancers ◽  
Bilateral Lung

Abstract Background Bilateral lung neoplasms are becoming more common, but distinguishing two primary lung cancers from metastatic disease can be difficult and only long-term follow-up after treatment can disclose the real behavior of the disease.The present study aimed to identify the appropriate candidates for bilateral surgical resections from the perspective of short-term postoperative complications and long-term outcomes. Methods Two hundred and fifteen consecutive patients undergoing bilateral pulmonary resection for lung cancers over a 20-year period were analyzed. Preoperative patient characteristics were noted, including demographic information, operative details, pathologic information including histology and tumor stage according to the eighth edition of the tumor nodes metastases staging system, and the use of neoadjuvant or adjuvant treatments. Results Patients receiving the second pulmonary resection more than 24 months from the first procedure as well as patients receiving bilateral lobectomies had higher overall 3-, 5-, and 10-year survival rates compared with the others. Conclusion Patients receiving the second resection more than 24 months from the first procedure have the best long-term results irrespective of the type of resection.

Long-term results of full-dose gemcitabine with radiation therapy compared to 5-fluorouracil with radiation therapy for locally advanced pancreatic cancer.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 287-287
Author(s):  
J. Huang ◽  
J. M. Robertson ◽  
J. H. Margolis ◽  
S. Balaraman ◽  
G. S. Gustafson ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Patient Characteristics ◽  
Tumor Stage ◽  
Tumor Location ◽  
Long Term Results ◽  
Full Dose

287 Background: To retrospectively compare the efficacy and toxicity of full-dose gemcitabine-based chemoradiotherapy (GemRT) vs. 5-fluorouracil (5-FU)-based chemoradiotherapy (5FURT) for locally advanced pancreas cancer (LAPC). Methods: From January 1998 to December 2008, 93 patients with LAPC were treated either with 5FURT (n=38) or GemRT (n=55). 5FURT consisted of standard-field radiotherapy given concurrently with infusional 5-FU or capecitabine. GemRT consisted of involved-field radiotherapy given concurrently with full-dose gemcitabine (1000 mg/m2 weekly) with or without erlotinib. The follow-up time was calculated from the time of diagnosis to the date of death or last contact. Results: Eighty-eight of 93 patients have died, and only one was lost to follow-up after developing DM. The median OS was 11.2 months (range 1.5-96). Patient characteristics (including Zubrod score, age, tumor stage, nodal stage, tumor location, and grade) were not significantly different between treatment groups. The OS was significantly better for GemRT compared to 5FURT (median 12.5 months vs. 10.2 months; 51% vs. 34% at 1 year; 12% vs. 0% at 3 years; 7% vs. 0% at 5 years; respectively; p=0.04), although the two groups had same DM (34% at 1 year). GemRT cohort was more likely to receive gemcitabine before or after chemoradiotherapy than 5FURT cohort (85% vs. 37%, p<0.001). Of the subset who received gemcitabine either before or after chemoradiotherapy, OS was still significantly better for GemRT without concurrent erlotinib compared to 5FURT (median 15.1 months vs. 10.7 months; 70% vs. 36% at 1 year; 21% vs. 0% at 3 years; 11% vs. 0% at 5 years; respectively; p=0.005), as was the rate of DM (23% vs. 45%; respectively; p=0.04). The subsequent hospitalization, percent of survival time spend in the hospital, acute and late grade 3-5 gastrointestinal toxicities were not significantly different between the GemRT and 5FURT groups. Conclusions: Full-dose GemRT was associated with improved OS compared to standard 5FURT. This approach yielded a moderate number of long-term survivors and was not associated with increased hospitalization or severe gastrointestinal toxicity. No significant financial relationships to disclose.

Erratum to: Surgical Treatment of Bilateral Lung Cancers: Long-Term Outcomes and Prognostic Factors

2019 ◽  
Author(s):  
Francesco Petrella ◽  
Samuele Frassoni ◽  
Vincenzo Bagnardi ◽  
Monica Casiraghi ◽  
Daniela Brambilla ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Surgical Treatment ◽  
Long Term Outcomes ◽  
Lung Cancers ◽  
Bilateral Lung

Transapical versus Conventional Aortic Valve Replacement�A Propensity-Matched Comparison

2012 ◽  
Vol 15 (1) ◽  
pp. 4 ◽  
Author(s):  
David M. Holzhey ◽  
William Shi ◽  
A. Rastan ◽  
Michael A. Borger ◽  
Martin H�nsig ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Survival Rates ◽  
Long Term Results ◽  
Term Survival ◽  
Kaplan Meier ◽  
Risk Patients ◽  
Short And Long Term ◽  
Good Treatment Option ◽  
Matched Comparison

<p><b>Introduction:</b> The goal of this study was to compare the short- and long-term outcomes after aortic valve (AV) surgery carried out via standard sternotomy/partial sternotomy versus transapical transcatheter AV implantation (taTAVI).</p><p><b>Patients and Methods:</b> All 336 patients who underwent taTAVI between 2006 and 2010 were compared with 4533 patients who underwent conventional AV replacement (AVR) operations between 2001 and 2010. Using propensity score matching, we identified and consecutively compared 2 very similar groups of 167 patients each. The focus was on periprocedural complications and long-term survival.</p><p><b>Results:</b> The 30-day mortality rate was 10.8% and 8.4% (<i>P</i> = .56) for the conventional AVR patients and the TAVI patients, respectively. The percentages of postoperative pacemaker implantations (15.0% versus 6.0%, <i>P</i> = .017) and cases of renal failure requiring dialysis (25.7% versus 12.6%, <i>P</i> = .004) were higher in the TAVI group. Kaplan-Meier curves diverged after half a year in favor of conventional surgery. The estimated 3-year survival rates were 53.5% � 5.7% (TAVI) and 66.7% � 0.2% (conventional AVR).</p><p><b>Conclusion:</b> Our study shows that even with all the latest successes in catheter-based AV implantation, the conventional surgical approach is still a very good treatment option with excellent long-term results, even for older, high-risk patients.</p>

Pulmonary Homografts for Aortic Valve Replacement: Long-term Comparison with Aortic Grafts

2011 ◽  
Vol 14 (4) ◽  
pp. 237 ◽  
Author(s):  
Ferdinand Vogt ◽  
Anke Kowert ◽  
Andres Beiras-Fernandez ◽  
Martin Oberhoffer ◽  
Ingo Kaczmarek ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Survival Rates ◽  
Long Term Results ◽  
Rank Test ◽  
Aortic Graft ◽  
Valve Prostheses ◽  
Retrospective Comparative Study

<p><b>Objective:</b> The use of homografts for aortic valve replacement (AVR) is an alternative to mechanical or biological valve prostheses, especially in younger patients. This retrospective comparative study evaluated our single-center long-term results, with a focus on the different origins of the homografts.</p><p><b>Methods:</b> Since 1992, 366 adult patients have undergone AVR with homografts at our center. We compared 320 homografts of aortic origin and 46 homografts of pulmonary origin. The grafts were implanted via either a subcoronary technique or the root replacement technique. We performed a multivariate analysis to identify independent factors that influence survival. Freedom from reintervention and survival rates were calculated as cumulative events according to the Kaplan-Meier method, and differences were tested with the log-rank test.</p><p><b>Results:</b> Overall mortality within 1 year was 6.5% (21/320) in the aortic graft group and 17.4% (8/46) in the pulmonary graft group. In the pulmonary graft group, 4 patients died from valve-related complications, 1 patient died after additional heterotopic heart transplantation, and 1 patient who entered with a primary higher risk died from a prosthesis infection. Two patients died from non-valve-related causes. During the long-term follow-up, the 15-year survival rate was 79.9% for patients in the aortic graft group and 68.7% for patients in the pulmonary graft group (<i>P</i> = .049). The rate of freedom from reoperation was 77.7% in the aortic graft group and 57.4% in the pulmonary graft group (<i>P</i> < .001). The reasons for homograft explantation were graft infections (aortic graft group, 5.0%; pulmonary graft group, 6.5%) and degeneration (aortic graft group, 7.5%; pulmonary graft group, 32.6%).</p><p><b>Conclusion:</b> Our study demonstrated superior rates of survival and freedom from reintervention after AVR with aortic homografts. Implantation with a pulmonary graft was associated with a higher risk of redo surgery, owing to earlier degenerative alterations.</p>

scholarly journals Long-term outcomes with frontline nilotinib versus imatinib in newly diagnosed chronic myeloid leukemia in chronic phase: ENESTnd 10-year analysis

Leukemia ◽  
2021 ◽  
Author(s):  
Hagop M. Kantarjian ◽  
Timothy P. Hughes ◽  
Richard A. Larson ◽  
Dong-Wook Kim ◽  
Surapol Issaragrisil ◽  
...  
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Survival Rates ◽  
Chronic Phase ◽  
Individual Treatment ◽  
Molecular Response ◽  
Newly Diagnosed ◽  
Long Term Outcomes ◽  
Treatment Free Remission

AbstractIn the ENESTnd study, with ≥10 years follow-up in patients with newly diagnosed chronic myeloid leukemia (CML) in chronic phase, nilotinib demonstrated higher cumulative molecular response rates, lower rates of disease progression and CML-related death, and increased eligibility for treatment-free remission (TFR). Cumulative 10-year rates of MMR and MR4.5 were higher with nilotinib (300 mg twice daily [BID], 77.7% and 61.0%, respectively; 400 mg BID, 79.7% and 61.2%, respectively) than with imatinib (400 mg once daily [QD], 62.5% and 39.2%, respectively). Cumulative rates of TFR eligibility at 10 years were higher with nilotinib (300 mg BID, 48.6%; 400 mg BID, 47.3%) vs imatinib (29.7%). Estimated 10-year overall survival rates in nilotinib and imatinib arms were 87.6%, 90.3%, and 88.3%, respectively. Overall frequency of adverse events was similar with nilotinib and imatinib. By 10 years, higher cumulative rates of cardiovascular events were reported with nilotinib (300 mg BID, 16.5%; 400 mg BID, 23.5%) vs imatinib (3.6%), including in Framingham low-risk patients. Overall efficacy and safety results support the use of nilotinib 300 mg BID as frontline therapy for optimal long-term outcomes, especially in patients aiming for TFR. The benefit-risk profile in context of individual treatment goals should be carefully assessed.

scholarly journals Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mirhasan Rahimli ◽  
Aristotelis Perrakis ◽  
Vera Schellerer ◽  
Andrew Gumbs ◽  
Eric Lorenz ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Colorectal Liver Metastases ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Short Term ◽  
Minimally Invasive Liver Surgery ◽  
Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

scholarly journals Surgical treatment of pulmonary artery sarcoma: a report of 17 cases

2021 ◽  
Vol 11 (1) ◽  
pp. 204589402098639
Author(s):  
Wu Song ◽  
Long Deng ◽  
Jiade Zhu ◽  
Shanshan Zheng ◽  
Haiping Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Survival Rates ◽  
Tumor Resection ◽  
Long Term Results ◽  
Pulmonary Endarterectomy ◽  
Pulmonary Artery Sarcoma ◽  
The Mean ◽  
Operative Findings

Pulmonary artery sarcoma (PAS) is a rare and devastating disease. The diagnosis is often delayed, and optimal treatment remains unclear. The aim of this study is to report our experience in the surgical management of this disease. Between 2000 and 2018, 17 patients underwent operations for PAS at our center. The medical records were retrospectively reviewed to evaluate the clinical characteristics, operative findings, the postoperative outcomes, and the long-term results. The mean age at operation was 46.0 ± 12.4 years (range, 26–79 years), and eight (47.1%) patients were male. Six patients underwent tumor resection alone, whereas the other 11 patients received pulmonary endarterectomy (PEA). There were two perioperative deaths. Follow-up was completed for all patients with a mean duration of 23.5 ± 17.6 months (1–52 months). For all 17 patients, the median postoperative survival was 36 months, and estimated cumulative survival rates at 1, 2, 3, and 4 years were 60.0%, 51.4%, 42.9%, and 21.4%, respectively. The mean survival was 37.0 months after PEA and 14.6 months after tumor resection only ( p = 0.046). Patients who had no pulmonary hypertension (PH) postoperatively were associated with improved median survival (48 vs. 5 months, p = 0.023). In conclusion, PAS is often mistaken for chronic pulmonary thromboembolism. The prognosis of this very infrequent disease remains poor. Early detection is essential for prompt and best surgical approach, superior to tumor resection alone, and PEA surgery with PH relieved can provide better chance of survival.

Short- and Long-Term Outcomes of Robotic Surgery for Rectal Neuroendocrine Tumor

2021 ◽  
pp. 155335062110304
Author(s):  
Kentaro Saito ◽  
Yusuke Yamaoka ◽  
Akio Shiomi ◽  
Hiroyasu Kagawa ◽  
Hitoshi Hino ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Neuroendocrine Tumor ◽  
Surgical Approach ◽  
Anal Verge ◽  
Survival Rates ◽  
Long Term Outcomes ◽  
Conversion To Open Surgery ◽  
Short And Long Term ◽  
Rectal Neuroendocrine Tumor

Background. The optimal radical surgical approach for rectal neuroendocrine tumor (NET) is unknown. Methods. This study evaluated the short- and long-term outcomes of 27 patients who underwent robotic radical surgery for rectal NET between 2011 and 2019. Results. The median distance from the lower border of the tumor to the anal verge was 5.0 cm. The median tumor size was 9.5 mm. Six patients (22%) had lymph node metastasis. The incidences of postoperative complications of grade II and grade III or more according to the Clavien–Dindo classification were 11% and 0%, respectively. All patients underwent sphincter-preserving surgery, and no patients required conversion to open surgery. The median follow-up time was 48.9 months, and both the 3-year overall survival and relapse-free survival rates were 100%. Conclusions. Short- and long-term outcomes of robotic surgery for rectal NET tumor were favorable. Robotic surgery may be a useful surgical approach for rectal NET.

Abstract WP302: Transferring Patients with Primary Intracerebral Hemorrhage to Comprehensive Stroke Centers

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Farhaan Vahidy ◽  
Liang Zhu ◽  
Nancy J Edwards
Keyword(s):  
Intracerebral Hemorrhage ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Stroke Severity ◽  
Long Term Outcomes ◽  
Similar Treatment ◽  
Euroqol 5D ◽  
Transferred Patients

Introduction: The American Heart Association’s updated guidelines for management of patients with primary intracerebral hemorrhage (ICH) recommend monitoring and early care at centers with advanced nursing and neuro-critical care expertise. This entails frequent transfer of ICH patients to certified Comprehensive Stroke Centers (CSC) for higher level of care. We hypothesized that transferred patients (TP) to a CSC will differ from directly admitted patients (DAP) in terms of patient characteristics, treatment factors, and functional and quality of life (QOL) outcomes. Methods: We analyzed data from a prospectively collected ICH registry at our CSC. Patients with traumatic or secondary causes of ICH were excluded. We collected data on demographics, comorbidities, presentation lab values, clinical characteristics, radiological parameters, in-hospital treatment variables, and discharge and long term outcomes. Functional outcomes were captured as modified Rankin Scale (mRS) and EuroQol 5D (EQ-5D) was used to assess QOL indices. Results: Out of a total 192 primary ICH patients, 114 (59.4%) were transferred-in. TP were significantly older, had lower diastolic blood pressure, lower arrival National Institutes of Health Stroke Scale (NIHSS) score, and smaller hematoma volumes as compared to DAP. A higher proportion of TP had a good discharge functional outcome (mRS score 0 - 3) as compared to DAP (29.8% vs. 15.4%, p = 0.02), this trend was also observed for Day-90 mRS (34.2% vs. 24.4%, p = 0.09). TP also reported significantly better QOL indices at Day-90; EQ-5D total median (Q1, Q3) score [10 (6,16) vs. 15 (9.5,18), p = 0.02] and self-reported median (Q1,Q3) score [75 (50,88) vs. 62.5(40,70)], p < 0.01]. Day-90 data are complete for approximately 50% patients. After adjusting for initial stroke severity, the discharge mRS was however not significantly different between TP and DAP. Conclusions: A larger proportion of ICH patients were transferred-in. Our data suggest that TP have lower disease severity, and better discharge and long term outcomes. However, they had similar treatment intensity as DAP at the CSC. We continue to capture day-90, 6 and 12-month functional and QOL data, which will be presented.

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