scholarly journals Staged total cavopulmonary connection: serial comparison of intra-atrial lateral tunnel and extracardiac conduit taking account of current surgical adaptations

2019 ◽  
Vol 29 (3) ◽  
pp. 453-460 ◽  
Author(s):  
Eva van den Bosch ◽  
Sjoerd S M Bossers ◽  
Ad J J C Bogers ◽  
Daniëlle Robbers-Visser ◽  
Arie P J van Dijk ◽  
...  

AbstractOBJECTIVESOur goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a ≥18-mm conduit.METHODSWe included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias).RESULTSOf the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5–16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with ≥18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14).CONCLUSIONSA comparison between the updated prosthetic ILT and current ≥18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 144-144
Author(s):  
Boo Gyeong Kim ◽  
Byung-Wook Kim ◽  
Joon Sung Kim ◽  
Sung Min Park ◽  
Keun Joon Lim ◽  
...  

144 Background: The aim of this study is to evaluate the long-term clinical and oncologic outcome of ESD for differentiated EGC of an expanded indication compared to surgical resection. Methods: Retrospective analyses were performed in patients who underwent ESD or surgical resection for EGC of an expanded indication from 2006 and 2008 in Incheon St. Mary’s Hospital, Seoul St. Mary’s Hospital, Yeouido St. Mary’s Hospital, and St. Paul’s Hospital. First arm study was performed according to pre-ESD diagnosis including pathologic diagnosis and endoscopic findings. Second arm study was obtained from post-ESD final pathologic result. All the patients were checked with endoscopy and stomach CT regularly at least 5 years. Clinical outcomes, disease free survival and overall survival were compared between the ESD group and surgical resection group in each arm. Results: In first arm study, 41 patients who received ESD and 106 patients who received surgical resection were enrolled. Metachronous recur was found in 4 patients among ESD group and in 2 patients among surgical resection group during the follow up period. There was no local recurrence in both groups. The disease free survival was not different between the two groups (ESD vs surgical resection; 87.8 vs 95.3%, p=0.291). The 5-year overall survival rate was 100% in both groups. In second arm study, 74 patients who received ESD and 165 patients who received surgical resection were enrolled. Metachronous recur was found in 5 patients among ESD group and in 2 patients among surgical resection group during the follow up period. Local recurrence did not occur in both groups. Surgical resection group was superior to ESD group in disease free survival (97.6% vs 87.6%, p=0.002). The 5-year overall survival rate was 100% in both groups. Conclusions: ESD for EGC might be acceptable considering the overall survival rates. However, intensive surveillance should be performed to find the metachronous recur after ESD.


2006 ◽  
Vol 120 (5) ◽  
pp. 397-404 ◽  
Author(s):  
Alexander C Vlantis ◽  
Brian K H Yu ◽  
Raymond K Y Tsang ◽  
Michael K M Kam ◽  
Phoebe S Y Lo ◽  
...  

Objectives: We aimed to conduct a retrospective analysis of patients treated with radiotherapy for laryngeal carcinoma at a single institution.Methods: We analysed data from 202 consecutive patients treated with primary or post-operative radiotherapy for laryngeal carcinoma over a 10-year period.Results: Sixty-nine patients had a T1, 65 a T2, 39 a T3 and 29 a T4 lesion. Forty-one patients were node-positive. The clinical stage was I in 67 patients, II in 53, III in 36 and IV in 46. Primary radiotherapy was given to 152 patients. The median follow up was 60 months. The five-year overall local control rate was 86 per cent, the ultimate local control rate was 93 per cent, the five-year regional control rate was 96 per cent, the five-year relapse-free survival rate was 82 per cent and the five-year overall survival rate was 69 per cent.Conclusions: Patients with laryngeal carcinoma treated with primary or post-operative radiotherapy had a five-year overall survival rate of 69 per cent.


Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2682-2682
Author(s):  
Rajani Priya Yedla ◽  
Venkateswar Rao Pydi ◽  
Nageswara Reddy Palukuri ◽  
Ravichandran Ambalathandi ◽  
Stalin Chowdary Bala ◽  
...  

Abstract Background: Acute promyelocytic leukemia (APL) accounts for approximately 10% of acute myeloid leukemia(AML) cases in adults. With the advent of targeted therapy like all- trans retinoic acid (ATRA) and arsenic trioxide, survival rates have improved leading to cure in majority of patients. The present study was designed to analyze the outcomes in newly diagnosed APL. Aims and objectives: The primary objective of this study was to analyze overall survival and relapse rate in APL. Secondary objective was to study the parameters impacting outcomes in APL. Materials and methods: All newly diagnosed patients with APL between January 2005 and December 2017 were retrospectively analyzed. Diagnosis of APL was confirmed by demonstration of PML-RARA translocation by polymerase chain reaction or fluorescence in situ hydridization. Risk stratification was done using Sanz risk. Event free survival was defined as the time from diagnosis till relapse, death or lost to follow up. Overall survival was defined as time from diagnosis till death or lost to follow up. Statistical analysis was done using SPSS software, v.25. Overall survival curves were plotted using the Kaplan-Meier method. INCLUSION CRITERIA: All cases of APL diagnosed by morphology and confirmed by RT PCR (PML RARα) were included in this study. EXCLUSION CRITERIA: Age ≤ 18yrs Death within 72 hours of admission / not taken treatment Prior chemotherapy or radiotherapy for the treatment of malignancy. Results: Data of 1396 AML patients between 2005 and 2017 was collected, of which 190(13.6%) patients had APL. Of 190 patients, 111 patients who met inclusion and exclusion criteria were analyzed. The median age at presentation was 33 years (range,19-60). The male female ratio was 1.01:1. The median duration of symptoms at presentation was 15 days (range, 3-180). According to Sanz risk grouping, high, intermediate and low risk were seen in 48 (43.1%), 46 (42.4%), 17(14.5%) patients respectively. The baseline characteristics are tabulated in Table 1. Of 111 patients, 96 (86.5%) patients received induction chemotherapy with ATRA and daunorubicin and 15(13.5%) patients received ATRA and arsenic trioxide. Induction mortality was 23(20.7%). Eighty-eight (79%) patients survived induction chemotherapy, of which 87(98.8%) were in complete molecular remission (CMR) at the end of consolidation. At a median follow up of 30 months, the event free survival rate, overall survival rate and relapse rate were 72%, 74.7% and 9% respectively. The overall survival rate in low-intermediate and high-risk groups were 84.1% and 62.5% respectively. Of eight patients who relapsed, five patients received second line chemotherapy and attained second CMR (100%). On univariate analysis, the strongest predictors for OS were high risk and bcr3 variant(p=0.007, p=<0.001 respectively). On multivariate analysis, only high risk was significant for overall survival (p=0.02). Conclusion: Majority of APL patients were high risk at presentation. High risk and bcr3 variant had significant impact on survival outcome in APL. As relapse rates were low and second CMR can be achieved with salvage chemotherapy in majority of patients, improving induction outcomes will further improve survivals in APL. Disclosures No relevant conflicts of interest to declare.


2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 5597-5597
Author(s):  
Jin Yi Lang ◽  
Weidong Wang ◽  
Peng Xu

5597 Background: To evaluate the 5-yrs clinical outcomes and prognostic factors of 582 nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT). Methods: 582 NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from Jan.2001 to Dec.2004 were analyzed retrospectively, including 460 males and 122 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67-76Gy in 30-33 fractions, positive neck lymph nodes (GTVln-R/L) 60-70Gy in 30-33 fractions, The lower neck and the supraclavicular fossae were irradiated with the conventional 2D technique using an anterior field. The Kaplan-Meier method was used to calculate the local-regional control rate (LRC) and overall survival rate (OS). Acute and late toxicities were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria, meanwhile analyze the prognostic factors. Results: The median follow-up interval was 66.4 months. The 5-year local control, regional control, distant metastasis-free survival, disease free survival, disease specific survival and overall survival rate was 89.8%, 95.2%, 74.1%, 69.6%, 83.2% and 77.1%. 133 patients died during the follow-up. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 75.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2% respectively.Univariate analysis revealed that gender, T/N stage, clinical stage, radiotherapy interruption, anemia and weight loss was the significant prognostic factor for the OS. Multivariate analysis showed that N stage, radiotherapy interruption, chemotherapy, the volume of GTVnx, age, anemia and weight loss was the independent prognostic factors for the OS. Conclusions: The 5-year local control and overall survival rate of NPC treating with IMRT was 89.8% and 77.1%. The clinical stage, N stage , volume of GTVnx and chemotherapy was the main prognostic factor for the OS. The acute and late toxicities were mainly grade I and II. Distant metastasis was the main pattern of failure.


2021 ◽  
Vol 8 (04) ◽  
pp. 219-223
Author(s):  
Niharika Darasani

BACKGROUND Single modality treatment for stage I and stage II squamous cell carcinomas of glottis region gave excellent results. Since a long time these are treated either with definitive radiation therapy or surgical excision with endoscopes. There was not much difference with regard to voice preservation, local recurrence and disease-free survival period. Our aim was to study the clinical presentation and management protocol of glottis carcinoma in a tertiary hospital and observe the final outcome of stage II (T2N0M0) glottis carcinoma and specific factor for survival in patients treated with surgery, radiotherapy and concurrent chemoradiation. METHODS 43 patients of glottis carcinoma stage II (T2N0M0) attending a tertiary teaching hospital between May 2015 and April 2017 were included in the study. Demography and smoking status of subjects were recorded. Staging of the disease was according to American Joint Committee on Cancer (AJCC) Staging System 7th edition. Paraglottic space infiltration was taken as a criteria to upgrade the staging. The overall survival rate, recurrence free survival, disease specific survival rate and laryngeal function preservation rate were calculated. RESULTS Out of 43 patients, males were 90.69 % and 09.30 % were females. Male to female ratio was 10.57 : 1. Mean age was 58.62 ± 2.35 years. 67.44 % were current smokers, 27.90 % were former smokers and 02.32 % were non-smokers. The overall survival scores and disease specific survival was 100 % with 11.62 % locoregional recurrences. The voice preservation was 86.04 %. Radiotherapy was used in 72.09 %, chemoradiation in 18.60 % patients and 11.62 % patients underwent surgery. 11.62 % patients presented with locoregional recurrence during 24 months of follow up. 02.32 % patients had to undergo tracheostomy. CONCLUSIONS The overall survival scores and disease specific survival were 100 % with 11.62 % loco-regional recurrence. Voice preservation was 86.04 %. Proactive prevention rather than escalation of treatment protocol gives better prognosis. KEYWORDS Glottis, Larynx, Supra Glottis, Sub Glottis, Squamous Cell Carcinoma, Chemo Radiation and Trans Oral Laryngeal Surgeries


Neurosurgery ◽  
2011 ◽  
Vol 70 (5) ◽  
pp. 1081-1094 ◽  
Author(s):  
Miran Skrap ◽  
Massimo Mondani ◽  
Barbara Tomasino ◽  
Luca Weis ◽  
Riccardo Budai ◽  
...  

Abstract BACKGROUND: Despite intraoperative technical improvements, the insula remains a challenging area for surgery because of its critical relationships with vascular and neurophysiological functional structures. OBJECTIVE: To retrospectively investigate the morbidity profile in insular nonenhancing gliomas, with special emphasis on volumetric analysis of tumoral resection. METHODS: From 2000 to 2010, 66 patients underwent surgery. All surgical procedures were conducted under cortical-subcortical stimulation and neurophysiological monitoring. Volumetric scan analysis was applied on T2-weighted magnetic resonance images (MRIs) to establish preoperative and postoperative tumoral volume. RESULTS: The median preoperative tumor volume was 108 cm3. The median extent of resection was 80%. The median follow-up was 4.3 years. An immediate postoperative worsening was detected in 33.4% of cases; a definitive worsening resulted in 6% of cases. Patients with extent of resection of &gt; 90% had an estimated 5-year overall survival rate of 92%, whereas those with extent of resection between 70% and 90% had a 5-year overall survival rate of 82% (P &lt; .001). The difference between preoperative tumoral volumes on T2-weighted MRI and on postcontrast T1-weighted MRI ([T2 − T1] MRI volume) was computed to evaluate the role of the diffusive tumoral growing pattern on overall survival. Patients with preoperative volumetric difference &lt; 30 cm3 demonstrated a 5-year overall survival rate of 92%, whereas those with a difference of &gt; 30 cm3 had a 5-year overall survival rate of 57% (P = .02). CONCLUSION: With intraoperative cortico-subcortical mapping and neurophysiological monitoring, a major resection is possible with an acceptable risk and a significant result in the follow-up.


2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 19508-19508
Author(s):  
S. A. Saravanan ◽  
V. Sokolovski ◽  
V. Voloshin ◽  
M. Aliev ◽  
V. Zybikov ◽  
...  

19508 Background: To analyse the five-year survival rate in patients with proximal femoral tumours after total hip replacement. Methods: Between the period of 1994–2003, 50 patients were operated (Total Hip Replacement) for proximal femoral tumours at the Department of General Oncology (Bone & Soft tissue tuomurs), N. N. Blokhin Cancer Research Institute & Moscow Regional Clinical Research Institute, Moscow, Russian Federation. The histological diagnoses included 14 - metastases, 10 - osteosarcoma, 8 - chondrosarcoma, 4 - Ewing’s sarcoma, 4 - Giant cell tumor, 3 - malignant fibrous histiocytoma, 2 paraosteal and 2 periosteal osteosarcoma, and 1 each from primary neuroectodermal tumor, myeloid disease, and aneurysmal bone cyst. The follow-up ranged from 1–9 years (mean follow-up 5 years). 21 patients (45.7%) had pathological fracture. The cause of the pathological fracture was metastasis in 12 patients (26%). 28 patients (60.8%), had soft tissue invasion. All the survival analyses were done using Kaplan-Meier survivorship analysis method. Functional outcome was estimated using Enneking’s evaluation criteria. Results: The overall survival rate of patients was 66.7% at 5 years. 2 patients had local recurrence.12 patients had metastases after surgery. In that 11 patients were died. There was no evidence of disease in 32 patients. In 3 patients, we performed disarticulation of the hip joint because of the local recurrence. The overall survival rate of limb was 92.7% at 5 years. The overall survival rate of prostheses was 84.2% at 5 years. At the latest follow up, functional outcome was excellent in 15 (30%) patients, good in 27 (54%) patients, fair in 5 (10%) patients, poor in 3 (6%) patients. Conclusions: Though the extent of the muscle and bone resection is large, there is no doubt that endoprosthetic replacement of the proximal femur provides a good functional and oncological outcome when compared with the various other reconstructive surgeries. No significant financial relationships to disclose.


2011 ◽  
Vol 29 (33) ◽  
pp. 4387-4393 ◽  
Author(s):  
Mitsuru Sasako ◽  
Shinichi Sakuramoto ◽  
Hitoshi Katai ◽  
Taira Kinoshita ◽  
Hiroshi Furukawa ◽  
...  

Purpose The first planned interim analysis (median follow-up, 3 years) of the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer confirmed that the oral fluoropyrimidine derivative S-1 significantly improved overall survival, the primary end point. The results were therefore opened at the recommendation of an independent data and safety monitoring committee. We report 5-year follow-up data on patients enrolled onto the ACTS-GC study. Patients and Methods Patients with histologically confirmed stage II or III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were randomly assigned to receive S-1 after surgery or surgery only. S-1 (80 to 120 mg per day) was given for 4 weeks, followed by 2 weeks of rest. This 6-week cycle was repeated for 1 year. The primary end point was overall survival, and the secondary end points were relapse-free survival and safety. Results The overall survival rate at 5 years was 71.7% in the S-1 group and 61.1% in the surgery-only group (hazard ratio [HR], 0.669; 95% CI, 0.540 to 0.828). The relapse-free survival rate at 5 years was 65.4% in the S-1 group and 53.1% in the surgery-only group (HR, 0.653; 95% CI, 0.537 to 0.793). Subgroup analyses according to principal demographic factors such as sex, age, disease stage, and histologic type showed no interaction between treatment and any characteristic. Conclusion On the basis of 5-year follow-up data, postoperative adjuvant therapy with S-1 was confirmed to improve overall survival and relapse-free survival in patients with stage II or III gastric cancer who had undergone D2 gastrectomy.


2020 ◽  
Vol 10 (3) ◽  
pp. 183-189
Author(s):  
Sh. Kh. Gantsev ◽  
O. N. Lipatov ◽  
K. V. Menshikov ◽  
D. S. Tursumetov ◽  
Kh. S. Saydulaeva

Introduction. Hepatocellular carcinoma (HCC) is the most common primary malignant neoplasm of the liver. During the early stages, HCC is asymptomatic, which makes X-ray examination a particularly important diagnostic tool. According to WHO data, the mortality rate from HCC was 782,000 in 2018. HCC is associated with a number of risk factors: a high viral load, liver cirrhosis, detected HBeAg and elevated serum HBsAg levels. Inhibitors of tyrosine kinase receptors increase the overall survival and progression-free survival rates in patients with metastatic HCC. In this article, we conduct an analysis of results of the REFLECT study obtained for Russian patients by the Republican Clinical Oncological Dispensary, Ufa.Materials and methods. The experimental group included 9 patients (52.9%) receiving Lenvatinib. The control group included 8 patients (47.1%)) underwent therapy with Sorafenib at a dose of 800 mg per day 7 (41.17%) patients had a history of chronic hepatitis, of which hepatitis B and chronic hepatitis C was confirmed in 6 and 1 cases, respectively.Results and discussion. Over the period from 2017 up to the present, progression-free survival was observed in three patients (17.6%), of which 2 and 1 received Lenvatinib and Sorafenib, respectively. Overall survival was 10.5 months. The median overall survival rate in the experimental and control groups was 9.8 and 11.2 months, respectively. These parameters are considered comparable, provided that the sample was small.Conclusions. The use of Lenvatinib demonstrated the efficacy comparable to that of Sorafenib in terms of the overall survival rate in patients with inoperable HCC. Lenvatinib allowed statistically and clinically significant improvement in the progression-free survival and time to progression to be achieved. 


1996 ◽  
Vol 114 (6) ◽  
pp. 1298-1302 ◽  
Author(s):  
Flávio Xavier ◽  
Lucélia de Azevedo Henn ◽  
Oliveira Marja ◽  
Luciane Orlandine

The frequency of smoking among patients with primary lung cancer diagnoses admitted to the Hospital de Clinicas de Porto Alegre (HCPA) during the 1980's was investigated. The objective of this study was to analyze cigarette consumption patterns through the number of cigarettes smoked per day and the age at which smoking began, correlating this data to the overall survival rate and histological type of the lung cancer. Methods: This retrospective study analyzed patients with primary lung cancer diagnosed at the HCPA between January 1980 and December 1989. All patients considered underwent follow-up for at least three years. Patient information was obtained either from the hospital's records or by contacting patients via letter or phone. Results: More than 90 percent of the patients were smokers or had smoked previously; most had started smoking before the age of 20.The overall 24-month survival rate after diagnosis varied depending on whether the patient had smoked less than 40 cigarettes per day or not. The percentage of smokers and non-smokers was established for each histological type, with the bronchoalveolar adenocarcinoma type showing the highest percentage of non-smokers (40 percent). Conclusion:The overall survival rates of patients with lung cancer was related to the number of cigarettes smoked, and not to the fact of the patient having smoked or not.The number of smokers among patients with lung cancer was not so high only for the bronchoalveolar adenocarcinoma histological type.


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