Post-Discharge Outcomes After Pancreatic Necrosectomy: A Single Institution Experience Following Endoscopic vs Open Debridement

2021 ◽  
pp. 000313482110385
Author(s):  
Manuel Martinez ◽  
Steven Medeiros ◽  
James Dove ◽  
Mohsen Shabahang
Keyword(s):  
Necrotizing Pancreatitis ◽  
Long Term Results ◽  
Source Control ◽  
Tertiary Referral Hospital ◽  
Term Survival ◽  
Pancreatic Necrosectomy ◽  
Medical Comorbidities ◽  
Number Of Patients ◽  
Significant Difference

Background Pancreatic necrosectomy outcomes have been studied extensively; however, long-term results of these procedures have not been well characterized. Our study aimed to assess the outcomes at and after discharge for patients following necrosectomy. Methods Data from patients undergoing pancreatic necrosectomy at a single tertiary referral hospital from January 1, 2007, to June 1, 2019 were retrospectively analyzed. Patients were stratified into an open pancreatic necrosectomy (OPN) and an endoscopic pancreatic necrosectomy (EPN) group. Results Cohorts were composed of an OPN (n = 30) and EPN (n = 31) groups with a mean follow-up of 22 and 13.5 months, respectively. There was no statistically significant difference in the demographics or etiology of disease; however, the presence of severe sepsis and elevated BISAP scores was significantly higher in the OPN group (40% vs 13% p = .016, 37% vs 10% p = .012, respectively). There was no significant difference in discharge parameters or disposition other than a higher need for wound care in the OPN group (14% vs 0% p =< .0001). No significant difference in the number of patients who returned to baseline, 12-month ED visits, 12-month readmissions, medical comorbidities, or long-term survival was noted. Conclusions Previous studies have demonstrated that OPN patients have a higher severity of disease and higher inpatient mortality; however, this does not hold true once the acute phase of the illness has passed. Long-term medical comorbidities and survival of patients with necrotizing pancreatitis who endure the primary insult do not differ in long term, regardless of the debridement modality performed for source control.

scholarly journals Results of surgical treatment of carcinoma of papilla of Vater

Medicina ◽  
2006 ◽  
Vol 43 (6) ◽  
pp. 455 ◽  
Author(s):  
Giedrius Barauskas ◽  
Antanas Gulbinas ◽  
Juozas Pundzius
Keyword(s):  
Postoperative Morbidity ◽  
Postoperative Mortality ◽  
Long Term Results ◽  
Papilla Of Vater ◽  
Term Survival ◽  
Retrospective Design ◽  
Significant Difference ◽  
Survival Pattern ◽  
Better Than

Adenocarcinoma is the most common malignant tumor of the ampulla, but in general, it is still rare. Therefore, these tumors are difficult to study, and most reports are of retrospective design. To evaluate immediate postoperative and long-term results, we have collected data prospectively in a specially created database on 21 consecutive patients with adenocarcinoma of the papilla of Vater, operated on at the Department of Surgery, Kaunas University of Medicine Hospital. All patients have undergone classical or pylorus-preserving pancreatoduodenectomy. Postoperative mortality was 4.8% and overall morbidity – 28.6%. Pancreas-associated morbidity was 14.3% in the series. Actuarial 3-year survival among our patients was 89%. Stage I–II patients with T1–T2 and/or N negative tumors had significantly better 3-year survival when compared with stage III–IV patients, T3–T4 and/or N positive tumors. Patients with highly or moderately differentiated tumors (G1, G2) survived better than patients with poor cell differentiation (G3), though significant difference was not achieved. Results are satisfactory in terms of overall postoperative morbidity and mortality. Long-term survival pattern concerning T, N, and G status corresponds with other reports in literature, while the 3-year survival results are promising and speaks in favor of our surgical strategy.

scholarly journals Evolving impact of long-term survival results on metastatic melanoma treatment

2020 ◽  
Vol 8 (2) ◽  
pp. e000948 ◽  
Author(s):  
Olivier Michielin ◽  
Michael B Atkins ◽  
Henry B Koon ◽  
Reinhard Dummer ◽  
Paolo Antonio Ascierto
Keyword(s):  
Targeted Therapies ◽  
Survival Data ◽  
Long Term Results ◽  
Tumor Type ◽  
Term Survival ◽  
Long Term Survival ◽  
The Past ◽  
Number Of Patients ◽  
Melanoma Treatment

Melanoma treatment has been revolutionized over the past decade. Long-term results with immuno-oncology (I-O) agents and targeted therapies are providing evidence of durable survival for a substantial number of patients. These results have prompted consideration of how best to define long-term benefit and cure. Now more than ever, oncologists should be aware of the long-term outcomes demonstrated with these newer agents and their relevance to treatment decision-making. As the first tumor type for which I-O agents were approved, melanoma has served as a model for other diseases. Accordingly, discussions regarding the value and impact of long-term survival data in patients with melanoma may be relevant in the future to other tumor types. Current findings indicate that, depending on the treatment, over 50% of patients with melanoma may gain durable survival benefit. The best survival outcomes are generally observed in patients with favorable prognostic factors, particularly normal baseline lactate dehydrogenase and/or a low volume of disease. Survival curves from melanoma clinical studies show a plateau at 3 to 4 years, suggesting that patients who are alive at the 3-year landmark (especially in cases in which treatment had been stopped) will likely experience prolonged cancer remission. Quality-of-life and mixture-cure modeling data, as well as metrics such as treatment-free survival, are helping to define the value of this long-term survival. In this review, we describe the current treatment landscape for melanoma and discuss the long-term survival data with immunotherapies and targeted therapies, discussing how to best evaluate the value of long-term survival. We propose that some patients might be considered functionally cured if they have responded to treatment and remained treatment-free for at least 2 years without disease progression. Finally, we consider that, while there have been major advances in the treatment of melanoma in the past decade, there remains a need to improve outcomes for the patients with melanoma who do not experience durable survival.

Long-term symptom burden and orodental health of oropharyngeal cancer (OPC) survivors following treatment with chemoradiotherapy (CRT) or sequential therapy (ST).

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9530-9530
Author(s):  
Sewanti Atul Limaye ◽  
Robert I. Haddad ◽  
Ann Partridge ◽  
Anne M. O'Neill ◽  
Andrea Radossi ◽  
...  
Keyword(s):  
Head And Neck ◽  
Thermal Sensitivity ◽  
Symptom Burden ◽  
Treatment Completion ◽  
Age At Diagnosis ◽  
Term Survival ◽  
Hpv Status ◽  
Number Of Patients ◽  
Significant Difference

9530 Background: OPC treatment is associated with significant long-term toxicity. Very little is known about the long-term symptom burden and orodental health in OPC survivors >2 yrs from treatment. Methods: Survivors treated for OPC with CRT/ST (involving definitive RT) at Dana Farber Cancer Institute between 2002-2011 and >2 yrs from treatment completion, were identified by chart review and asked to complete the Vanderbilt Head and Neck Symptom Survey version 2 (VHNSS v2), National Health And Nutrition Examination Survey for Oral Health Questionnaire, health care availability survey. Results: 200 survivors were contacted, 127 responded (RR: 64%). Median age at diagnosis was 54 yrs; 85% males; 85% stage IVA/B, 13% stage III; 56% CRT, 43% ST. HPV status: 47% (+), 10% (-), 43% unknown. Median time from treatment completion: 50 mths (24-135 mths). Residual moderate to severe toxicities reported in VHNSS v2: 71% dry mouth; 59% difficulty chewing/swallowing food; 53% feeling of food becoming stuck in the throat; 53% prolonged time to eat; 31% thick mucus, 6% had difficulty sleeping secondary to this; 16% trouble speaking, 27% trouble hearing;30% limitation of neck/shoulder movement; altered taste/smell - 45%/23%; sensitivity to spicy food and dryness-57%/62%; 30% decreased desire to eat, 11% had moderate weight loss. Orodental health assessment: 13% thermal sensitivity, 21% teeth cracking and chipping, 20% loose teeth, 33% had treatment for gum disease, 42% had lost bone around teeth. 98% survivors had health insurance; only 66% had dental insurance. No statistically significant difference was noted with respect to symptoms between CRT or ST. ST did not affect long-term toxicity compared to CRT alone. Conclusions: OPC is known to correlate with HPV positivity, early age at diagnosis and high rates of long-term survival after appropriate therapy. Our study documents that the OPC survivors have substantial residual long-term head and neck and orodental symptoms directly related to the treatment that significantly impacts their quality of life. A substantial number of patients lack dental health coverage, which likely further impacts symptom burden and QOL.

Hydrocephalus in achondroplasia: efficacy of endoscopic third ventriculostomy

2021 ◽  
pp. 1-8
Keyword(s):  
Surgical Complications ◽  
Medical Records ◽  
Endoscopic Third Ventriculostomy ◽  
Ventricular Volume ◽  
Long Term Results ◽  
Third Ventriculostomy ◽  
Historical Comparison ◽  
Number Of Patients ◽  
Significant Difference

OBJECTIVE Ventriculoperitoneal shunts (VPSs) for hydrocephalus in patients with achondroplasia are known to have a higher failure rate than in other hydrocephalus populations. However, the etiology of hydrocephalus in this group is considered “communicating,” and, therefore, potentially not amenable to endoscopic third ventriculostomy (ETV). ETV has, nonetheless, been reported to be successful in a small number of patients with achondroplasia. The authors aimed to investigate the long-term results of ETV in this population. METHODS Patients with achondroplasia who had undergone surgical treatment for hydrocephalus (ETV or VPS placement) were identified. In patients who had undergone ETV, medical records and neuroimages were reviewed to determine ventricular volumes and frontal and occipital horn ratios (FOHRs) pre- and postoperatively, as well as the incidence of surgical complications and reoperation. Patients who underwent VPS placement were included for historical comparison, and their medical records were reviewed for basic demographic information as well as the incidence of surgical complications and reoperation. RESULTS Of 114 pediatric patients with achondroplasia referred for neurosurgical consultation, 19 (17%) were treated for hydrocephalus; 10 patients underwent ETV only, 7 patients underwent VPS placement only, and 2 patients had a VPS placed followed by ETV. In patients treated with ETV, ventricular volume and FOHRs were normal, if measured at birth, and increased significantly until the time of the ETV. After ETV, all patients demonstrated significant and sustained decreases in ventricular measurements with surveillance up to 15 years. There was a statistically significant difference in rates of repeat CSF surgery between the ETV and VPS cohorts (0/12 vs 7/9, p < 0.001). CONCLUSIONS ETV was efficacious, safe, and durable in the treatment of hydrocephalus in patients with achondroplasia. Although many studies have indicated that hydrocephalus in these patients is “communicating,” a subset may develop an “obstructive” component that is progressive and responsive to ETV.

scholarly journals Long-term clinical outcome of cardiogenic shock patients undergoing Impella CP treatment vs. standard of care

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
C Scherer ◽  
E Luesebrink ◽  
S Massberg ◽  
M Orban
Keyword(s):  
Cardiogenic Shock ◽  
Mechanical Circulatory Support ◽  
Vascular Complications ◽  
University Hospital ◽  
Circulatory Support ◽  
Term Survival ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background The number of patients treated with the mechanical circulatory support device Impella Cardiac Power (CP) for cardiogenic shock is steadily increasing. The aim of this study was to investigate long-term survival and complications related to this modality. Methods Patients undergoing Impella CP treatment for cardiogenic shock were retrospectively enrolled and matched with cardiogenic shock patients not treated with mechanical circulatory support between 2010 and 2020. Data were collected from the cardiogenic shock registry of our university hospital. Results 68 patients with refractory cardiogenic shock without mechanical circulatory support were matched with 68 patients treated with Impella CP. At presentation, the mean age was 67 ± 14 years with 82% being male in the group without support and 68 ± 14 years (p = 0.65) with 77% being male (p = 0.52) in the group with Impella. There was no significant difference in the rate of cardiac arrest (57% vs. 54%, p = 0.86) and myocardial infarction was the predominant cause of cardiogenic shock in both groups (66% vs. 74%, p = 0.34). A total of 46% of patients without cardiocirculatory support and 54% of patients with Impella support died during the first month (p = 0.32). After one year, mortality rates were similar in both groups (53% in conventional vs. 59% in Impella CP group, p = 0.51) as was mortality rate at long-term 5-years follow-up (73% in conventional vs. 72% in Impella CP group, p = 0.50). The rate of clinically significant bleedings during ICU stay was much lower in the conventional group than in the Impella support group (25% vs. 42%, p = 0.03). Conclusion In this small observational and non-randomized analysis no difference in long-term outcome between patients treated with Impella CP vs. guideline directed cardiogenic shock therapy without mechanical circulatory support could be detected. Care must be taken regarding the high rate of bleeding and vascular complications when using Impella CP. Large, adequately powered studies are urgently needed to investigate the efficacy and safety of Impella CP in cardiogenic shock.

Long-term Survival Rates of Implants Supporting Overdentures

2015 ◽  
Vol 41 (2) ◽  
pp. 173-177 ◽  
Author(s):  
José Balaguer ◽  
Javier Ata-Ali ◽  
David Peñarrocha-Oltra ◽  
Berta García ◽  
María Peñarrocha-Diago
Keyword(s):  
Survival Rate ◽  
Survival Rates ◽  
Long Term Results ◽  
Dental Arch ◽  
Term Survival ◽  
Lower Survival Rate ◽  
Significant Difference ◽  
A Prospective Study

The study aims were to evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated, and number of implants per dental arch. This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least 3 years. 95 patients with 107 overdentures were supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95 ± 20.3 months (range 36–159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (P &lt; .05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for 6 but 85.7% for 4. Three mandibular implants achieved higher survival rates (100%) but with 2 (96.6%) or 4 (99%) survival was lower, although without significant difference. Long-term results suggest that 3-implant mandibular overdentures have an equivalent survival rate to 4-implant overdentures. In the maxilla, results showed that 6 implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures.

scholarly journals Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

2015 ◽  
Vol 100 (5) ◽  
pp. 790-796
Author(s):  
Mitsugu Kochi ◽  
Masashi Fujii ◽  
Ken Hagiwara ◽  
Hidenori Tamegai ◽  
Megumu Watanabe ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elective Surgery ◽  
Long Term Results ◽  
Morbidity Rate ◽  
Term Survival ◽  
Significant Difference ◽  
Colonic Decompression ◽  
Group 2 ◽  
Nasointestinal Tube

Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P = 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone.

Implant survival rate in bone-anchored hearing aid users: long-term results

2011 ◽  
Vol 125 (11) ◽  
pp. 1131-1135 ◽  
Author(s):  
E Wallberg ◽  
G Granström ◽  
A Tjellström ◽  
J Stalfors
Keyword(s):  
Survival Rate ◽  
Hearing Aid ◽  
Long Term Results ◽  
Term Survival ◽  
Number Of Patients ◽  
High Incidence ◽  
Bone Anchored Hearing Aid ◽  
Prospective Database

AbstractObjective:To investigate the long-term survival rate of bone-anchored hearing aid implants, and to assess the number of patients who stop using their bone-anchored hearing aid.Method:Patients who underwent bone-anchored hearing aid surgery between September 1977 and December 1986 were identified from a prospective database. Data were collected from patient records.Results:During the study period, 143 patients were fitted with a bone-anchored hearing aid. Records from 132 patients were found, with a mean follow up of nine years. A total of 150 implants were installed in these patients. A total of 41 implants (27 per cent) were lost during follow up: 17 lost osseointegration, 16 were removed and eight were lost due to direct trauma. At the end of follow up, 119/132 (90 per cent) patients were still using their bone-anchored hearing aid.Conclusion:Despite a high incidence of implant loss over time, a large number of patients still continued to use their bone-anchored hearing aid.

Should Left Ventricular Assist Devices be Implanted in Patients Seventy Years of Age and Older: A Comparative Analysis

2014 ◽  
Vol 17 (4) ◽  
pp. 182 ◽  
Author(s):  
Jeffrey A. Morgan ◽  
Hassan W. Nemeh ◽  
Gaetano Paone
Keyword(s):  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Long Term Results ◽  
Circulatory Support ◽  
Left Ventricular Assist Devices ◽  
Term Survival ◽  
Ventricular Assist ◽  
Significant Difference ◽  
Left Ventricular Assist

<p><b>Background:</b> We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age.</p><p><b>Methods:</b> From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ?70 years of age. Patients in the age group ?70 years were compared to the group of patients < 70 years for perioperative mortality, long-term survival and incidence of postoperative complications.</p><p><b>Results:</b> Mean age was 72.2 � 2.3 (70-75) years for the older group and 52.8 � 11.4 (18-69) years for the younger group (<i>P</i> < .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (<i>P</i> = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (<i>P</i> = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (<i>P</i> = NS).</p><p><b>Conclusions:</b> These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. Results support the use of long-term mechanical circulatory support in carefully selected elderly patients.</p>

Surgery in drug use-associated infective endocarditis: long-term survival is negatively affected by recurrence

2019 ◽  
Vol 30 (4) ◽  
pp. 528-534 ◽  
Author(s):  
Vilem Rohn ◽  
Branislav Laca ◽  
Milan Horn ◽  
Lukas Vlk ◽  
Petra Antonova ◽  
...  
Keyword(s):  
Drug Use ◽  
Intravenous Drug ◽  
Long Term Outcomes ◽  
Short Term ◽  
Term Survival ◽  
Long Term Survival ◽  
Number Of Patients ◽  
Significant Difference

Abstract OBJECTIVES The prevalence of infectious endocarditis (IE) in intravenous drug users (IDUs) is increasing, and the number of patients who need surgery is also rising. Relatively little is known about the short-term and long-term outcomes of these operations. METHODS This study is a retrospective analysis of our institutional results, focussing on risk factors for perioperative death, major adverse events and long-term survival. A total of 50 of the 66 (75.75%) patients had postoperative follow-up, and the mean follow-up time was 53.9 ± 9.66 months. Patients were divided into 2 groups depending on whether they were having their first operation or were being reoperated for recurrent IE. RESULTS From March 2006 to December 2015, a total of 158 patients underwent surgery for IE; 72 (45.6%) of them were identified as active IDUs. The operative mortality in IDUs was 8.33% (6 patients), with no significant difference between the 2 groups (P = 0.6569). Survival rates at 1 year, at 3 years and at the end of follow-up were 92%, 72% and 64%, respectively. There was significantly worse survival of patients with recurrent IE (log-rank test, P = 0.03). CONCLUSIONS Although the short-term results of operation for IE in IDUs are good, long-term outcomes are not satisfactory. The survival of patients with recurrence of IE caused by return to intravenous drug use is significantly worse.

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