Palliative esophagectomy in unexpected metastatic disease: sense or nonsense?

Background Despite integrated positron emission tomography and computed tomography screening before and after neoadjuvant treatment in patients with locally advanced esophageal cancer, unexpected metastatic disease is still found in some patients during surgery. Should then esophagectomy be aborted or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with potentially resectable esophageal cancer were sheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients, a potentially curative esophagectomy was performed. In 12 patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of metastases; 10 of them had oligometastatic disease (≤4 single-organ metastases). Esophagectomy was not performed in 117 patients (because of disease progression in 50); 14 were also single-organ oligometastatic. Data of 10 single-organ oligometastatic patients who underwent esophageal resection (group 1) were compared those of 10 non-resected but treated counterparts (group 2) and with 228 patients who underwent potentially curative esophagectomy with persistent pathological lymph nodes (group 3). Results Five oligometastatic esophagectomy patients had lung metastases: 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. Two oligometastatic non-resected patients had lung, 5 liver, and 3 brain metastases. Median overall survival was 21.4, 12.1, and 20.2 months in the respective groups (group 1 vs. group 2 p = 0.042; group 2 vs. group 3 p = 0.002; group 1 vs. group 3 p = 0.88). Conclusions Survival is longer in patients undergoing palliative esophagectomy with unexpected single-organ oligometastatic disease and comparable to survival in patients with persistent pathological lymph nodes. Palliative resection in these patients seems to be justified.

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PS02.128: SENSE OR NONSENSE OF A PALLIATIVE ESOPHAGECTOMY IN CASE OF UNEXPECTED OLIGOMETASTATIC DISEASE

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.128 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 157-157

Author(s):

Lieven Depypere ◽

Johnny Moons ◽

Toni Lerut ◽

Willy Coosemans ◽

Hans Van Veer ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Nodes ◽

Conflicts Of Interest ◽

Lung Metastases ◽

Locally Advanced ◽

Esophageal Resection ◽

Palliative Resection ◽

Oligometastatic Disease ◽

Curative Esophagectomy ◽

Single Organ

Abstract Background Screening is an important tool in staging esophageal cancer as only patients without suspicion of metastases are considered for surgery-based treatment. Nevertheless unexpected metastatic disease is still found in some patients during surgery. In these cases should esophagectomy be aborted, or is there a place for palliative resection? Methods Between 2002 and 2015, 681 patients with locally advanced potentially resectable esophageal cancer were scheduled for neoadjuvant therapy and subsequent esophagectomy. In 552 patients potentially curative esophagectomy was performed. In twelve patients, unexpected disease was discovered during surgery but esophagectomy was performed with synchronous resection of the metastases. Ten of them were oligometastatic (≤ 4 single organ metastases). In 117 patients esophagectomy was not performed with among them 50 patients because of disease progression. Fourteen of these patients were also single organ oligometastatic and ten of them received systemic treatment. 10 single organ oligometastatic patients that underwent esophageal resection (group1) were compared to 10 non-resected—but treated—counterparts (group2) and to 228 patients that underwent a potentially curative esophagectomy with persistent pathological lymph nodes (group3). Clinicopathological data were retrospectively reviewed and survival of the three groups was compared from date of pathological diagnosis. Results In the oligometastatic esophagectomy patients, 5 had lung metastases, 1 peritoneal, 2 adrenal, 1 pleural, and 1 pancreatic. In the oligometastatic non-resected patients, 2 had lung metastases, 5 liver and 3 brain metastases. Median overall survival was 21.4, 12.1 and 20.2 months in the respective groups. (group1 vs group2: P = 0.042; group2 vs group3: P = 0.002; group1 vs group3: P = 0.88). Conclusion Survival is prolonged in patients undergoing palliative esophagectomy in case of unexpected single organ oligometastatic disease during surgery and is comparable to survival of patients with persistent pathological lymph nodes. Palliative resection in unexpected oligometastatic disease seems to be justified. Disclosure All authors have declared no conflicts of interest.

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Comparison of Rare Types of Breast Cancer

Journal of Cancer and Tumor International ◽

10.9734/jcti/2021/v11i230146 ◽

2021 ◽

pp. 9-17

Author(s):

Osman Erdogan ◽

Alper Parlakgumus ◽

Ugur Topal ◽

Kemal Yener ◽

Umit Turan ◽

...

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Radical Mastectomy ◽

Treatment Modalities ◽

Breast Carcinomas ◽

Term Survival ◽

Prognostic Features ◽

Group 3 ◽

Group 2 ◽

Group 1

Aims: Mucinous, medullary, and papillary carcinomas are rarely encountered types of breast cancer. This study aims to contribute to the literature by comparing the clinical and prognostic features and treatment alternatives of rare breast carcinomas. Study Design: Thirty-four patients with rare breast cancer out of a total of 1368 patients who underwent surgery for breast cancer in our clinic between January 2011 and December 2020 were included in the study. Methodology: The patients were assigned into three groups, i.e., medullary carcinoma group (Group 1), mucinous carcinoma group (Group 2) and papillary carcinoma group (Group 3). Demographic and clinical features, treatment modalities used, surgical approaches, pathological features of tumors and survival were compared between the groups. Results: Thirty-four patients were included in the study. The mean age of the patients in Group 3 was higher, though it was not statistically significant. Modified radical mastectomy was more frequently performed in all the groups. The number of the lymph nodes removed through axillary dissections and the number of the positive lymph nodes were similar in all the groups. The tumors in all the groups were also of comparable sizes (30 mm in Group 1, 42.5 mm in Group 2 and 30 mm in Group 3; p:0.464). Estrogen receptors were negative in a significantly higher rate of Group 1(66.7% of Group 1, p<0,001). A significantly higher rate of Group 1 received postoperative chemotherapy (93,3% of Group 1,p:0.001), but the rate of the patients receiving hormonotherapy in this group was significantly lower (26.7% of Group, p<0,001). The patients with medullary cancer had significantly longer survival than those with mucinous cancer and those with papillary cancer (76.2 in Group 1, 54.5 in Group 2 and 58.4 in Group 3; p:0.005). Conclusion: While rare subtypes of breast carcinoma did not affect opting for surgical treatment, selection of oncological therapy was affected depending on the hormone receptor status of these tumors. The long-term survival differed between rare breast tumors. In view of the unique clinical pictures of the tumors, the patients should be evaluated individually, and the evaluation should be associated with theevidence-based principles available for more common breast carcinomas.

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Efficacy of ferumoxytol as a lymphatic contrast agent in prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.6_suppl.186 ◽

2018 ◽

Vol 36 (6_suppl) ◽

pp. 186-186 ◽

Cited By ~ 1

Author(s):

Michael J. Dattoli ◽

Stephen M Bravo ◽

Daniel Kaplon ◽

Matt Hayes ◽

Alexandria Osorio ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Contrast Agent ◽

Metastatic Disease ◽

High Signal ◽

Mri Findings ◽

Comparison Results ◽

Group 2 ◽

Group 1

186 Background: Ferumoxytol (Feraheme) is a ferromagnetic nanoparticle with lymphotrophic biokinetics, delivered to lymph nodes by normal macrophages. MRI suppresses normal lymph nodes containing Feraheme. Objective is to validate safety and efficacy in finding lymph node positivity in prostate cancer (PCa). Methods: Nonrandomized prospective evaluation of 178 consecutive PCa patients (pts) at high risk for lymph node spread enrolled 2/13-3/15. All received IV Feraheme. 177 received 6/mg/kg over 20 min. One pt received 3 mg/kg infusion. T2 MEDIC and T2* sequence imaging of abdomen and pelvis, given 24 hours later. Images reviewed by 2 board certified radiologists with same interpretations, blinded to clinical and histo-path info (pre-MRI TNM stage/PSA/Gleason). Nodes were deemed abnormal if they did not suppress after Feraheme infusion (group 1, 94 patients). Nodes were deemed suspicious if suppressed and met usual size criteria with high signal intensity on DWI and decreased ADC map values and morphologic features (group 2, 84 pts). 83 group 1 pts had CT biopsies (77 pelvis, 6 retroperitoneum);11 pts had open PLND. 382 lymph nodes sampled. 76 group 2 patients had CT biopsies (73 pelvis, 3 retroperitoneum); 9 pts had open PLND. 340 lymph nodes sampled. Rad-path correlation was performed. Nodes were stained; reviewed by a single pathologist with no knowledge of MRI findings. Histo-path results for each node were cataloged for later MRI comparison. Results: 90 group 1 pts (96%) proved metastatic PCa; 4 pts (4%) were normal. 68 group 1 pts (77%) had malignant lymph nodes not meeting usual imaging criteria. 39 group 2 pts (47%) showed metastatic PCa; 46 pts (53%) were normal. One group 2 pt had an allergic reaction with hives; infusion ceased at 3mg/kg; pt treated to full resolution with 50 mg IV Benadryl. Conclusions: Feraheme can evaluate lymphatic dissemination of metastatic disease in PCa patients, with a lower limit of resolution of focal lymph node metastases of 2-3 mm. Better resolution gives implications for therapeutic radiation planning of newly diagnosed or recurrent/metastatic PCa. Toxicity was very acceptable at 6mg/kg. Feraheme may play a significant role as a lymphatic contrast agent in the early dissemination of lymphatic metastatic disease.

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Spinal computed tomography and computed tomographic metrizamide myelography in the early diagnosis of metastatic disease.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.4.576 ◽

1986 ◽

Vol 4 (4) ◽

pp. 576-583 ◽

Cited By ~ 47

Author(s):

T O'Rourke ◽

C B George ◽

J Redmond ◽

H Davidson ◽

P Cornett ◽

...

Keyword(s):

Computed Tomography ◽

Metastatic Disease ◽

Compression Fracture ◽

Benign Disease ◽

Plain Radiographs ◽

Spinal Ct ◽

Epidural Compression ◽

Group 3 ◽

Group 2 ◽

Group 1

New lesions were shown by Tc99m bone scans to have developed in sixty patients with known metastatic cancer or high-risk primary cancer and normal neurologic examinations; they were further evaluated with plain radiographs, spinal computed tomography (CT), and CT myelography (CT-M) according to an algorithm. Three groups were identified based on plain radiographs: group 1 (normal radiograph), group 2 (compression fracture as indicated by radiograph), group 3 (evidence of metastasis as indicated by radiograph). In group 1 (n = 18), spinal CT revealed that 33% of the patients had benign disease and 67%, metastases; epidural compression was seen in 25% of the patients with metastasis as indicated by CT-M. In group 2 (n = 26), CT-M disclosed that 38% had a benign compression fracture and 62% had metastases and that 63% of the patients with metastases had an epidural compression. In group 3 (n = 16), spinal CT revealed that 15 patients had metastases (one patient had benign disease). Epidural cord compression was seen in 47% of the patients with metastatic disease. In all groups, the presence of cortical bone discontinuity around the neural canal (seen in 31 patients) was highly associated with epidural compression (seen in 20 patients). Our approach allowed the early and accurate diagnosis of spinal metastasis and epidural tumor as well as the diagnosis of benign disease and was useful in planning optimal local therapy.

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FA05.02: AN ANALYSIS OF SURVIVAL TRENDS IN 471 PATIENTS AFTER ESOPHAGECTOMY FOR ESOPHAGEAL ADENOCARCINOMA

Diseases of the Esophagus ◽

10.1093/dote/doy089.fa05.02 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 9-10

Author(s):

Michal Lada ◽

Christian Peyre ◽

Joseph Wizorek ◽

Thomas Watson ◽

Jeffrey Peters ◽

...

Keyword(s):

Esophageal Cancer ◽

Neoadjuvant Therapy ◽

Esophageal Adenocarcinoma ◽

Clinical Staging ◽

Early Stage Disease ◽

Pet Ct ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

Abstract Background Five-year survival after the surgical treatment of esophageal cancer has traditionally been reported to be as low as 15%. More recently, the improvement of clinical staging involving PET/CT and the introduction of neoadjuvant chemo-radiation have each altered the survival outcomes of patients with this lethal disease. The impact of these factors on survival trends has not been well described in literature. The aim of this study was to analyze the survival trends after esophagectomy for esophageal adenocarcinoma at a high-volume center. Methods The study population consisted of 471 consecutive patients undergoing esophagectomy for esophageal adenocarcinoma at a university-based medical center between January 1, 2000 and July 31, 2017. Clinical variables were collected for three groups based on the date of esophagectomy and were compared (Group 1: 2000–2004, Group 2: 2005–2011, Group 3: 2012–2017). Survival was compared via the Kaplan-Meier (KM) method. Results The 471 patients had a median age of 64.0 years (range 27.0–86.2) and 395/471 (84%) were male. Dysphagia (282/471, 60%), heartburn (63/471, 13%) and chest pain (29/471, 6%) were the most common presenting symptoms. The majority of the patients underwent transhiatal esophagectomy (n = 279, 59.1%) and en-bloc esophagectomy (n = 85, 18.0%). Staging with PET/CT was utilized in 316/471 patients (67%) with 6% of Group 1, 76% of Group 2 and 100% of Group 3, P < 0.001. Neoadjuvant therapy was utilized in 44% of patients, 209/357 (0% of Group 1, 45% of Group 2 and 76% of Group 3, P < 0.001). The median survival for the entire cohort was 30.0 months (range 0.3–208.0) with 5-year KM survival of 30% for Group 1, 43% for Group 2 and 47% for Group 3, P < 0.001, Figure. When comparing Group 1 and Group 2, the 10-year KM survival improved from 23% to 37%, P < 0.001. Conclusion This analysis reveals an improvement in 5-year survival after esophagectomy from 30% to 47% over the past two decades. Similarly, 10-year survival has improved from 23% to 37%. The evolution of better clinical staging and advancements in neoadjuvant therapy likely played a vital role in these trends. In contrast to the earliest cohort, PET/CT is now routinely utilized in the staging of esophageal cancer. Further, other than those with early stage disease, all patients are currently evaluated for neoadjuvant chemo-radiation. Notably, the 5-year survival rate for the most recent cohort (2012–2017) approaches 50% and would likely be higher if patients with esophageal adenocarcinoma treated endoscopically were included. Improvements in staging and treatment paradigms for esophageal adenocarcinoma have resulted in significant progress towards cure. Disclosure All authors have declared no conflicts of interest.

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Preoperative prediction of the axillary lymph nodes status in patients with breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.10547 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 10547-10547

Author(s):

E. Angelidou ◽

G. Sotiropoulou ◽

E. Poulianou ◽

E. Politi ◽

H. Koutselini

Keyword(s):

Breast Cancer ◽

Lymph Nodes ◽

Cancer Cells ◽

Axillary Lymph ◽

Versus Group ◽

Node Positive ◽

Positive Rate ◽

Group 3 ◽

Group 2 ◽

Group 1

10547 Background: We developed a preoperative score-system (S) and evaluated prospectively its predictive value for the axillary(a) status of patients (p) with breast cancer. Our aim was to select preoperatively (p) with negative axilla, who could possibly avoid the standard (a) surgery. (S) uses preoperative clinical, epidemiological and immunocytological data, obtained from the FNA-smears of (p)‘ tumors, and attempts to guide the choice of (a) treatment, as an alternative to the method of sentinel lymph node. Methods: (S) is calculated by adding the preoperative values of clinical tumor size, (p) age, nuclear grade (NG), type of the cancer cells and the immunocytochemical positiveness of the biomarkers p53, HER2 and MIB1. Values range from 1–4 for size (1–10, 11–15, 16–20, 20–30 mm), 1 to 4 for age (70 and over, 51–69, 41–50, 40 years or less), 1–3 for NG1–3, 1–2 for type of cancer cells (lobular, ductal) respectively and 0–3 for the expression (1 point for every positive biomarker) or absence (0) of p53, HER2 and MIB1 in the FNA of the primary tumors of the (p). (S) ranges from 4 to 16.We applied (S) to 224 (p), with clinically negative axilla. These (p) underwent modified radical mastectomy or lumpectomy and standard (a) dissection level I and II. The number of the infiltrated nodes was identified in each case. Results: (S) of 4 - 8 (57 patients, group 1) identify (p) with free nodes ( node positive rate 0%). (S) of 9 and 10 (67 patients, group 2) carry an average node positive rate of 65,67%, of which 31,34% involves the invasion of 1 node, 23,88% of 2–3 and 10,44% of 4 or more nodes (P < 0.001, group 1 versus group 2). (S) of 11 and more (100 patients, group 3) identify (p) with an average node positive rate of 83%, of which 55% involves the invasion of 4 or more nodes (P < 0.001, group 3 versus group 1). (S) allows the separation of (p) into two (a) management groups. Group 1 are those (p), who possibly have free lymph nodes and therefore may need no (a) surgery at all, whereas group 2 and 3 may be considered for standard (a) dissection, because they present with increased possibility infiltrated nodes. Conclusion: (S) was studied to aid the selection of (p) towards reasonable (a) treatment choices for the benefit of (p). (S) might serve as a guideline in the clinical practice to reduce the postoperative morbidity of the breast cancer (p). No significant financial relationships to disclose.

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Differential expression of long noncoding RNAs in patients with metastatic and nonmetastatic colorectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e15023 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e15023-e15023

Author(s):

Denis S. Kutilin ◽

Marina A. Gusareva ◽

Natalia G Kosheleva ◽

Mikhail S. Zinkovich ◽

Astanda K. Gvaramiya ◽

...

Keyword(s):

Colorectal Cancer ◽

Lymph Nodes ◽

Liver Metastases ◽

Differential Expression ◽

Colon Adenocarcinoma ◽

Rna Isolation ◽

Lncrna Malat1 ◽

Group 3 ◽

Group 2 ◽

Group 1

e15023 Background: Long non-coding RNAs (lncRNA) play an important role in many biological processes, and their dysregulation can lead to various diseases, including colorectal cancer (CRC). In recent years, interactions between lncRNA, miRNA and mRNAs in development of CRC have attracted more and more attention. However, the currently obtained data on the complex regulatory interactions between lncRNA and microRNA during metastasis in patients with CRC are fragmentary, often contradictory and obtained on samples that are not significant in size. Therefore, the aim of the study was to analyze the features of lncRNA expression in CRC patients without metastases, with lymph nodes metastases and with liver metastases. Methods: The study included 200 patients with colon adenocarcinoma. The patients were divided into 3 groups: without metastases (T2N0MO, group 1, n = 100), with lymph node metastases (T2-3N1-2M0, group 2, n = 60) and with liver metastases (T3N2M1-2, group 3, n = 40). RNA isolation was performed by guanidine-thiocyanate-phenol-chloroform extraction. The lncRNA list was generated based on bioinformatic analysis. The relative expression of 20 lncRNAs (NEAT1, HELLPAR, AP000766.1, LINC00265, MIRLET7BHG, OLMALINC, AC245884.8, MEOX2-AS1, MEG3, NORAD, HCG11, WASIR2, AC005332.7, PURLN, OIP5-AS1, SNHG14, TUG1, XIST, MALAT1, FAM66E) was evaluated by RT-qPCR method. Differences were assessed using the Mann-Whitney test, and the Bonferroni correction was used to correct multiple comparisons. Results: Differential expression of 5 lncRNA (MALAT1, TUG1, XIST, LINC00265, HELLPAR) was found between CRC patients without metastases and patients with metastases to lymph nodes and liver. Thus, in group 1, expressions of MALAT1, TUG1 and HELLPAR were lower by 2.5, 4.0 and 5.5 times (p < 0.005) than in combined group of patients with metastases to lymph nodes and liver, and XIST and LINC00265 expressions were higher by 2.2 and 3.4 times (p < 0.05), respectively. Differential expression of 2 lncRNA (NORAD, WASIR2) was also found between group 2 and group 3. The NORAD expression in patients in group 3 was 5.5 times (p < 0.05) lower than in patients in group 2, and WASIR2 expression, on the contrary, was 2.5 times (p < 0.05) higher in patients in group 3. Conclusions: Thus, differential expression of lncRNA (MALAT1, TUG1, XIST, LINC00265, HELLPAR, NORAD and WASIR2), associated with regulation of proliferation and invasive ability of tumor cells, was found in 3 groups of CRC patients.

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In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽

10.1024/0301-1526/a000867 ◽

2020 ◽

Vol 49 (4) ◽

pp. 281-284

Author(s):

Atıf Yolgosteren ◽

Gencehan Kumtepe ◽

Melda Payaslioglu ◽

Cuneyt Ozakin

Keyword(s):

Vascular Graft ◽

Graft Infection ◽

Vascular Graft Infection ◽

Group 4 ◽

Significant Difference ◽

Group 3 ◽

Group 2 ◽

Prosthetic Vascular Graft Infection ◽

Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

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Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661190 ◽

1984 ◽

Vol 52 (03) ◽

pp. 253-255 ◽

Cited By ~ 11

Author(s):

C Isles ◽

G D O Lowe ◽

B M Rankin ◽

C D Forbes ◽

N Lucie ◽

...

Keyword(s):

Blood Pressure ◽

Blood Viscosity ◽

Renal Damage ◽

Antithrombin Iii ◽

Plasma Viscosity ◽

Malignant Hypertension ◽

Fibrin Deposition ◽

Group 3 ◽

Group 2 ◽

Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

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Features of postoperative period in patients with chronic venous insufficiency: phlebectomy versus thermal ablation

Hirurg (Surgeon) ◽

10.33920/med-15-2001-05 ◽

2020 ◽

pp. 64-75

Author(s):

E. Burleva ◽

O. Smirnov ◽

S. Tyurin

Keyword(s):

Postoperative Period ◽

Chronic Venous Insufficiency ◽

Thermal Ablation ◽

Venous Insufficiency ◽

Clinical Symptoms ◽

Varicose Veins ◽

Statistical Processing ◽

Group 3 ◽

Group 2 ◽

Group 1

The purpose of the study was to conduct a comparative assessment of the course of the postoperative period after phlebectomy and thermal ablation in patients with varicose veins of the lower extremities in the system of the great saphenous vein (GSV) with class C2 of chronic venous insufficiency (CVI) — CEAP class C2. Materials and methods: 455 patients (455 limbs) with CEAP class C2. Group 1 (n = 154) received stripping + minimally invasive phlebectomy; Group 2 — endovenous laser ablation (EVLA) of GSV trunk + sclerotherapy of varicose veins; 3 group (n = 150) — radiofrequency ablation (RFA) of the GSV + sclerotherapy. All patients were united by a single tactical solution — the elimination of pathological vertical reflux in GSV. In each group, patients were with similar hemodynamic profile were selected (Group 1 = 63; Group 2 = 61; Group 3 = 61). The course of the postoperative period (from 2 days to 2 months) was compared for pain (visual analog scale — VAS), clinical symptoms of chronic venous insufficiency, degree of satisfaction (Darvall questionnaire), and duration of disability. Statistical processing was carried out using Excel programs for Windows XP, MedCalc® (version 11.4.2.0., Mariakerke, Belgium). Results: Postoperative pain is more pronounced (during day 1 for Group 1–4.0, Group 2–3.0, Group 3–2.0) and more prolonged (up to 4 days) after open surgeries (p < 0.05). The dynamics of the clinical symptoms of CVI (including varicose syndrome and use of compression therapy) could not be fully evaluated in connection with the ongoing sclerotherapy procedures for patients of Groups 2 and 3. Satisfaction of patients with aesthetic aspects was higher than expected in all groups. Reliable statistical differences proved decrease in days of disability (Group 1–14; Group 2–4; Group 3–3) and earlier return to physical activities and work in patients after thermal ablation in comparison with phlebectomy. Conclusion: The study shows that all three methods for eliminating vertical reflux in the GSV can be proposed for a large category of patients with CEAP of class C3 and C2. Medical and social rehabilitation of patients using endovascular thermal ablation technologies proceeds faster, which is beneficial both for the patients and for society.

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