The impact of neoadjuvant chemoradiation versus chemotherapy on short and long-term outcomes among gastric carcinoma patients.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 78-78
Author(s):  
Basem Azab ◽  
Francisco Igor Macedo ◽  
Omar Picado ◽  
Dido Franceschi ◽  
Alan S Livingstone ◽  
...  
Keyword(s):  
Gastric Carcinoma ◽  
Data Base ◽  
Postoperative Mortality ◽  
Neoadjuvant Chemoradiation ◽  
R0 Resection ◽  
Surgical Morbidity ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

78 Background: There is little consensus on the use of neoadjuvant chemoradiation (NCRT) versus neoadjuvant chemotherapy (NCT) in gastric carcinoma (GC) patients. We sought to compare the outcomes of these two approaches in a large national data base. Methods: National Cancer Data Base PUF (2004-2014) of GC patients who underwent NCRT/NCT followed by resection were included. Primary outcome was overall survival (OS), secondary outcomes were pathological complete response (pCR), R0 resection and postoperative mortality. Results: A total of 4204 GC patients with NCT were included, 62% of them had additional neoadjuvant radiotherapy (NRT). NCRT had higher pCR and R0 rates [551/2613 (21%), 2314/2561 (90%)] than NCT group [148/1573 (9%), 1242/1543 (80%)], p < 0.0001. Multivariate logistic regression showed similar higher odds of pCR (OR 2.8, 95% CI 1.65-4.60, p < 0.0001) and R0 (OR 1.5, 95% CI 1.14-1.99, p = 0.004) among NCRT versus NCT. There was no significant difference in length of hospital stay, 30-day readmission rate, 30- and 90-day postoperative mortality. Median, 3- and 5-year OS for NCRT versus NCT were: (20.4 months, 24% and 11%) versus (18.3 months, 19% and 6%), p < 0.001. Univariate cox regression analysis showed superior OS with NRT (HR 0.9, 95% CI 0.80-0.91, p < 0.001). After adjusting for confounding variables, pCR (HR 0.2, 95% CI 0.18-0.24, p < 0.001) and R0 (HR 0.7, 95% CI 0.61-0.75, p < 0.001) had better OS, while NRT was not. Conclusions: NRT improved pCR and R0 rates in GC without increase in surgical morbidity/mortality. The long-term OS benefit of NRT is likely secondary to higher pCR and R0 resection.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

Neoadjuvant therapy for localized gastrointestinal stromal tumors (GISTs): A propensity score weighted analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e23516-e23516
Author(s):  
Kathryn E. Marqueen ◽  
Erin Moshier ◽  
Michael Buckstein ◽  
Celina Ang
Keyword(s):  
Overall Survival ◽  
Logistic Regression ◽  
Propensity Score ◽  
Survival Benefit ◽  
Postoperative Mortality ◽  
Phase Iii ◽  
R0 Resection ◽  
Treatment Groups ◽  
Significant Difference ◽  
The Impact

e23516 Background: Retrospective and single-arm prospective studies have reported clinical benefit associated with receipt of neoadjuvant imatinib for GISTs. In the absence of randomized phase III data, the impact of neoadjuvant systemic therapy (NAT) on survival, in comparison to upfront resection, remains unknown. Methods: We identified N = 14,402 patients with complete clinical, demographic, treatment and pathologic data within the National Cancer Database (2004-2016) who underwent resection of localized GIST of the stomach, esophagus, small bowel, and colorectum, with or without ≥3 months of NAT. Inverse probability of treatment weighting (IPTW) was used to adjust for covariable imbalance among treatment groups, with the propensity score estimated by logistic regression. The effect of NAT on overall survival was estimated with a weighted time-dependent Cox proportional hazards model. A weighted logistic regression was used to estimate the effect of NAT on 90-day postoperative mortality and R0 resection. Results: 759 (5.3%) patients received NAT followed by resection, compared to 13,643 (94.7%) who underwent upfront resection. Median length of NAT was 6.3 months. 53% of NAT patients were male vs. 49% of UR patients, 68% vs. 66% had primary gastric GIST, and 73% vs 49% were high risk. Patients receiving NAT had larger tumors (p < 0.001) and higher mitotic index (p = 0.003). There was a significant survival benefit associated with receipt of NAT (table). 90-day postoperative mortality rate was 3/759 (0.4%) among NAT patients vs. 307/13,643 (2.3%) UR patients. Receipt of NAT was significantly associated with lower odds of 90-day postoperative mortality (table). Of the 13,562 patients with information on margin status, the R0 resection rate was 635/716 (88.7%) for the neoadjuvant group vs. 11,823/12,846 (92%), with no significant difference between treatment groups (table). Conclusions: After adjustment for imbalance in prognostic and demographic factors, this analysis demonstrates that receipt of NAT for localized GIST is associated with a modest overall survival benefit. Although NAT patients had higher risk features, NAT was associated with a lower risk of 90-day postoperative mortality, with no difference in likelihood of achieving an R0 resection. [Table: see text]

The value of lymphadenectomy in esophageal cancer after neoadjuvant chemoradiation.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 79-79
Author(s):  
Basem Azab ◽  
Francisco Igor Macedo ◽  
Omar Picado ◽  
Caroline Ripat ◽  
Dido Franceschi ◽  
...  
Keyword(s):  
Cox Regression ◽  
Locally Advanced ◽  
Postoperative Mortality ◽  
Complete Response ◽  
Neoadjuvant Chemoradiation ◽  
National Cancer Data Base ◽  
Cox Regression Analysis ◽  
Cancer Data ◽  
The Impact ◽  
Total Lymph Node

79 Background: There are conflicting reports on the value of the extent of post neoadjuvant chemoradiation (NCRT) lymphadenectomy (LND) in locally advanced esophageal adenocarcinoma (E-ADC) and squamous cell carcinoma (E-SCC). We sought to study the impact of LND variables [positive and total lymph node (LN) number and LN ratio (LNR)] on oncological outcomes in these patients. Methods: The National Cancer Data Base 2004-2014 was queried for patients with NCRT followed by esophagectomy. The median examined LN number was used to divide the patients into a higher (> 12) and lower (≤ 12) LND groups. The primary outcome was overall survival (OS) and secondary outcomes were 30- and 90-day postoperative mortality. Results: A total 4708 patients were included. The median of positive, negative LN, and LNR were and (0, 11, 0%). The median and 5-year OS for higher LND group were higher than the lower LND group (39 vs. 32 months, 38% vs. 34%), p < 0.0001. OS was not significantly different among E-SCC subset or among those who achieved pathological complete response (pCR). The higher LND group had better 30- and 90-day postoperative mortality rates (61/2335 = 2.6%, 141/2308 = 6.1%) than lower LND group (86/2262 = 3.8%, 184/2251 = 8.2%), p = 0.01 and 0.001, respectively . In multivariate Cox regression analysis, higher LND group (HR 0.88, 95% CI 0.81-0.96, p = 0.004) and LNR (per 10% increase: 1.11, 95% CI 1.09-1.13, p < 0.0001) were significant predictor of OS. Conclusions: The LND (> 12 examined LN) remains as a crucial treatment goal after NCRT with potential survival benefit, especially among E-ADC and those did not achieve pCR.

scholarly journals COVID-19 in liver transplant candidates: pretransplant and post-transplant outcomes - an ELITA/ELTR multicentre cohort study

Gut ◽  
2021 ◽  
pp. gutjnl-2021-324879
Author(s):  
Luca Saverio Belli ◽  
Christophe Duvoux ◽  
Paolo Angelo Cortesi ◽  
Rita Facchetti ◽  
Speranta Iacob ◽  
...  
Keyword(s):  
Liver Disease ◽  
Respiratory Failure ◽  
Meld Score ◽  
Decompensated Cirrhosis ◽  
Cox Regression Analysis ◽  
Post Transplant ◽  
End Stage Liver Disease ◽  
Significant Difference ◽  
End Stage ◽  
The Impact

ObjectiveExplore the impact of COVID-19 on patients on the waiting list for liver transplantation (LT) and on their post-LT course.DesignData from consecutive adult LT candidates with COVID-19 were collected across Europe in a dedicated registry and were analysed.ResultsFrom 21 February to 20 November 2020, 136 adult cases with laboratory-confirmed SARS-CoV-2 infection from 33 centres in 11 European countries were collected, with 113 having COVID-19. Thirty-seven (37/113, 32.7%) patients died after a median of 18 (10–30) days, with respiratory failure being the major cause (33/37, 89.2%). The 60-day mortality risk did not significantly change between first (35.3%, 95% CI 23.9% to 50.0%) and second (26.0%, 95% CI 16.2% to 40.2%) waves. Multivariable Cox regression analysis showed Laboratory Model for End-stage Liver Disease (Lab-MELD) score of ≥15 (Model for End-stage Liver Disease (MELD) score 15–19, HR 5.46, 95% CI 1.81 to 16.50; MELD score≥20, HR 5.24, 95% CI 1.77 to 15.55) and dyspnoea on presentation (HR 3.89, 95% CI 2.02 to 7.51) being the two negative independent factors for mortality. Twenty-six patients underwent an LT after a median time of 78.5 (IQR 44–102) days, and 25 (96%) were alive after a median follow-up of 118 days (IQR 31–170).ConclusionsIncreased mortality in LT candidates with COVID-19 (32.7%), reaching 45% in those with decompensated cirrhosis (DC) and Lab-MELD score of ≥15, was observed, with no significant difference between first and second waves of the pandemic. Respiratory failure was the major cause of death. The dismal prognosis of patients with DC supports the adoption of strict preventative measures and the urgent testing of vaccination efficacy in this population. Prior SARS-CoV-2 symptomatic infection did not affect early post-transplant survival (96%).

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

scholarly journals What is the impact of methotrexate on liver in patients with juvenile idiopathic arthritis? Results of liver SWE performed in a single centre

2021 ◽  
Author(s):  
Vildan Güngörer ◽  
Mehmet Öztürk ◽  
Mustafa Yasir Özlü ◽  
Şükrü Arslan
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Shear Wave Elastography ◽  
Term Therapy ◽  
Control Group ◽  
Significant Difference ◽  
Group 2 ◽  
Long Term Therapy ◽  
And Control ◽  
The Impact

ABSTRACT Objectives Long-term therapy with low-dose methotrexate (MTX) is widely used in treatment of rheumatic diseases, in children. The purpose of this study was to evaluate liver elasticity in patients with juvenile idiopathic arthritis (JIA) who received MTX and compare the results with control group. Methods Liver elasticity was evaluated with shear wave elastography (SWE) technique in 25 patients aged 3–17 years who were followed up with JIA and received MTX and compared with 25 healthy controls of the same age and weight. Factors that had an effect on liver elasticity were examined. Results The mean SWE value of patients was 2.64 ± 2.13 m/s and 24.10 ± 18.50 kPa, whereas 1.83 ± 0.16 m/s and 10.09 ± 1.83 kPa in control group. There was a significant difference in liver elasticity in the patient and control groups. When the patients were evaluated as Group 1 (&lt; 1000 mg) and Group 2 (≥ 1000 mg) according to the cumulative MTX dose, no significant difference was obtained. There was positive correlation between liver elasticity and weekly MTX dose and age. Conclusions Our study revealed that liver elasticity significantly decreased in patients who received MTX when compared with the control group. The elastography technique will be understood better over time and used safely in many areas.

scholarly journals The Impact of Visual Aids on the Retention of English Word Stress Patterns

2018 ◽  
Vol 7 (2) ◽  
pp. 225 ◽  
Author(s):  
Farid Ghaemi ◽  
Fahimeh Rafi
Keyword(s):  
English Word ◽  
Placement Test ◽  
Visual Aids ◽  
Word Stress ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Impact ◽  
Stress Patterns

The present study aimed at comparing the effectiveness of three different techniques on learners’ long term memorization of English word stress patterns. After administering a quick placement test, 67 Iranian EFL elementary learners at language institutes were selected to participate in the study. Then they were divided into three groups. Before starting the instruction, a pretest was conducted to classify the participants’ abilities on word stress patterns. Then the new techniques were used to teach English word stress patterns. In all three groups, words were printed largely on a piece of paper and the syllables were clearly specified by dots. In group ‘A’, pronunciation and stress pattern of new words were taught aurally through the repetition of the words. In group ‘B’, all the procedure was exactly similar to that of group ‘A’, the only difference was that the stressed syllables were printed in bold. In group ‘C’, all the procedure was exactly similar to that of group ‘B’,  except that the stressed syllables were not only printed in bold, but also introduced by teacher’s hand gesture. After two weeks, a delayed posttest was conducted to check long term memorization of the word stress patterns. The results of the study indicated that there was a significant difference between pretest and delayed posttest in all three groups. But the most meaningful difference belonged to group ‘C’. That is, the participants in the third group (gesture group) outperformed those in the other groups. Finally, some implications and suggestions provided for further research.   

A Standardized Approach to Cesarean Surgical Technique and Its Effect on Operative Time and Surgical Morbidity

2018 ◽  
Vol 36 (03) ◽  
pp. 277-284 ◽  
Author(s):  
M. Pallister ◽  
J. Ballas ◽  
J. Kohn ◽  
C. S. Eppes ◽  
M. Belfort ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Operative Time ◽  
Retrospective Chart Review ◽  
Surgical Morbidity ◽  
Entire Cohort ◽  
Cesarean Deliveries ◽  
Significant Difference ◽  
Secondary Outcomes ◽  
The Impact ◽  
Academic Year

Objective To evaluate the impact of a standardized surgical technique for primary cesarean deliveries (CDs) on operative time and surgical morbidity. Materials and Methods Two-year retrospective chart review of primary CD performed around the implementation of a standardized CD surgical technique. The primary outcome was total operative time (TOT). Secondary outcomes included incision-to-delivery time (ITDT), surgical site infection, blood loss, and maternal and fetal injuries. Results When comparing pre- versus postimplementation surgical times, there was no significant difference in TOT (76.5 vs. 75.9 minutes, respectively; p = 0.42) or ITDT (9.8 vs. 8.8 minutes, respectively; p = 0.06) when the entire cohort was analyzed. Subgroup analysis of CD performed early versus late in an academic year among the pre- and postimplementation groups showed no significant difference in TOT (79.3 early vs. 73.8 minutes late; p = 0.10) or ITDT (10.8 early vs. 8.8 minutes late; p = 0.06) within the preimplementation group. In the postimplementation group, however, there was significant decrease in TOT (80.5 early vs. 71.3 minutes late; p = 0.02) and ITDT (10.6 early vs. 6.8 minutes late; p < 0.01). Secondary outcomes were similar for both groups. Conclusion A standardized surgical technique combined with surgical experience can decrease TOT and ITDT in primary CD without increasing maternal morbidity.

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.

O193 ROLE OF MALNUTRITION IN 0ESOPHAGEAL SURGERY FOR CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
R Alfieri ◽  
M Nardi ◽  
V Moretto ◽  
E Pinto ◽  
M Briarava ◽  
...  
Keyword(s):  
Weight Loss ◽  
Postoperative Complications ◽  
Nutritional Status ◽  
Term Survival ◽  
Long Term Outcome ◽  
Long Term Survival ◽  
Oesophagogastric Junction ◽  
Significant Difference ◽  
The Impact

Abstract Aim To investigate whether preoperative malnutrition is associated with long term outcome and survival in patients undergoing radical oesophagectomy for oesophageal or oesophagogastric junction cancer. Background & Methods Dysphagia, weight loss, chemo-radiationtherapy frequently lead to malnutrition in patients with oesophageal or oesophagogastric junction cancer. Severe malnutrition is associated with higher risk of postoperative complications but little is known on the correlation with long term survival. We conducted a single center retrospective study on a prospectively collected database of patients undergoing oesophagectomy from 2008 and 2012 in order to evaluate the impact of preoperative malnutrition with postoperative outcome and long term survival. Preoperative malnutrition was classified as: prealbumin level less than 220 mg/dL (PL), MUST index (Malnutrition Universal Screeening Tool) >2 and weight loss >10%. Results 177 consecutive patients were considered: due to incomplete data 60 were excluded from the analysis that was performed on 117 patients. PL was reported in 52 (44%) patients, MUST index was recorded in 62 (53%), 58 (49%) patients presented more than 10% weight loss at the preoperative evaluation. PL was associated with more postoperative Clavien-Dindo 1-2 complications (p=0.048, OR 2.35 95%IC 1.001-5.50), no differences were observed in mortality, anastomotic leak, major pulmonary complications. MUST index was not correlated with postoperative complications nor mortality but resulted worse in patients treated with chemo-radiotherapy (p=0.046, OR 1.92 95%CI 1.011-3.64). Weight loss >10% was not associated with postoperative complications or mortality. Overall 7 years survival rate was 69%. and DFS was 68%. Malnourished patients did not differ from non-malnourished regarding age, sex, tumor site, tumor stage and histology. No significant difference in 7 years survival rates was observed in patients with PL <220 mg/dL ( 55 % vs 67%), neither in patients with MUST score>2 (58% vs 72%), nor in patients with weight loss >10% (53% vs 70%). Conclusions Malnutrition is more common in patients treated with chemoradiation therapy and it is associated with postoperative complications. However, both long term and disease free survival are not affected by preoperative nutritional status. Larger patient population and data on long term postoperative nutritional status will be analyzed in further studies.

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