Ensuring Quality in Thyroid Cancer Surgery

Thyroid cancer incidence is increasing worldwide. Though long-term survival rates are excellent, recurrence remains a significant problem, which highlights potential areas of needed improvement, including the surgical care of these patients. This review paper identifies tools and markers that can be used to improve surgical quality in thyroid cancer. Preoperative surgical planning starts with an adequate ultrasound evaluation of the cervical lymph node basins. Postoperatively, thyroglobulin and radioactive iodine uptake scans can track adequacy of resection. In addition, lymph node yield and lymph node ratios serve as indirect markers for assessing the quality of lymph node dissections. Current research also suggests that high-volume surgeons have improved oncological outcomes. Surgeons can use these tools and information to follow and potentially improve the care provided to patients.

Download Full-text

Pediatric Cancer Survivorship: Research and Clinical Care

Journal of Clinical Oncology ◽

10.1200/jco.2006.07.3114 ◽

2006 ◽

Vol 24 (32) ◽

pp. 5160-5165 ◽

Cited By ~ 43

Author(s):

Anna T. Meadows

Keyword(s):

Pediatric Cancer ◽

Late Effects ◽

Clinical Care ◽

Survival Rates ◽

The United States ◽

Term Survival ◽

Pediatric Cancer Survivors ◽

Effects Of Aging

Regardless of how one defines survivorship, more than 10 million individuals in the United States have been treated for a malignant disease; about 250,000 were younger than 21 years of age at diagnosis. Thirty years ago, pediatric oncologists recognized that children with cancer might be cured by adding chemotherapy to surgery and radiation. Studies were then begun of complications that could reduce survival or the quality of survival, and that might be associated with previous therapy. The complications were termed late effects, and studies focused on patients who were likely to be cured, or less likely to succumb to the original cancer than they were to experience disabilities. Clinical trials tested whether changes in therapy to reduce complications could maintain the same excellent survival rates. During the last 20 years, articles detailing late effects and the relationship between therapy and outcome have been published. This article reviews the progress made in understanding the outcomes reported and the efforts made to improve the quality of long-term survival for children and adolescents. Several questions remain regarding the long-term complications of therapy. Clinicians need more data regarding the effects of aging to guide them in managing former patients. Caregivers and pediatric cancer survivors who are now adults seek the optimal venue in which to receive care as independent adults. In addition, medical oncologists need to determine whether the models for research and clinical care of survivors created in pediatric oncology can be applied to survivors of adult-onset cancer.

Download Full-text

Cryopreservation of sperm

Oxford Textbook of Endocrinology and Diabetes ◽

10.1093/med/9780199235292.003.9118 ◽

2011 ◽

pp. 1447-1449

Author(s):

A. Kamischke ◽

Eberhard Nieschlag

Keyword(s):

Quality Of Life ◽

Survival Rates ◽

Young Patients ◽

Malignant Diseases ◽

Term Survival ◽

Younger Adults ◽

Critical Situation ◽

Oncological Patients

Malignant diseases in adolescence and younger adults such as testicular cancer, lymphomas and leukaemia have long-term survival rates of up to 80% if treated adequately. As a result, long-term quality of life, including reproductive health, has become increasingly important. The cryopreservation of sperm from oncological patients represents the most frequent indication for the procedure. Depending on the substance and dosages administered, chemo- and/or radiotherapy, as well as surgical intervention, can lead to persistent azoospermia independent of the patienńs pubertal status. Theoretically, hormonal gonadal protection and retransplantation of germ cell stem cells preserved prior to chemotherapy offer options to preserve fertility, but neither approach has yet proven to be of clinical benefit. Therefore at present, cryopreservation of sperm prior to oncological therapy offers the only possibility of circumventing the deleterious effects of disease and therapy on fertility, thereby contributing to the personal stabilization of the predominantly young patients in this critical situation. Currently, men undergoing diagnostic and therapeutic testicular biopsies, performed to detect sperm possibly remaining in the testis for use in intracytoplasmic sperm injection (ICSI) (Chapter 9.4.14), may opt for cryopreservation. Until histological examination is complete, the remaining tissue remains frozen, for later use or subsequent thawing or disposal.

Download Full-text

Hepatic Arterial Embolization for the Treatment of Metastatic Neuroendocrine Tumors

International Journal of Hepatology ◽

10.1155/2012/471203 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 14

Author(s):

Eric Lee ◽

H. Leon Pachter ◽

Umut Sarpel

Keyword(s):

Liver Metastases ◽

Neuroendocrine Tumors ◽

Survival Rates ◽

Arterial Embolization ◽

Progression Free Survival ◽

Term Survival ◽

Free Survival ◽

Hepatic Arterial Embolization

Neuroendocrine tumors (NETs) have a high predilection for metastasizing to the liver and can cause severe debilitating symptoms adversely affecting quality of life. Although surgery remains the treatment of choice, many liver metastases are inoperable at presentation. Hepatic arterial embolization procedures take advantage of the arterial supply of NET metastases. The goals of these therapies are twofold: to increase overall survival by stabilizing tumor growth, and to reduce the morbidity in symptomatic patients. Patients treated with hepatic arterial embolization demonstrate longer progression-free survival and have 5-year survival rates of nearly 30%. The safety of repeat embolizations has also been proven in the setting of recurrent symptoms or progression of the disease. Despite not being curative, hepatic arterial embolization should be used in the management of NETs with liver metastases. Long-term survival is not uncommon, making aggressive palliation of symptoms an important component of treatment.

Download Full-text

Diabetics have Inferior Long-Term Survival and Quality of Life after CABG

International Journal of Angiology ◽

10.1055/s-0038-1676791 ◽

2019 ◽

Vol 28 (01) ◽

pp. 050-056

Author(s):

Matti Hokkanen ◽

Heini Huhtala ◽

Otso Järvinen

Keyword(s):

Quality Of Life ◽

Health Survey ◽

Artery Bypass ◽

Survival Rates ◽

Term Survival ◽

Long Term Survival ◽

Related Quality

A prevalence of diabetes is increasing among the patients undergoing coronary artery bypass grafting (CABG). Data on whether health-related quality of life improves similarly after CABG in diabetics and nondiabetics are limited. We assessed long-term mortality and changes in quality of life (RAND-36 Health Survey) after CABG.Seventy-four of the 508 patients (14.6%) operated on in a single institution had a history of diabetes and were compared with nondiabetics. The RAND-36 Health Survey was used as an indicator of quality of life. Assessments were made preoperatively and repeated 1 and 12 years later.Thirty-day mortality was 2.7 versus 1.6 (p = 0.511) in the diabetics and nondiabetics. One- and 10-year survival rates in the diabetics and nondiabetics were 94.6% versus 97.0% (p = 0.287) and 63.5% versus 81.6% (p < 0.001), respectively. After 1 year, diabetics improved significantly (p < 0.005) in seven, and nondiabetics (p < 0.001) in all eight RAND-36 dimensions. Despite an ongoing decline in quality of life over the 12-year follow-up, an improvement was maintained in four out of eight dimensions among diabetics and in seven dimensions among nondiabetics. Physical and mental component summary scores on the RAND-36 improved significantly (p < 0.001) in both groups after 1 year, and at least slight improvement was maintained during the 12-year follow-up time.Diabetics have inferior long-term survival after CABG as compared with nondiabetics. They gain similar improvement of quality of life in 1 year after surgery, but they have a stronger decline tendency over the years.

Download Full-text

Hospital Volume, Margin Status, and Long-Term Survival after Pancreaticoduodenectomy for Pancreatic Adenocarcinoma

The American Surgeon ◽

10.1177/000313481207800243 ◽

2012 ◽

Vol 78 (2) ◽

pp. 225-229 ◽

Cited By ~ 21

Author(s):

Marco La Torre ◽

Giuseppe Nigri ◽

Linda Ferrari ◽

Giulia Cosenza ◽

Matteo Ravaioli ◽

...

Keyword(s):

Pancreatic Surgery ◽

Hospital Volume ◽

Survival Rates ◽

High Volume ◽

Margin Status ◽

Negative Margin ◽

Term Survival ◽

Modeling And Analysis ◽

Low Volume

An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers ( P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year, respectively ( P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals dedicated to pancreatic surgery.

Download Full-text

772 PREDICTORS OF LONG-TERM SURVIVAL OF PATIENTS WITH HIGH VOLUME OF NODAL METASTASES AT EXTENDED PELVIC LYMPH NODE DISSECTION FOR PROSTATE CANCER. THE IMPORTANCE OF AN INTEGRATED, MULTIMODAL APPROACH

The Journal of Urology ◽

10.1016/j.juro.2012.02.859 ◽

2012 ◽

Vol 187 (4S) ◽

Author(s):

Nazareno Suardi ◽

Alberto Briganti ◽

Andrea Gallina ◽

Firas Abdollah ◽

Lorenzo Rocchini ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Lymph Node Dissection ◽

High Volume ◽

Pelvic Lymph Node Dissection ◽

Nodal Metastases ◽

Multimodal Approach ◽

Node Dissection ◽

Term Survival

Download Full-text

329 GASTRECTOMY VERSUS ESOPHAGECTOMY FOR GASTROESOPHAGEAL-JUNCTION TUMORS: SHORT- AND LONG-TERM OUTCOMES FROM A NATIONAL AUDIT

Diseases of the Esophagus ◽

10.1093/dote/doaa087.74 ◽

2020 ◽

Vol 33 (Supplement_1) ◽

Author(s):

E Jezerskyte ◽

A Mertens ◽

S van Dieren ◽

W Eshuis ◽

M van Berge Henegouwen ◽

...

Keyword(s):

Overall Survival ◽

Lymph Node ◽

Total Gastrectomy ◽

Postoperative Morbidity ◽

Conditional Survival ◽

Term Survival ◽

Lymph Node Yield ◽

Icu Stay ◽

Node Yield

Abstract Both a total gastrectomy and an esophagectomy may be technically possible in a patient with a gastroesophageal (GEJ) carcinoma. The aim of this study was to investigate the morbidity, mortality, pathology results and long-term survival in patients following an esophagectomy or a total gastrectomy for GEJ cancer. Methods A retrospective comparative cohort study of prospectively collected data from the Dutch Upper-GI Cancer Audit combined with survival data of the medical insurance database of the Netherlands was performed. Patients with a GEJ carcinoma in whom a total gastrectomy or an esophagectomy was performed, between 2011–2016 were included. Primary outcome was 3-year overall survival. Postoperative morbidity, mortality, 3-year conditional survival, reinterventions, radicality of surgery, (y)pTNM stage and lymph node yield were secondary endpoints. Results A total of 999 patients were included: 918 underwent an esophagectomy and 81 underwent a gastrectomy. Postoperative morbidity (54.9% vs 49.4%, p = 0.336), mortality (30-day; 2.3% vs 3.7%, p = 0.436; 90-day: 1.9% vs 2.5%, p = 0.662) and 3-year conditional survival (38.3% vs 30.3%, p = 0.553) did not differ significantly between groups. A longer ICU-stay (median 2 [IQR1–4] vs 1 days [IQR0–2], p < 0.001) and a lower lymph node yield (median 17 [IQR 12–23] vs 21 [IQR 16–31], p < 0.001) were seen following esophagectomy. The 3-year overall survival was 37.4% after esophagectomy and 28.4% after gastrectomy (HR 1.047, 95%CI 0.795–1.380, p = 0.742). Conclusion Patients with GEJ tumors after an esophagectomy required longer ICU-stay and had comparable short-term morbidity and mortality when compared to a total gastrectomy. Long-term overall and conditional survival was not significantly different between groups. The two procedures are therefore largely comparable from an oncological viewpoint, and the choice for either procedure might also be based on other outcomes such as quality of life.

Download Full-text

Prognostic Value of Lymph Node Yield on Long-term Survival in Colorectal Cancer Patients: A Systematic Review and Meta-analysis

10.37766/inplasy2020.4.0066 ◽

2020 ◽

Author(s):

Junjun She

Keyword(s):

Colorectal Cancer ◽

Systematic Review ◽

Lymph Node ◽

Prognostic Value ◽

Meta Analysis ◽

Term Survival ◽

Lymph Node Yield ◽

Colorectal Cancer Patients ◽

Node Yield

Download Full-text

Surgical Outcomes and Comparative Analysis of Transduodenal Ampullectomy and Pancreaticoduodenectomy: A Single-Center Study

Annals of Surgical Oncology ◽

10.1245/s10434-021-11190-9 ◽

2021 ◽

Author(s):

Eun-Ki Min ◽

Seung Soo Hong ◽

Ji Su Kim ◽

Munseok Choi ◽

Hyeo Seong Hwang ◽

...

Keyword(s):

Lymph Node ◽

Malignant Tumors ◽

Survival Rates ◽

Disease Free Survival ◽

Operation Time ◽

Ampulla Of Vater ◽

Perioperative Outcomes ◽

Term Survival ◽

Estimated Blood Loss

Abstract Background Transduodenal ampullectomy (TDA) is performed for adenoma or early cancer of the ampulla of Vater (AoV). This study aimed to analyze the short- and long-term outcomes of TDA (TDA group) when compared with conventional pancreaticoduodenectomy (PD) or pylorus-preserving pancreaticoduodenectomy (PD group). Methods Patients who underwent TDA between January 2006 and December 2019, and PD cases performed for AoV malignancy with carcinoma in-situ (Tis) (high-grade dysplasia, HGD) and T1 and T2 stage from January 2010 to December 2019 were reviewed. Results Forty-six patients underwent TDA; 21 had a benign tumor, and 25 cases with malignant tumors were compared with PD cases (n = 133). Operation time (p < 0.001), estimated blood loss (p < 0.001), length of hospital stays (p = 0.003), and overall complication rate (p < 0.001) were lower in the TDA group than in the PD group. Lymph node metastasis rates were 14.6% in pT1 and 28.9% in pT2 patients. The 5-year disease-free survival and 5-year overall survival rates for HGD/Tis and T1 tumor between the two groups were similar (TDA group vs PD group, 72.2% vs 77.7%, p = 0.550; 85.6% vs 79.2%, p = 0.816, respectively). Conclusion TDA accompanied with lymph node dissection is advisable in HGD/Tis and T1 AoV cancers in view of superior perioperative outcomes and similar long-term survival rates compared with PD.

Download Full-text

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

The Heart Surgery Forum ◽

10.1532/hsf98.20111084 ◽

2012 ◽

Vol 15 (1) ◽

pp. 4 ◽

Cited By ~ 23

Author(s):

David M. Holzhey ◽

William Shi ◽

A. Rastan ◽

Michael A. Borger ◽

Martin H�nsig ◽

...

Keyword(s):

Aortic Valve ◽

Survival Rates ◽

Long Term Results ◽

Term Survival ◽

Kaplan Meier ◽

Risk Patients ◽

Short And Long Term ◽

Good Treatment Option ◽

Matched Comparison

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

Download Full-text