Long-Term Outcomes of Hemostatic Therapy for Gastrointestinal Variceal Bleeding and the Transition of Hemostatic Therapy: A Retrospective Study

Abstract BACKGROUND Gastrointestinal varices are dilated submucosal veins in the gastrointestinal lumen associated with portal hypertension and represent important complications of liver cirrhosis (LC). Gastrointestinal variceal bleeding has serious life-threatening outcomes; although hemostatic therapy is possible in many cases, there are only a few studies reporting the detailed course of patients with variceal bleeding after hemostatic therapy and the transition of hemostatic therapy. This study aimed to evaluate the long-term outcomes of endoscopic hemostatic therapy for gastrointestinal variceal bleeding and of the transition of hemostatic therapy.METHODS A total of 125 patients who underwent emergency hemostatic therapy for gastrointestinal variceal bleeding between April 2006 and June 2020 were included. Data on the bleeding site, therapeutic method, primary therapeutic success rate, cumulative survival rates, factors associated with prognosis, recurrence rates, re-bleeding rates after treatment, and causes of re-bleeding were analyzed. Additionally, patients were classified into two groups: the previous term and the latter term. Patients’ background, therapeutic method, and treatment results were compared between the groups.RESULTS Overall, 94.4% had cirrhosis. The average Child-Pugh (CP) score (CPS) was 8.90. The rate of successful primary hemostasis was 98.4%, and 5.6% died within two weeks, all with a CPS ≥9. The respective one- and five-year survival rates for CP grade A/B were 81.3% and 55.4%, while those for CP grade C were 58.1% and 17.8%. CP grade C or hepatocellular carcinoma was significantly associated with poor prognosis. In total, 21.6% experienced variceal re-bleeding, and 62.9% of variceal re-bleeding cases were triggered by alcohol consumption. There was no significant difference in survival between patients with and without variceal re-bleeding. There was no significant difference in post-treatment survival between the previous and latter terms. In the latter term, the number of cases caused by alcohol consumption increased.CONCLUSIONS The hemostasis rate for variceal bleeding was high. Multidisciplinary treatment and continuation of proper management after treatment are crucial. Alcohol consumption increased variceal re-bleeding in the post-direct-acting antivirals era.

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Tracheal resection and anterior mediastinal tracheostomy in the multidisciplinary treatment of esophageal cancer with tracheal invasion

Diseases of the Esophagus ◽

10.1093/dote/doz101 ◽

2020 ◽

Vol 33 (5) ◽

Cited By ~ 1

Author(s):

Makoto Yamasaki ◽

Kotaro Yamashita ◽

Takuro Saito ◽

Koji Tanaka ◽

Tomoki Makino ◽

...

Keyword(s):

Esophageal Cancer ◽

Multidisciplinary Treatment ◽

Survival Rates ◽

Prior Treatment ◽

Tracheal Resection ◽

High Morbidity ◽

Long Term Outcomes ◽

Tracheal Invasion ◽

Mediastinal Tracheostomy

Summary Combined tracheal resection and anterior mediastinal tracheostomy (AMT) for esophageal cancer with tracheal invasion is a challenging treatment because of its high morbidity and the lack of evidence regarding long-term outcomes. The aim of this study was to assess the short- and long-term outcomes of AMT as part of the multidisciplinary treatment for esophageal cancer with tracheal invasion. This retrospective study included 27 consecutive patients with esophageal cancer with tracheal invasion who underwent combined tracheal resection and AMT in their multidisciplinary treatment for esophageal cancer. We evaluated postoperative complications, body weight loss, and survival and examined the prognostic value of preoperative factors. All patients underwent chemotherapy and/or chemoradiotherapy as prior treatment. R0 resection was achieved in all cases. Clavien–Dindo grade I or greater complications occurred in 17 patients (63%), and grade III or greater complications occurred in 12 (44%). Overall in-hospital mortality was 4%, with one patient dying on postoperative day 48 when the brachiocephalic artery ruptured from tracheal compression. The 30- and 90-day mortality rates were 0% and 4%, respectively. Median weight change in patients without recurrence in the year after surgery was −1.7% (−9.6–21%). All of these patients received nutrition by oral intake and were living independently at home without public assistance. The 3- and 5-year disease-free survival rates were 25.9% and 18.5%, respectively; 3- and 5-year overall survival rates were 38.6% and 25.7%, respectively. Multivariate analysis identified response to prior treatment as an independent prognostic factor in these patients. Combined tracheal resection and AMT may be adapted as part of the multidisciplinary treatment of esophageal cancer with tracheal invasion. Improving AMT safety and optimizing patient selection may improve prognosis among patients with this cancer.

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Liver Transplantation from Voluntary Organ Donor System in China: A Comparison between DBD and DCD Liver Transplants

Gastroenterology Research and Practice ◽

10.1155/2019/5736702 ◽

2019 ◽

Vol 2019 ◽

pp. 1-7

Author(s):

Wei Chen ◽

Dipesh Kumar Yadav ◽

Xueli Bai ◽

Jianying Lou ◽

Risheng Que ◽

...

Keyword(s):

Liver Transplantation ◽

Organ Donation ◽

Survival Rates ◽

Organ Donor ◽

Long Term Outcomes ◽

Significant Difference ◽

Short And Long Term ◽

Donor System

Background. In China, the cases of liver transplantation (LT) from donation after citizens’ death have rose year by year since the citizen-based voluntary organ donor system was initiated in 2010. The objective of our research was to investigate the early postoperative and late long-term outcomes of LT from donation after brain death (DBD) and donation after circulatory death (DCD) according to the current organ donation system in China. Methods. Sixty-two consecutive cases of LT from donation after citizens’ death performed in our hospital between February 2012 and June 2017 were examined retrospectively for short- and long-term outcomes. These included 35 DCD LT and 27 DBD LT. Result. Subsequent median follow-up time of 19 months and 1- and 3-year graft survival rates were comparative between the DBD group and the DCD group (81.5% and 66.7% versus 67.1% and 59.7%; P=0.550), as were patient survival rates (85.2% and 68.7% versus 72.2% and 63.9%; P=0.358). The duration of ICU stay of recipients was significantly shorter in the DBD group, in comparison with that of the DCD group (1 versus 3 days, P=0.001). Severe complication incidence (≥grade III) after transplantation was identical among the DBD and DCD groups (48.1% versus 60%, P=0.352). There was no significant difference in postoperative mortality between the DBD and DCD groups (3 of 27 cases versus 5 of 35 cases). Twenty-one grafts (33.8%) were lost and 18 recipients (29.0%) were dead till the time of follow-up. Malignancy recurrence was the most prevalent reason for patient death (38.8%). There was no significant difference in incidence of biliary stenosis between the DBD and DCD groups (5 of 27 cases versus 6 of 35 cases, P=0.846). Conclusion. Although the sample size was small to some extent, this single-center study first reported that LT from DCD donors showed similar short- and long-term outcomes with DBD donors and justified the widespread implementation of voluntary citizen-based deceased organ donation in China. However, the results should be verified with a multicenter larger study.

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Quantitative washout in patients with hepatocellular carcinoma undergoing TACE: an imaging biomarker for predicting prognosis?

Cancer Imaging ◽

10.1186/s40644-022-00446-6 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Lukas Müller ◽

Felix Hahn ◽

Florian Jungmann ◽

Aline Mähringer-Kunz ◽

Fabian Stoehr ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Tertiary Care ◽

Objective Response ◽

Survival Rates ◽

Imaging Biomarker ◽

Remnant Liver ◽

Long Term Outcomes ◽

Number Of Patients ◽

Significant Difference

Abstract Background The delayed percentage attenuation ratio (DPAR) was recently identified as a novel predictor of an early complete response in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). In this study, we aimed to validate the role of DPAR as a predictive biomarker for short-, mid-, and long-term outcomes after TACE. Methods We retrospectively reviewed laboratory and imaging data for 103 treatment-naïve patients undergoing initial TACE treatment at our tertiary care center between January 2016 and November 2020. DPAR and other washin and washout indices were quantified in the triphasic computed tomography performed before the initial TACE. The correlation of DPAR and radiologic response was investigated. Furthermore, the influence of DPAR on the 6-, 12-, 18-, and 24-month survival rates and the median overall survival (OS) was compared to other established washout indices and estimates of tumor burden and remnant liver function. Results The DPAR was significantly of the target lesions (TLs) with objective response to TACE after the initial TACE session was significantly higher compared to patients with stable disease (SD) or progressive disease (PD) (125 (IQR 118–134) vs 110 (IQR 103–116), p < 0.001). Furthermore, the DPAR was significantly higher in patients who survived the first 6 months after TACE (122 vs. 115, p = 0.04). In addition, the number of patients with a DPAR > 120 was significantly higher in this group (n = 38 vs. n = 8; p = 0.03). However, no significant differences were observed in the 12-, 18-, and 24-month survival rates after the initial TACE. Regarding the median OS, no significant difference was observed for patients with a high DPAR compared to those with a low DPAR (18.7 months vs. 12.7 months, p = 0.260). Conclusions Our results confirm DPAR as the most relevant washout index for predicting the short-term outcome of patients with HCC undergoing TACE. However, DPAR and the other washout indices were not predictive of mid- and long-term outcomes.

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Long-term outcomes of synchronous splenectomy and hepatectomy or radiofrequency ablation for hepatocellular carcinoma and esophagogastric variceal bleeding

10.21203/rs.3.rs-367796/v1 ◽

2021 ◽

Author(s):

Jia-li Ma ◽

Li Jiang ◽

Ping Li ◽

Ling-ling He ◽

Hong-shan Wei

Keyword(s):

Hepatocellular Carcinoma ◽

Overall Survival ◽

Variceal Bleeding ◽

Survival Rates ◽

Recurrence Free Survival ◽

Long Term Outcomes ◽

Survival Curves ◽

Free Survival ◽

Overall Survival Rates

Abstract Aim: This study aimed to compare the long-term outcomes of hepatectomy and radiofrequency ablation (RFA) combined with pericardial devascularization (PCDV) plus splenectomy for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding.Materials and Methods: Between October 2008 and March 2018, 46 patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding for portal hypertension were included in this study. The overall survival curves, recurrence-free survival curves, and rebleeding-free survival curves were plotted using Kaplan–Meier analysis. The log-rank test was used to compare time-to-event curves between groups.Results: The median follow-up time was 38 months. Among 20 patients undergoing RFA, the 1-, 3-, and 5-year overall survival rates were 95.00%,60.00%, and 35.00%, respectively. The 1-, 3- and 5-year recurrence-free survival rates were 35.00%, 25.00%, and 10.00%, respectively. The 1,3- and 5-year rebleeding-free survival rates were 85.00%, 60.00%, and 40.00%, respectively. Among 26 patients undergoing hepatectomy, the 1-, 3-, and 5-year overall survival rates were 96.15%,50.00%, and 34.62%, respectively. The 1-, 3-, and 5-year recurrence-free survival rates were 65.38%, 19.23%, and 11.54%, respectively. The 1-, 3-, and 5-year rebleeding-free survival rates were 73.08%, 42.31%, and 26.92%, respectively. No significant differences were found in overall, recurrence-free, and rebleeding-free survival rates.Conclusions: Hepatectomy or RFA with PCDV plus splenectomy might be a safe and effective treatment for patients with cirrhosis having hepatocellular carcinoma and esophagogastric variceal bleeding. “Hepatectomy first” strategy may be considered due to its lower and later recurrence. More attention should be paid to background liver diseases after surgery.

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Long-term outcomes with frontline nilotinib versus imatinib in newly diagnosed chronic myeloid leukemia in chronic phase: ENESTnd 10-year analysis

Leukemia ◽

10.1038/s41375-020-01111-2 ◽

2021 ◽

Author(s):

Hagop M. Kantarjian ◽

Timothy P. Hughes ◽

Richard A. Larson ◽

Dong-Wook Kim ◽

Surapol Issaragrisil ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Survival Rates ◽

Chronic Phase ◽

Individual Treatment ◽

Molecular Response ◽

Newly Diagnosed ◽

Long Term Outcomes ◽

Treatment Free Remission

AbstractIn the ENESTnd study, with ≥10 years follow-up in patients with newly diagnosed chronic myeloid leukemia (CML) in chronic phase, nilotinib demonstrated higher cumulative molecular response rates, lower rates of disease progression and CML-related death, and increased eligibility for treatment-free remission (TFR). Cumulative 10-year rates of MMR and MR4.5 were higher with nilotinib (300 mg twice daily [BID], 77.7% and 61.0%, respectively; 400 mg BID, 79.7% and 61.2%, respectively) than with imatinib (400 mg once daily [QD], 62.5% and 39.2%, respectively). Cumulative rates of TFR eligibility at 10 years were higher with nilotinib (300 mg BID, 48.6%; 400 mg BID, 47.3%) vs imatinib (29.7%). Estimated 10-year overall survival rates in nilotinib and imatinib arms were 87.6%, 90.3%, and 88.3%, respectively. Overall frequency of adverse events was similar with nilotinib and imatinib. By 10 years, higher cumulative rates of cardiovascular events were reported with nilotinib (300 mg BID, 16.5%; 400 mg BID, 23.5%) vs imatinib (3.6%), including in Framingham low-risk patients. Overall efficacy and safety results support the use of nilotinib 300 mg BID as frontline therapy for optimal long-term outcomes, especially in patients aiming for TFR. The benefit-risk profile in context of individual treatment goals should be carefully assessed.

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Female Sex and Outcomes after Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Propensity Score Matched Cohort Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10010162 ◽

2021 ◽

Vol 10 (1) ◽

pp. 162

Author(s):

Christian-Alexander Behrendt ◽

Thea Kreutzburg ◽

Jenny Kuchenbecker ◽

Giuseppe Panuccio ◽

Mark Dankhoff ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Propensity Score ◽

Acute Limb Ischemia ◽

Insurance Claims ◽

Long Term Outcomes ◽

Term Survival ◽

Abdominal Aortic ◽

Significant Difference

Objective: Previous studies have showed a potential disadvantage of female patients who underwent abdominal aortic aneurysm (AAA) repair. The current study aims to determine sex-specific perioperative and long-term outcomes using propensity score matched unselected nationwide health insurance claims data. Methods: Insurance claims from a large German fund were used, covering around 8% of the insured German population. Patients who underwent endovascular aortic repair (EVAR) for intact AAA from 1 January 2011 to 30 April 2017 were included in the cohort. A 1:2 female to male propensity score matching was applied to adjust for confounding variables. Perioperative and long-term outcomes after 5 years were determined using matching and regression methods. Results: Among a total of 3736 patients (19.3% females, mean 75 years) undergoing EVAR for intact AAA, we identified 1863 matched patients. Before matching, females were more likely to be previously diagnosed with hypothyroidism, electrolyte disorders, rheumatoid disorders, and depression, while males were more often diabetics. In the matched sample, 23.4% of the females and 25.8% of the males died during a median follow-up of 776 and 792 days, respectively. Perioperatively, females were more likely to exhibit acute limb ischemia (5.3% vs. 3.2%, p = 0.031) and major bleeding (22.0% vs. 15.9%, p = 0.001) before they were discharged to rehabilitation (5.5% vs. 1.5%, p < 0.001) when compared to males. No statistically significant difference in perioperative (odds ratio 1.12, 95% CI 0.54–2.16) or long-term mortality (hazard ratio 0.91, 95% CI 0.76–1.08) was observed between sexes. This was also true regarding aortic reintervention rates after 1 year (2.0% vs. 2.9%) and 5 years (10.9% vs. 8.1%). Conclusion: The current retrospective matched analysis of insurance claims revealed high early access-related morbidity in females when compared to their male counterparts. Short-term or long-term survival and reintervention outcomes were similar between sexes.

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Randomized Controlled Trial of the Clinical Recovery and Biodegradation of Polylactide-co-glycolide Implants Used in the Intramedullary Nailing of Children’s Forearm Shaft Fractures with at Least Four Years of Follow-Up

Journal of Clinical Medicine ◽

10.3390/jcm10050995 ◽

2021 ◽

Vol 10 (5) ◽

pp. 995

Author(s):

Marja Perhomaa ◽

Tytti Pokka ◽

Linda Korhonen ◽

Antti Kyrö ◽

Jaakko Niinimäki ◽

...

Keyword(s):

Intramedullary Nailing ◽

Controlled Trial ◽

Long Term Outcomes ◽

Intramedullary Nails ◽

Metal Implants ◽

Shaft Fractures ◽

Fractures In Children ◽

Significant Difference

The preferred surgical fixation of forearm shaft fractures in children is Elastic Stable Intramedullary Nailing (ESIN). Due to known disadvantageous effects of metal implants, a new surgical method using biodegradable polylactide-co-glycolide (PLGA) intramedullary nails has been developed but its long-term outcomes are unclear. The aim of this study was to compare the long-term outcomes of Biodegradable Intramedullary Nailing (BIN) to ESIN and assess the biodegradation of the study implants via magnetic resonance imaging (MRI). The study population of the prospective, randomized trial consisted of paediatric patients whose forearm shaft fractures were treated with BIN (n = 19) or ESIN (n = 16). Forearm rotation at minimally four years’ follow-up was the main outcome. There was no clinically significant difference in the recovery of the patients treated with the BIN as compared to those treated with the ESIN. More than half of the implants (57.7%, n = 15/26) were completely degraded, and the rest were degraded almost completely. The PLGA intramedullary nails used in the treatment of forearm shaft fractures in this study resulted in good function and anatomy. No unexpected disadvantages were found in the degradation of the implants. However, two implant failures had occurred in three months postoperatively.

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Robotic and laparoscopic liver surgery for colorectal liver metastases: an experience from a German Academic Center

World Journal of Surgical Oncology ◽

10.1186/s12957-020-02113-1 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Mirhasan Rahimli ◽

Aristotelis Perrakis ◽

Vera Schellerer ◽

Andrew Gumbs ◽

Eric Lorenz ◽

...

Keyword(s):

Abdominal Surgery ◽

Minimally Invasive ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Survival Rates ◽

Long Term Outcomes ◽

Short Term ◽

Minimally Invasive Liver Surgery ◽

Previous Abdominal Surgery

Abstract Background Minimally invasive liver surgery (MILS) in the treatment of colorectal liver metastases (CRLM) is increasing in incidence. The aim of this work was to present our experience by reporting short-term and long-term outcomes after MILS for CRLM with comparative analysis of laparoscopic (LLS) and robotic liver surgery (RLS). Methods Twenty-five patients with CRLM, who underwent MILS between May 2012 and March 2020, were selected from our retrospective registry of minimally invasive liver surgery (MD-MILS). Thirteen of these patients underwent LLS and 12 RLS. Short-term and long-term outcomes of both groups were analyzed. Results Operating time was significantly longer in the RLS vs. the LLS group (342.0 vs. 200.0 min; p = 0.004). There was no significant difference between the laparoscopic vs. the robotic group regarding length of postoperative stay (8.8 days), measured blood loss (430.4 ml), intraoperative blood transfusion, overall morbidity (20.0%), and liver surgery related morbidity (4%). The mean BMI was 27.3 (range from 19.2 to 44.8) kg/m2. The 30-day mortality was 0%. R0 resection was achieved in all patients (100.0%) in RLS vs. 10 patients (76.9%) in LLS. Major resections were carried out in 32.0% of the cases, and 84.0% of the patients showed intra-abdominal adhesions due to previous abdominal surgery. In 24.0% of cases, the tumor was bilobar, the maximum number of tumors removed was 9, and the largest tumor was 8.5 cm in diameter. The 1-, 3- and 5-year overall survival rates were 84, 56.9, and 48.7%, respectively. The 1- and 3-year overall recurrence-free survival rates were 49.6 and 36.2%, respectively, without significant differences between RLS vs. LLS. Conclusion Minimally invasive liver surgery for CRLM is safe and feasible. Minimally invasive resection of multiple lesions and large tumors is also possible. RLS may help to achieve higher rates of R0 resections. High BMI, previous abdominal surgery, and bilobar tumors are not a barrier for MILS. Laparoscopic and robotic liver resections for CRLM provide similar long-term results which are comparable to open techniques.

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Short- and Long-Term Outcomes of Robotic Surgery for Rectal Neuroendocrine Tumor

Surgical Innovation ◽

10.1177/15533506211030436 ◽

2021 ◽

pp. 155335062110304

Author(s):

Kentaro Saito ◽

Yusuke Yamaoka ◽

Akio Shiomi ◽

Hiroyasu Kagawa ◽

Hitoshi Hino ◽

...

Keyword(s):

Robotic Surgery ◽

Neuroendocrine Tumor ◽

Surgical Approach ◽

Anal Verge ◽

Survival Rates ◽

Long Term Outcomes ◽

Conversion To Open Surgery ◽

Short And Long Term ◽

Rectal Neuroendocrine Tumor

Background. The optimal radical surgical approach for rectal neuroendocrine tumor (NET) is unknown. Methods. This study evaluated the short- and long-term outcomes of 27 patients who underwent robotic radical surgery for rectal NET between 2011 and 2019. Results. The median distance from the lower border of the tumor to the anal verge was 5.0 cm. The median tumor size was 9.5 mm. Six patients (22%) had lymph node metastasis. The incidences of postoperative complications of grade II and grade III or more according to the Clavien–Dindo classification were 11% and 0%, respectively. All patients underwent sphincter-preserving surgery, and no patients required conversion to open surgery. The median follow-up time was 48.9 months, and both the 3-year overall survival and relapse-free survival rates were 100%. Conclusions. Short- and long-term outcomes of robotic surgery for rectal NET tumor were favorable. Robotic surgery may be a useful surgical approach for rectal NET.

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