scholarly journals Anesthesia Techniques and Long-Term Oncological Outcomes

2021 ◽  
Vol 11 ◽  
Author(s):  
Maria F. Ramirez ◽  
Juan P. Cata
Keyword(s):  
Cancer Progression ◽  
Clinical Evidence ◽  
Cancer Recurrence ◽  
Oncologic Outcomes ◽  
Long Term Outcomes ◽  
Cancer Treatments ◽  
Anesthesia Technique ◽  
Accelerated Growth ◽  
After Cancer

Despite advances in cancer treatments, surgery remains one of the most important therapies for solid tumors. Unfortunately, surgery promotes angiogenesis, shedding of cancer cells into the circulation and suppresses anti-tumor immunity. Together this increases the risk of tumor metastasis, accelerated growth of pre-existing micro-metastasis and cancer recurrence. It was theorized that regional anesthesia could influence long-term outcomes after cancer surgery, however new clinical evidence demonstrates that the anesthesia technique has little influence in oncologic outcomes. Several randomized controlled trials are in progress and may provide a better understanding on how volatile and intravenous hypnotics impact cancer progression. The purpose of this review is to summarize the effect of the anesthesia techniques on the immune system and tumor microenvironment (TME) as well as to summarize the clinical evidence of anesthesia techniques on cancer outcomes.

THU-255-Long term outcomes of alcoholic patients without clinical evidence of liver disease: A 15 years follow-up study

2019 ◽  
Vol 70 (1) ◽  
pp. e274-e275
Author(s):  
sonia bernardo ◽  
Ricardo Crespo ◽  
Helena Cortez-Pinto ◽  
Mariana Machado
Keyword(s):  
Liver Disease ◽  
Clinical Evidence ◽  
Long Term Outcomes ◽  
Follow Up Study

Perioperative and Long-Term Outcomes of Robot-Assisted Partial Nephrectomy: A Systematic Review

2020 ◽  
pp. 000313482094891
Author(s):  
Amber B. Tang ◽  
Margherita Lamaina ◽  
Christopher P. Childers ◽  
Selene S. Mak ◽  
Qiao Ruan ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Oncologic Outcomes ◽  
Surgical Approaches ◽  
Long Term Outcomes ◽  
Robot Assisted ◽  
Cancer Specific Survival ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss

Background Adoption of the robotic surgical platform for small renal cancers has rapidly expanded, but its utility compared to other approaches has not been established. The objective of this review is to assess perioperative and long-term oncologic and functional outcomes of robot-assisted partial nephrectomy (RAPN) compared to laparoscopic partial nephrectomy (LPN) and open partial nephrectomy (OPN). Methods A search in PubMed, Embase, and Cochrane (2010-2019) was conducted. Of 3877 articles screened, 7 observational studies were included. Results RAPN was associated with 24-50 mL less intraoperative blood loss compared to LPN and 39-84 mL less than OPN. RAPN also demonstrated trends of other postoperative benefits, such as shorter length of stay and fewer major complications. Several studies reported better long-term functional kidney outcomes, but these findings were inconsistent. Recurrence and cancer-specific survival (CSS) were similar across groups. While RAPN had a 5-year CSS of 90.1%-97.9%, LPN and OPN had survival rates of 85.9%-86.9% and 88.5-96.3% respectively. Conclusions RAPN may be associated with a lower estimated blood loss and comparable long-term outcomes when compared to other surgical approaches. However, additional randomized or propensity matched studies are warranted to fully assess long-term functional kidney and oncologic outcomes.

scholarly journals Robotic rectal resection: oncologic outcomes

2020 ◽  
Author(s):  
Claudio Fiorillo ◽  
Giuseppe Quero ◽  
Roberta Menghi ◽  
Caterina Cina ◽  
Vito Laterza ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Robotic Surgery ◽  
Rectal Resection ◽  
Oncologic Outcomes ◽  
Long Term Results ◽  
Perioperative Outcomes ◽  
Pathological Features ◽  
Long Term Outcomes ◽  
Robotic Rectal Resection

Abstract Robotic surgery has progressively gained popularity in the treatment of rectal cancer. However, only a few studies on its oncologic effectiveness are currently present, with contrasting results. The purpose of this study is to report a single surgeon’s experience on robotic rectal resection (RRR) for cancer, focusing on the analysis of oncologic outcomes, both in terms of pathological features and long-term results. One-hundred and twenty-two consecutive patients who underwent RRR for rectal cancer from January 2013 to December 2019 were retrospectively enrolled. Patients’ characteristics and perioperative outcomes were collected. The analyzed oncologic outcomes were pathological features [distal (DM), circumferential margin (CRM) status and quality of mesorectal excision (TME)] and long-term outcomes [overall (OS) and disease-free survival (DFS)]. The mean operative time was 275 (± 60.5) minutes. Conversion rate was 6.6%. Complications occurred in 27 cases (22.1%) and reoperation was needed in 2 patients (1.5%). The median follow-up was 30.5 (5.9–86.1) months. None presented DM positivity. CRM positivity was 2.5% (2 cases) while a complete TME was reached in 94.3% of cases (115 patients). Recurrence rate was 5.7% (2 local, 4 distant and 1 local plus distant tumor relapse). OS and DFS were 90.7% and 83%, respectively. At the multivariate analysis, both CRM positivity and near complete/incomplete TME were recognized as negative prognostic factors for OS and DFS. Under appropriate logistic and operative conditions, robotic surgery for rectal cancer proves to be oncologically effective, with adequate pathological results and long-term outcomes. It also offers acceptable peri-operative outcomes, further confirming the safety and feasibility of the technique.

scholarly journals Transsphenoidal Surgery for Cushing Disease

Neurosurgery ◽  
2011 ◽  
Vol 70 (1) ◽  
pp. 70-81 ◽  
Author(s):  
Ivan Ciric ◽  
Jin-Cheng Zhao ◽  
Hongyan Du ◽  
James W. Findling ◽  
Mark E. Molitch ◽  
...  
Keyword(s):  
Clinical Evidence ◽  
Statistical Significance ◽  
Long Term Results ◽  
Long Term Outcomes ◽  
Cushing Disease ◽  
Transsphenoidal Microsurgery ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri

Abstract BACKGROUND This is a retrospective study of 136 patients with Cushing disease treated with transsphenoidal microsurgery. OBJECTIVE To evaluate factors influencing immediate postoperative results and long-term outcomes. METHODS Data regarding clinical presentation, endocrine evaluation, imaging studies, surgical technique, immediate postoperative biochemical remission (IPBR), and long-term results were entered into a database and analyzed statistically. IPBR was based on biochemical evidence of adrenal cortical insufficiency and clinical evidence of such insufficiency. RESULTS IPBR for the entire series was 83.4%. In microadenomas, IPBR was 89.8% with a mean immediate postoperative plasma cortisol (IPPC) of 2.1 μg/dL (range, <0.5-5.3). Positive magnetic resonance imaging (MRI) was associated with 18 times greater odds of finding microadenoma at surgery (P > .001) and with 4.1 times greater odds of IPBR (P = .07). In patients with a negative MRI, a positive inferior petrosal sinus sampling (IPSS) test was associated with 93% of IPBR (P = .004). IPBR in macroadenomas was 30.7%. Of patients followed for 12 months or longer, 34.8% required glucocorticoid replacement for the duration of follow-up. The mean follow-up in microadenomas was 68.4 months with a 9.67% incidence of recurrences. The estimated actuarial incidence of recurrences increased with the passage of time and IPPC of greater than 2 μg/dL was associated with higher incidence of recurrences, although without statistical significance (P = .08). CONCLUSION In microadenomas, a positive MRI and positive IPSS test were associated with a higher incidence of IPBR. Recurrences increased with the passage of time, and an IPPC of greater than 2 μg/dL may be associated with higher incidence of recurrences.

Long-Term Outcomes of Myeloid Growth Factor Treatment

2011 ◽  
Vol 9 (8) ◽  
pp. 945-952 ◽  
Author(s):  
Gary H. Lyman ◽  
David C. Dale
Keyword(s):  
Growth Factors ◽  
Growth Factor ◽  
Dose Intensity ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Carcinogenic Agents ◽  
After Cancer ◽  
Almost All ◽  
Chronic Neutropenia

Myeloid growth factors are used to reduce myelotoxicity and the risk of infection after cancer chemotherapy and in patients with chronic neutropenia. This article addresses the long-term benefits and risks associated with granulocyte colony-stimulating factor (G-CSF) therapy in both settings. A systematic review of randomized controlled trials recently reported long-term outcomes regarding the risk of second malignancies and overall survival. Based on these studies, the risk for acute myeloid leukemia (AML) associated with known carcinogenic agents, such as chemotherapy, could not be distinguished from any risk associated with growth factor support. However, the enhanced delivery of chemotherapy dose intensity enabled by the use of G-CSF in these studies was associated with a significant reduction in all-cause mortality. Although some reduction in treatment-related mortality with G-CSF support may occur, the observed improvement in long-term survival likely relates to better disease control with more-intense G-CSF–supported chemotherapy. Myeloid growth factors have also been shown to benefit patients with severe chronic neutropenia. Almost all patients with cyclic, congenital, or idiopathic neutropenia experience response to G-CSFs. Treatment is titrated to determine a dose that provides a safe elevation in neutrophil counts. Reports have shown that patients can be maintained for years at the same dose after adjusting for growth and development. In congenital neutropenia, the inherent risk of developing myelodysplastic syndromes or AML requires careful monitoring, including routine blood counts and annual bone marrow examinations.

Survival benefit of additional surgery after non-curative endoscopic resection in patients with early gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 106-106
Author(s):  
Keun Won Ryu ◽  
Bang Wool Eom ◽  
Young-Il Kim ◽  
Kwang Hee Kim ◽  
Byung-Ho Nam ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Propensity Score ◽  
Cancer Recurrence ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
Additional Operation ◽  
Gastric Cancer Recurrence ◽  
Surgery Group ◽  
Operation Group

106 Background: The aim of this study is to compare the long-term outcomes between patients who underwent endoscopic submucosal dissection (ESD) and those who underwent surgery for early gastric cancers (EGCs) turned out to be out-of-indication of ESD. Methods: We retrospectively reviewed database on gastric cancer patient cohort who underwent ESD or surgery from 2004 to 2014. Patients whose lesions revealed to be out-of-indication for endoscopic resection after ESD or surgery were included in the analysis after 1:1 propensity score matching for baseline clinicopathologic characteristics. Overall survival (OS) and gastric cancer recurrence rates were compared between the matched ESD and surgery groups. Results: After propensity score matching, a total of 193 pairs of patients were included, and 126 pairs were ESD with additional operation group and 67 pairs were ESD without additional operation group. OS (5-year OS rates, 89.5% vs. 89.9%; P=.105) and gastric cancer recurrence rates (5-year recurrence rates, 2.6% vs. 1.6%; P=.080) were not different between the ESD and the matched surgery group. In the matched subgroups, ESD with additional operation group had comparable OS and gastric cancer recurrence rates in comparison with matched surgery group. However, ESD without additional operation group had significantly shorter OS (5-year OS rates, 76.8% vs. 86.3%; P=.032) and higher gastric cancer recurrence rates (5-year recurrence rates, 11.9% vs. 0%; P=.002) than matched surgery group. ESD without additional operation was also significant risk factor for overall mortality and gastric cancer recurrence in multivariate analyses. Conclusions: Patients who did not undergo additional operation after ESD for EGCs turned out be the out-of-indication had worse long-term outcomes. Additional operation should be recommended, when EGC was identified to be the out-of-indication after ESD.

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