Results of surgical treatment of carcinoma of papilla of Vater

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.

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Comparison of the prognosis of four different treatment strategies for acute left malignant colonic obstruction: A systematic review and network meta-analysis

10.21203/rs.3.rs-111092/v1 ◽

2020 ◽

Author(s):

Ling Tan ◽

Zi-Lin Liu ◽

Meng-Ni Ran ◽

Ling-Han Tang ◽

Yan-Jun Pu ◽

...

Keyword(s):

Meta Analysis ◽

Colonic Obstruction ◽

Treatment Strategies ◽

Long Term Results ◽

Bridge To Surgery ◽

Term Survival ◽

Malignant Colonic Obstruction ◽

Significant Difference ◽

Better Than

Abstract Background There is controversy regarding the efficacy of different treatment strategies for acute left malignant colonic obstruction. This study investigated the prognosis of several treatment strategies for acute left malignant colonic obstruction. Methods A systematic literature review and network meta-analysis were performed. Results The network meta-analysis involved 48 articles, including 8 (Randomized controlled trials) RCTs and 40 non-RCTs. Short-term results: Compared with emergency surgery (ES) strategies, colonic stent-bridge to surgery (CS-BTS) and transanal colorectal tube-bridge to surgery (TCT-BTS) strategies can significantly increase the primary anastomosis rate, CS-BTS and decompressing stoma-bridge to surgery (DS-BTS) strategies can significantly reduce mortality, and CS-BTS strategies can significantly reduce the permanent stoma rate. The hospital stay of DS-BTS is significantly longer than that of other strategies. There was no significant difference in the anastomotic leakage levels of several treatment strategies. Long-term results: The 5-year overall survival (OS) and disease-free survival (DFS) of the CS-BTS strategy and the DS-BTS strategy were significantly better than those of the ES strategy, and the 5-year OS of the DS-BTS strategy was significantly better than that of CS-BTS. The long-term survival of TCT-BTS was not significantly different from those of CS-BTS and ES. Conclusion Different preoperative decompression strategies may improve the prognosis of patients with acute left malignant colon obstruction. Comprehensive literature research, we found that timely and effective relief of intestinal obstruction would bring a better prognosis. Therefore, CS-BTS, DS-BTS and TCT-BTS are better than ES. Compared with CS-BTS and DS-BTS, CS-BTS has the risk of re-obstruction and intestinal perforation, and the long-term prognosis is slightly worse than that of DS-BTS. Without considering the length of stay and cost, DS-BTS strategy is the best choice.

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Post-Discharge Outcomes After Pancreatic Necrosectomy: A Single Institution Experience Following Endoscopic vs Open Debridement

The American Surgeon ◽

10.1177/00031348211038565 ◽

2021 ◽

pp. 000313482110385

Author(s):

Manuel Martinez ◽

Steven Medeiros ◽

James Dove ◽

Mohsen Shabahang

Keyword(s):

Necrotizing Pancreatitis ◽

Long Term Results ◽

Source Control ◽

Tertiary Referral Hospital ◽

Term Survival ◽

Pancreatic Necrosectomy ◽

Medical Comorbidities ◽

Number Of Patients ◽

Significant Difference

Background Pancreatic necrosectomy outcomes have been studied extensively; however, long-term results of these procedures have not been well characterized. Our study aimed to assess the outcomes at and after discharge for patients following necrosectomy. Methods Data from patients undergoing pancreatic necrosectomy at a single tertiary referral hospital from January 1, 2007, to June 1, 2019 were retrospectively analyzed. Patients were stratified into an open pancreatic necrosectomy (OPN) and an endoscopic pancreatic necrosectomy (EPN) group. Results Cohorts were composed of an OPN (n = 30) and EPN (n = 31) groups with a mean follow-up of 22 and 13.5 months, respectively. There was no statistically significant difference in the demographics or etiology of disease; however, the presence of severe sepsis and elevated BISAP scores was significantly higher in the OPN group (40% vs 13% p = .016, 37% vs 10% p = .012, respectively). There was no significant difference in discharge parameters or disposition other than a higher need for wound care in the OPN group (14% vs 0% p =< .0001). No significant difference in the number of patients who returned to baseline, 12-month ED visits, 12-month readmissions, medical comorbidities, or long-term survival was noted. Conclusions Previous studies have demonstrated that OPN patients have a higher severity of disease and higher inpatient mortality; however, this does not hold true once the acute phase of the illness has passed. Long-term medical comorbidities and survival of patients with necrotizing pancreatitis who endure the primary insult do not differ in long term, regardless of the debridement modality performed for source control.

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Long-term Survival Rates of Implants Supporting Overdentures

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-12-00178 ◽

2015 ◽

Vol 41 (2) ◽

pp. 173-177 ◽

Cited By ~ 10

Author(s):

José Balaguer ◽

Javier Ata-Ali ◽

David Peñarrocha-Oltra ◽

Berta García ◽

María Peñarrocha-Diago

Keyword(s):

Survival Rate ◽

Survival Rates ◽

Long Term Results ◽

Dental Arch ◽

Term Survival ◽

Lower Survival Rate ◽

Significant Difference ◽

A Prospective Study

The study aims were to evaluate survival rates of dental implants in patients wearing maxillary and mandibular overdentures in relation to age, sex, smoking, implant splinting or non-splinting, the maxilla rehabilitated, and number of implants per dental arch. This was a prospective study of patients who were completely edentulous in either mandible or maxilla or both, rehabilitated with implant-retained overdentures, with a follow-up of at least 3 years. 95 patients with 107 overdentures were supported by 360 implants were included in the study. Rehabilitations were monitored over an average of 95 ± 20.3 months (range 36–159). Implant survival in the maxilla was 91.9% and in the mandible 98.6%, representing a statistically significant difference (P < .05). Age, sex and implant splinting did not influence survival rates significantly. Smokers presented a lower survival rate. Implant numbers in the maxilla had a significant influence on survival, 100% for 6 but 85.7% for 4. Three mandibular implants achieved higher survival rates (100%) but with 2 (96.6%) or 4 (99%) survival was lower, although without significant difference. Long-term results suggest that 3-implant mandibular overdentures have an equivalent survival rate to 4-implant overdentures. In the maxilla, results showed that 6 implants may be the best treatment strategy. For smokers with fewer implants retaining the overdentures, there were higher numbers of implant failures.

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Effect of Preoperative Colonic Drainage for Obstructing Colorectal Cancer

International Surgery ◽

10.9738/intsurg-d-14-00262.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 790-796

Author(s):

Mitsugu Kochi ◽

Masashi Fujii ◽

Ken Hagiwara ◽

Hidenori Tamegai ◽

Megumu Watanabe ◽

...

Keyword(s):

Colorectal Cancer ◽

Elective Surgery ◽

Long Term Results ◽

Morbidity Rate ◽

Term Survival ◽

Significant Difference ◽

Colonic Decompression ◽

Group 2 ◽

Nasointestinal Tube

Obstructing colorectal cancer (OCRC) is believed to indicate poorer long-term survival. The purpose of this study was to compare retrospectively perioperative safety and long-term results in patients undergoing surgery for OCRC following preoperative colonic decompression with that in those undergoing elective surgery alone for nonobstructing colorectal cancer (CRC). A total of 656 consecutive CRC patients undergoing colectomy between 2001 and 2011 at our institute were eligible for inclusion in the study. The patients were divided into an OCRC group, which included 104 patients undergoing colectomy with preoperative colonic decompression, and a CRC group, which included 552 patients undergoing colectomy alone. Morbidity, mortality, and prognosis were assessed. In the OCRC group, decompression was performed by nasointestinal tube in 42 patients (40.4%), transanal tube in 15 (14.4%), and colostomy in 47 (45.2%). The mortality rate was 0% in the OCRC group and 0.4% in the CRC group (2 of 552 patients). The morbidity rate was 44.8% in the OCRC group (48 of 104 patients) and 36.6% in the CRC group (202 of 552 patients). The 5-year overall survival rate was 69.5% in the OCRC group and 72.9% in the CRC group [hazard ratio 0.76; 95% confidence interval, 0.35 to 1.16; P = 0.48)]. No statistically significant difference in survival was observed between the 2 groups in stage II, III, or IV, or overall. No difference was observed in safety or survival between advanced OCRC patients undergoing preoperative colonic decompression and advanced non-obstructing CRC patients undergoing surgery alone.

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Should Left Ventricular Assist Devices be Implanted in Patients Seventy Years of Age and Older: A Comparative Analysis

The Heart Surgery Forum ◽

10.1532/hsf98.2014386 ◽

2014 ◽

Vol 17 (4) ◽

pp. 182 ◽

Cited By ~ 5

Author(s):

Jeffrey A. Morgan ◽

Hassan W. Nemeh ◽

Gaetano Paone

Keyword(s):

Left Ventricular ◽

Ventricular Assist Devices ◽

Long Term Results ◽

Circulatory Support ◽

Left Ventricular Assist Devices ◽

Term Survival ◽

Ventricular Assist ◽

Significant Difference ◽

Left Ventricular Assist

Background: We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age.Methods: From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ?70 years of age. Patients in the age group ?70 years were compared to the group of patients < 70 years for perioperative mortality, long-term survival and incidence of postoperative complications.Results: Mean age was 72.2 � 2.3 (70-75) years for the older group and 52.8 � 11.4 (18-69) years for the younger group (P < .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS).Conclusions: These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. Results support the use of long-term mechanical circulatory support in carefully selected elderly patients.

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Factors affecting postoperative survival of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

10.21203/rs.2.18119/v3 ◽

2020 ◽

Author(s):

Tetsuro Ohba ◽

Hiroshi MD Yokomi ◽

Kensuke MD Koy ◽

Nobuki Tanaka ◽

Kotaro Oda ◽

...

Keyword(s):

Serum Albumin ◽

Surgical Procedures ◽

Vertebral Fractures ◽

Spinal Surgery ◽

Postoperative Mortality ◽

Term Survival ◽

Kaplan Meier ◽

Osteoporotic Vertebral Fractures ◽

Significant Difference

Abstract Background: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a long-term risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine long-term mortality. Methods: We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of £ 3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL. Results: The mean follow-up time for survival was 4.1 ±0.8 years. Two years after surgery, 15% of patients with OVF had died. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. Multivariate analysis revealed that only serum albumin £3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF. Conclusions: Preoperative hypoalbuminemia was associated with long-term postoperative mortality following surgery for OVF.

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Factors affecting postoperative survival of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

10.21203/rs.2.18119/v1 ◽

2019 ◽

Author(s):

Tetsuro Ohba ◽

Hiroshi MD Yokomi ◽

Kensuke MD Koy ◽

Nobuki Tanaka ◽

Kotaro Oda ◽

...

Keyword(s):

Serum Albumin ◽

Surgical Procedures ◽

Vertebral Fractures ◽

Spinal Surgery ◽

Postoperative Mortality ◽

Term Survival ◽

Kaplan Meier ◽

Osteoporotic Vertebral Fractures ◽

Significant Difference

Abstract Background: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a long-term risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. To evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine long-term mortality. Methods: We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Morbidity was estimated using the Kaplan-Meier method and a log-rank test. To determine which risk factors led to death among the OVF cases, the preoperative backgrounds of patients were analyzed. Kaplan-Meier curves were used to estimate survival based on the preoperative albumin levels of ≤3.5 g/dL (hypoalbuminemia) versus >3.5 mg/dL. Results: The mean follow-up for survival was 4.1 ±0.8 years. Two years after surgery, 15% of patients with OVF had died. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. Multivariate analysis revealed that only serum albumin ≤3.5 g/dL was a significant risk factor for long-term postoperative mortality of people with OVF. Conclusions: Preoperative hypoalbuminemia was associated with long-term postoperative mortality following surgery for OVF.

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Factors affecting postoperative survival of patients with insufficient union following osteoporotic vertebral fractures and impact of preoperative serum albumin on mortality

10.21203/rs.2.18119/v2 ◽

2020 ◽

Author(s):

Tetsuro Ohba ◽

Hiroshi MD Yokomi ◽

Kensuke MD Koy ◽

Nobuki Tanaka ◽

Kotaro Oda ◽

...

Keyword(s):

Serum Albumin ◽

Surgical Procedures ◽

Vertebral Fractures ◽

Spinal Surgery ◽

Postoperative Mortality ◽

Term Survival ◽

Kaplan Meier ◽

Osteoporotic Vertebral Fractures ◽

Significant Difference

Abstract Background: Numerous comparative studies of surgical procedures have focused on clinical and radiographical outcomes, as well as the effect of bone fragility on the outcome of spinal surgery; however, insights concerning a long-term risk of mortality or morbidity have been limited. Additionally, the effect of surgical therapy on survival after vertebral compression fractures remains controversial. Our aim was to evaluate the preoperative factors that affected the long-term survival of patients who underwent spinal surgery for an insufficient union following osteoporotic vertebral fractures (OVF) and to determine long-term mortality.Methods: We retrospectively reviewed the cases of 105 consecutive patients who underwent spinal surgery for OVF. Mortality was estimated using the Kaplan-Meier method and a log-rank test. The preoperative backgrounds of patients were analyzed to determine which risk factors led to death among the OVF cases. Kaplan-Meier curves were used to estimate survival based on preoperative albumin levels of £ 3.5 g/dL (hypoalbuminemia) versus > 3.5 mg/dL.Results: The mean follow-up time for survival was 4.1 ±0.8 years. Two years after surgery, 15% of patients with OVF had died. The ratio of male-to-female was significantly higher for patients with OVF who died than for those who were still alive. No significant difference in mortality was observed among surgical procedures for OVF. Multivariate analysis revealed that only serum albumin £3.5 g/dL was a significant risk factor for long-term postoperative mortality of patients with OVF.Conclusions: Preoperative hypoalbuminemia was associated with long-term postoperative mortality following surgery for OVF.Level of Evidence: Level 3

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Surgical reconstruction for unilateral iliac artery lesions in patients younger than 50 years

VASA ◽

10.1024/0301-1526/a000151 ◽

2011 ◽

Vol 40 (6) ◽

pp. 474-481 ◽

Cited By ~ 1

Author(s):

Radak ◽

Babic ◽

Ilijevski ◽

Jocic ◽

Aleksic ◽

...

Keyword(s):

Diabetes Mellitus ◽

Limb Salvage ◽

Iliac Artery ◽

Graft Patency ◽

Long Term Results ◽

Surgical Reconstruction ◽

Safe Procedure ◽

Term Survival

Background: To evaluate safety, short and long-term graft patency, clinical success rates, and factors associated with patency, limb salvage and mortality after surgical reconstruction in patients younger than 50 years of age who had undergone unilateral iliac artery bypass surgery. Patients and methods: From January 2000 to January 2010, 65 consecutive reconstructive vascular operations were performed in 22 women and 43 men of age < 50 years with unilateral iliac atherosclerotic lesions and claudication or chronic limb ischemia. All patients were followed at 1, 3, 6, and 12 months after surgery and every 6 months thereafter. Results: There was in-hospital vascular graft thrombosis in four (6.1 %) patients. No in-hospital deaths occurred. Median follow-up was 49.6 ± 33 months. Primary patency rates at 1-, 3-, 5-, and 10-year were 92.2 %, 85.6 %, 73.6 %, and 56.5 %, respectively. Seven patients passed away during follow-up of which four patients due to coronary artery disease, two patients due to cerebrovascular disease and one patient due to malignancy. Limb salvage rate after 1-, 3-, 5-, and 10-year follow-up was 100 %, 100 %, 96.3 %, and 91.2 %, respectively. Cox regression analysis including age, sex, risk factors for vascular disease, indication for treatment, preoperative ABI, lesion length, graft diameter and type of pre-procedural lesion (stenosis/occlusion), showed that only age (beta - 0.281, expected beta 0.755, p = 0.007) and presence of diabetes mellitus during index surgery (beta - 1.292, expected beta 0.275, p = 0.026) were found to be significant predictors of diminishing graft patency during the follow-up. Presence of diabetes mellitus during index surgery (beta - 1.246, expected beta 0.291, p = 0.034) was the only variable predicting mortality. Conclusions: Surgical treatment for unilateral iliac lesions in patients with premature atherosclerosis is a safe procedure with a low operative risk and acceptable long-term results. Diabetes mellitus and age at index surgery are predictive for low graft patency. Presence of diabetes is associated with decreased long-term survival.

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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.

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