Gland surgery最新文献

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The state of robotic vs. open pancreatoduodenectomy. 机器人胰十二指肠切除术与开腹胰十二指肠切除术的现状。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-20 DOI: 10.21037/gs-24-182
Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara
{"title":"The state of robotic <i>vs.</i> open pancreatoduodenectomy.","authors":"Kosei Takagi, Tomokazu Fuji, Kazuya Yasui, Motohiko Yamada, Takeyoshi Nishiyama, Yasuo Nagai, Noriyuki Kanehira, Toshiyoshi Fujiwara","doi":"10.21037/gs-24-182","DOIUrl":"https://doi.org/10.21037/gs-24-182","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1344-1348"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The use of prophylactic infusion of calcium gluconate compared to placebo in reducing the rate of early hypocalcaemia after total thyroidectomy: a double-blinded, randomized controlled trial. 与安慰剂相比,预防性输注葡萄糖酸钙可降低甲状腺全切除术后早期低钙血症的发生率:一项双盲随机对照试验。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-24-190
Kah Seng Khoo, Audrey Yeo, Muhammad Ridwan Bin Mirzan Asfian, Khoon Leong Ng
{"title":"The use of prophylactic infusion of calcium gluconate compared to placebo in reducing the rate of early hypocalcaemia after total thyroidectomy: a double-blinded, randomized controlled trial.","authors":"Kah Seng Khoo, Audrey Yeo, Muhammad Ridwan Bin Mirzan Asfian, Khoon Leong Ng","doi":"10.21037/gs-24-190","DOIUrl":"https://doi.org/10.21037/gs-24-190","url":null,"abstract":"<p><strong>Background: </strong>Hypocalcaemia as a common complication after total thyroidectomy [23-40% in University Malaya Medical Centre (UMMC)] and could result in prolonged hospital stay. We compared the early hypocalcaemia rate between prophylactic infusion of calcium and placebo among post total thyroidectomy patients and to establish whether prophylactic intravenous infusion of calcium reduces the rate of hypocalcaemia in the first 48 hours after surgery.</p><p><strong>Methods: </strong>Patients undergoing elective total thyroidectomy in UMMC between June 2020-May 2022, were recruited and randomized to receive placebo or prophylactic calcium infusion. Both groups of patients received same dosages of post-operative prophylactic vitamin D and oral calcium. Early hypocalcaemia (within 48 hours) rate after surgery was the primary outcome and duration of hospital stay was the secondary outcome. The data collected was analysed using per-protocol analysis.</p><p><strong>Results: </strong>Thirty-four patients were randomized equally (1:1) into both arms. No differences in the early hypocalcaemia rate between the intervention and placebo arms (0% <i>vs.</i> 5.8%, P>0.05). The median serum calcium levels were comparable between the intervention and placebo arms at 6 hours (2.33 <i>vs.</i> 2.37 mmol/L, P=0.59) and 48 hours (2.26 <i>vs.</i> 2.23 mmol/L, P=0.19) post-surgery. However, the median serum calcium level at 24 hours was statistically significantly higher in the intervention arm than the placebo arm (2.31 <i>vs.</i> 2.22 mmol/L, P=0.02). Similar duration of hospital stay between the both groups (2 <i>vs.</i> 2 days, P=0.81).</p><p><strong>Conclusions: </strong>Routine prophylactic calcium infusion with oral calcium and vitamin D does not diminish the rate of early symptomatic hypocalcaemia post total thyroidectomy in a low-risk group. However, its usefulness needs to be further assessed in a large scale randomized controlled trial (RCT) incorporating more bigger population.</p><p><strong>Trial registration: </strong>Registered on ClinicalTrials.gov (NCT04491357).</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1378-1386"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Efficacy of intermittent pneumatic compression on breast cancer-related upper limb lymphedema: a systematic review and meta-analysis in clinical studies. 间歇性气压疗法对乳腺癌相关上肢淋巴水肿的疗效:临床研究的系统回顾和荟萃分析。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-24-123
Shengqun Hou, Yun Li, Weiwu Lu, Xiaoju Zhang, Huiyu Luo, Jiajia Qiu, Zhenqi Lu
{"title":"Efficacy of intermittent pneumatic compression on breast cancer-related upper limb lymphedema: a systematic review and meta-analysis in clinical studies.","authors":"Shengqun Hou, Yun Li, Weiwu Lu, Xiaoju Zhang, Huiyu Luo, Jiajia Qiu, Zhenqi Lu","doi":"10.21037/gs-24-123","DOIUrl":"https://doi.org/10.21037/gs-24-123","url":null,"abstract":"<p><strong>Background: </strong>Complete decongestive therapy (CDT) and intermittent pneumatic compression (IPC) are the most common combination of treatments in breast cancer-related upper limb lymphedema. The effects of IPC as an addition to CDT are inconsistent in different studies. This meta-analysis aimed to explore whether IPC could bring additional benefits to CDT.</p><p><strong>Methods: </strong>Literatures were retrieved from databases with full-text publications ranging from January 1995 to March 2024. Fixed-effect models were applied to subsequent analysis if no heterogeneity was detected by using the Inverse formula. Publication bias was assessed using the Begg's test and Eagger's test.</p><p><strong>Results: </strong>Twelve studies were finally included for further analysis. Results showed that additional application of IPC to CDT could further improve lymphedema within 4 weeks after the treatment period [standard mean difference (SMD) =-0.2 mL, 95% confidence interval (CI): -0.33 to -0.07 mL]. However, this additional benefit was weakened within about 9.4±2.6 weeks' follow-up duration after ceasing physical therapy (SMD =-0.15 mL, 95% CI: -0.33 to 0.04 mL).</p><p><strong>Conclusions: </strong>Periodically continuous treatment should be suggested to maintain the effect of CDT + IPC to promote lymph drainage and lymphedema improvement. Nonetheless, the treatment involved in the studies ranged from 4 to 12 weeks, therefore potential bias might exist.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1358-1369"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microsurgical breast reconstruction in the United States: a narrative review of the current state. 美国的显微外科乳房再造:现状回顾。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-20 DOI: 10.21037/gs-24-63
Ambika Menon, Ciara A Brown, Albert Losken, Gabriela Del Pilar Garcia Nores
{"title":"Microsurgical breast reconstruction in the United States: a narrative review of the current state.","authors":"Ambika Menon, Ciara A Brown, Albert Losken, Gabriela Del Pilar Garcia Nores","doi":"10.21037/gs-24-63","DOIUrl":"https://doi.org/10.21037/gs-24-63","url":null,"abstract":"<p><strong>Background and objective: </strong>Breast reconstruction with microsurgical techniques allows for autologous reconstruction after mastectomy without the complications associated with alloplastic reconstruction. Autologous reconstruction has undergone significant improvement and now offers patients a variety of options depending on patient specific factors and aesthetic outcomes. This review aims to focus on the history of autologous reconstruction, operative considerations, general surgical techniques for flaps, and indications for choosing the ideal free tissue transfer for all medical specialties and not only plastic surgeons.</p><p><strong>Methods: </strong>A comprehensive review of the literature was performed using PubMed and Embase databases. Manuscripts that provided objective data with respect to history of microsurgical options, surgical techniques, patient considerations, and contraindications were utilized for this review with the objective to simplify data for all non-plastic surgeon readers.</p><p><strong>Key content and findings: </strong>In this study, we find that patient selection is critical in successful outcomes for microsurgical breast reconstruction. We find that abdominal free flaps are now considered gold standard for autologous reconstruction. However, reliable alternatives exist for patients who are not considered ideal candidates for this reconstruction. These include thigh-based flaps such as gracilis myocutaneous flaps, profunda artery perforator flaps, lateral thigh perforator flaps and trunk-based flaps such as lumbar artery perforator flap. Postoperative considerations involve clinical monitoring and enhanced recovery after surgery. The rate of reconstructive success and flap viability is greater that 95%, even in high-risk populations, and therefore risk stratification should be performed based on an individual basis. While there are no absolute contraindications to autologous reconstruction, relative contraindications do exist including obesity and elderly populations due to the increased surgical and medical complications.</p><p><strong>Conclusions: </strong>While implant-based reconstruction remains the predominant method of breast reconstruction in the United States, there have been many exciting advancements in autologous reconstruction that offers high aesthetic outcomes and patient satisfaction.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1535-1551"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Omission of axillary surgery in cN0, postmenopausal ER-positive/HER2-negative breast cancer patients undergoing breast-conserving treatment. 对接受保乳治疗的 cN0、绝经后 ER 阳性/HER2 阴性乳腺癌患者不进行腋窝手术。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-24-146
Yeonjoo Kwon, Jihe Lim, Boram Ha, Sanghwa Kim, Jung Ho Park, Young Ah Lim, Hee-Joon Kang, Doyil Kim, Janghee Lee
{"title":"Omission of axillary surgery in cN0, postmenopausal ER-positive/HER2-negative breast cancer patients undergoing breast-conserving treatment.","authors":"Yeonjoo Kwon, Jihe Lim, Boram Ha, Sanghwa Kim, Jung Ho Park, Young Ah Lim, Hee-Joon Kang, Doyil Kim, Janghee Lee","doi":"10.21037/gs-24-146","DOIUrl":"https://doi.org/10.21037/gs-24-146","url":null,"abstract":"<p><strong>Background: </strong>Previous clinical trials have diminished the significance of lymph node (LN) metastasis and axillary surgery in breast cancer, particularly in cN0, postmenopausal estrogen receptor (ER)-positive/human epidermal growth factor receptor 2 (HER2)-negative patients undergoing breast-conserving treatment (BCT). We assessed the replacement of axillary surgery with preoperative imaging modalities by analyzing the proportion of high nodal burden (HNB) patients with ≥3 LN metastases in these patients.</p><p><strong>Methods: </strong>We retrospectively identified 333 cN0, postmenopausal ER-positive/HER2-negative breast cancer patients who underwent BCT in two hospitals between January 2003 and December 2017. The proportion of LN metastasis patients and the number of metastatic LN were investigated. Risk factors of LN metastasis were analyzed and recurrence-free survival (RFS) was compared.</p><p><strong>Results: </strong>Axillary surgery confirmed LN metastasis in 81 (24.3%) of the cN0 patients. The clinical tumor size (cT) and age were factors associated with LN metastasis [cT: odds ratio (OR), 2.92, 95% confidence interval (CI): 1.69-5.05, P<0.001; age: OR, 0.33, 95% CI: 0.11-0.99, P=0.048]. However, HNB patients with ≥3 LN metastases were 15 (4.5%) of all the patients. There was statistically significant difference in the incidence of HNB between patients with cT1 tumors (3.6%) and those with cT2 tumors (7.4%) (P<0.001).</p><p><strong>Conclusions: </strong>In cN0, postmenopausal ER-positive/HER2-negative patients who underwent BCT, patients with cT1 tumors had lower rate of LN metastasis, and there were fewer instances of HNB. Therefore, in these patients, omission of axillary surgery including SLNB can be carefully considered.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1408-1417"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A comparison of ondansetron in preventing postoperative nausea and vomiting for patients with or without preoperative anxiety with painless egg retrieval: a prospective, randomized, controlled trial. 比较昂丹司琼对有无术前焦虑的无痛取卵患者预防术后恶心和呕吐的作用:一项前瞻性随机对照试验。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-12 DOI: 10.21037/gs-24-175
Ying Mou, Wei Zhao, Weizhou Pan, Xinnan Li, Manyun Sun, Yun Bo, Yanhua Zhao, Yaoshen Hu, Jun Peng, Cristian Deana, Alexander Kaserer, Koji Ishii, Liu Yang, Hua Jin
{"title":"A comparison of ondansetron in preventing postoperative nausea and vomiting for patients with or without preoperative anxiety with painless egg retrieval: a prospective, randomized, controlled trial.","authors":"Ying Mou, Wei Zhao, Weizhou Pan, Xinnan Li, Manyun Sun, Yun Bo, Yanhua Zhao, Yaoshen Hu, Jun Peng, Cristian Deana, Alexander Kaserer, Koji Ishii, Liu Yang, Hua Jin","doi":"10.21037/gs-24-175","DOIUrl":"https://doi.org/10.21037/gs-24-175","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patients undergoing painless egg retrieval are prone to preoperative anxiety, and whether preoperative anxiety induces postoperative nausea and vomiting (PONV) is debated. The primary objective of this prospective, randomized, controlled study was to compare the clinical effect of ondansetron in preventing PONV for patients with and without preoperative anxiety. The secondary objective was to investigate whether preoperative anxiety was associated with PONV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The self-rating anxiety scale (SAS) was used to assess the anxiety patients undergoing painless egg retrieval. Patients with a SAS standard score of 50-60 were selected to the anxiety group (n=105); and patients with a SAS standard score of 25-35 were assigned to the non-anxiety group (n=104). Venous blood samples of both groups of patients were obtained during admission and 1 hour after surgery, and all serotonin (5-HT) levels were tested using an enzyme-linked immunosorbent assay. The anxiety group was then randomly assigned into two subgroups: ondansetron (AO group, n=53) and placebo saline (AS group, n=52). Similarly, patients in the non-anxiety group were also randomly assigned to one of two subgroups: ondansetron (NO group, n=51) and placebo saline (NS group, n=53). The AO and NO groups received 8 mg (4 mL) of intravenous ondansetron 15 minutes before surgery, while the AS and NS groups received an equivalent volume (4 mL) of normal saline. We then analyzed the vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, incidences of nausea and vomiting in 24 hours after surgery, serum 5-HT level before and after surgery, other adverse responses, pain scores, and satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 200 patients eventually completed this study. The serum 5-HT values in the anxiety group were higher before and after surgery than in the non-anxiety group (P&lt;0.05), but there was no significant difference in serum 5-HT before and after surgery in the same group (P&gt;0.05). The incidence of PONV was more significant in the AS group than in the NS group (P&lt;0.05). The incidence of PONV was also higher in the AS group than in the AO group (P&lt;0.05). Still, there was no statistically significant difference between the NO and NS groups (P&gt;0.05). There were no significant differences between the four groups in vital signs, risk factors for nausea and vomiting, intraoperative anesthetic doses, other adverse responses and pain scores (P&gt;0.05). Patients in the AS group had lower satisfaction scores than those in the other three groups (P&lt;0.05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Patients experiencing preoperative anxiety have a greater risk of PONV following painless egg retrieval compared to those without preoperative anxiety. Ondansetron can reduce the occurrence of PONV in patients with preoperative anxiety, but it has no discernible preventative effect in non-anxious patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;T","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1522-1534"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Near-infrared fluorescence imaging plus indocyanine green fluorescence in patients undergoing a total thyroidectomy and central neck lymph node dissection: is it worth it? 对接受甲状腺全切除术和颈部中央淋巴结清扫术的患者进行近红外荧光成像和吲哚菁绿荧光成像:值得吗?
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-22 DOI: 10.21037/gs-24-181
Natalie M Liu, Claire Graves, Michael Campbell
{"title":"Near-infrared fluorescence imaging plus indocyanine green fluorescence in patients undergoing a total thyroidectomy and central neck lymph node dissection: is it worth it?","authors":"Natalie M Liu, Claire Graves, Michael Campbell","doi":"10.21037/gs-24-181","DOIUrl":"https://doi.org/10.21037/gs-24-181","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1341-1343"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Two step procedures: sequels are never any good. 两步程序:续集从来都不是什么好东西。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-24-229
Christian Sisó, Isabel T Rubio
{"title":"Two step procedures: sequels are never any good.","authors":"Christian Sisó, Isabel T Rubio","doi":"10.21037/gs-24-229","DOIUrl":"https://doi.org/10.21037/gs-24-229","url":null,"abstract":"","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1336-1340"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Current status of prepectoral breast reconstruction in Argentina. 阿根廷胸前乳房再造的现状。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-23-291
Alberto Rancati, Claudio Angrigiani, Gonzalo Lamas, Agustin Rancati, Valeria Berrino, Karen Barbosa, Julio Dorr, Marcelo Irigo
{"title":"Current status of prepectoral breast reconstruction in Argentina.","authors":"Alberto Rancati, Claudio Angrigiani, Gonzalo Lamas, Agustin Rancati, Valeria Berrino, Karen Barbosa, Julio Dorr, Marcelo Irigo","doi":"10.21037/gs-23-291","DOIUrl":"https://doi.org/10.21037/gs-23-291","url":null,"abstract":"<p><p>Breast cancer is among the most common cancers diagnosed in women, affecting one in eight women per year. Immediate implant-based breast reconstruction has emerged as the predominant approach for postmastectomy reconstruction, with a growing preference for the direct-to-implant (DTI) method over the traditional tissue expander technique. While conventionally, implants were typically positioned beneath the pectoralis major muscle, recent advancements have paved the way for implant placement above the muscle, in the prepectoral plane. Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) techniques can be combined with prepectoral breast reconstruction. The presence of sufficient fatty tissue coverage is considered one of the foremost independent factors influencing the success of immediate breast reconstruction and flap viability. DTI is a safe approach for prepectoral implant-based reconstruction with a number of advantages. However, careful patient selection and judicious assessment of flap perfusion help identify an appropriate subset of patients for prepectoral DTI reconstruction. Proposed breast tissue coverage classification (BTCC) and rigorous perfusion assessment techniques will aid to minimize postoperative complications and reconstruction failure. Based on the obtained range of coverage values (distance between the Cooper's ligaments and the skin) of preoperative digital mammogram evaluation, a three-type BTCC is as follows: Type 1: <1 cm (poor coverage), Type 2: between 1 and 2 cm (medium coverage), Type 3: >2 cm (good coverage). Prepectoral DTI reconstruction provides good results with complication rates similar to those of subpectoral techniques, eliminating breast animation. A meticulous surgical technique is essential to preserve the vascular network that guarantees the survival of the skin flap and nipple-areola complex (NAC). In the good coverage group (Type 3), an immediate DTI reconstruction could be safely performed. Aesthetic complications as rippling can occur if prepectoral implants are placed in Type 1 patients. Preoperative planning for prepectoral placement should not depend on breast volume, but on breast tissue coverage. Flap evaluation based on preoperative imaging measurements may be helpful when planning a conservative mastectomy. Patient selection, preoperative and intraoperative mastectomy flap evaluation, and modifications in implant technology play a critical role in this new and rapidly growing method for implant-based breast reconstruction.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1552-1560"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The effect of total thyroidectomy and radioactive iodine on long-term survival in unilateral T3/T4 follicular thyroid carcinoma: insights from a propensity-matched retrospective analysis. 甲状腺全切除术和放射性碘对单侧 T3/T4 滤泡性甲状腺癌长期生存的影响:倾向匹配回顾性分析的启示。
IF 1.5 3区 医学
Gland surgery Pub Date : 2024-08-31 Epub Date: 2024-08-28 DOI: 10.21037/gs-24-231
Yuhui Liu, Mengwei Zhang, Yutang Miao, Tong Chen, Tingting Meng, Tao Zhang
{"title":"The effect of total thyroidectomy and radioactive iodine on long-term survival in unilateral T3/T4 follicular thyroid carcinoma: insights from a propensity-matched retrospective analysis.","authors":"Yuhui Liu, Mengwei Zhang, Yutang Miao, Tong Chen, Tingting Meng, Tao Zhang","doi":"10.21037/gs-24-231","DOIUrl":"https://doi.org/10.21037/gs-24-231","url":null,"abstract":"<p><strong>Background: </strong>Follicular thyroid carcinoma (FTC) is the second most common thyroid malignancy and is particularly aggressive in advanced stages such as T3 and T4. This retrospective study aimed to evaluate the long-term survival outcomes of total thyroidectomy (TT) and radioactive iodine therapy (RAIT) in unilateral T3 or T4 FTC using propensity score-matched analysis.</p><p><strong>Methods: </strong>Utilizing the Surveillance, Epidemiology, and End Results (SEER) database, we identified patients diagnosed with T3 or T4 FTC and categorized them into two cohorts, namely those who were treated with TT and those who were not (non-TT). The non-TT group was further analyzed to determine the impact of RAIT on survival. Propensity score matching (PSM) was applied to adjust for confounding variables. Survival analysis, including Kaplan-Meier survival curves and landmark analysis, evaluated the effects on overall survival (OS) and cancer-specific survival (CSS).</p><p><strong>Results: </strong>A total of 2,957 patients were included, with 2,271 (76.8%) undergoing TT and 686 (23.2%) receiving alternative treatments. Before and after PSM, there were no significant differences in OS and CSS between the two groups. Post-PSM landmark analysis revealed that beyond 90 months, the TT group had superior CSS compared with the non-TT group (P=0.06). Cox multivariate regression identified follicular adenocarcinoma trabecular [hazard ratio (HR) =4.7041; 95% confidence interval (CI): 1.1218-19.727] and minimally invasive follicular carcinoma (HR =2.0202; 95% CI: 1.2140-3.362) as independent risk factors affecting prognosis. In the second part of the study, 671 patients were analyzed, namely 197 (29.4%) who received RAIT and 474 (70.6%) who did not. Landmark analysis indicated that after 30 months, the RAIT group had superior CSS compared with the non-RAIT group (P<0.05).</p><p><strong>Conclusions: </strong>TT does not improve the survival rates of patients with stage T3/T4 FTC. For those patients who have not undergone TT, RAIT proves beneficial for CSS; however, further in-depth studies are required.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"13 8","pages":"1477-1493"},"PeriodicalIF":1.5,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142284297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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