ISRN surgery最新文献

{"title":"Factors related to long-term survival in patients affected by well-differentiated endocrine tumors of the pancreas.","authors":"Riccardo Casadei,&nbsp;Claudio Ricci,&nbsp;Paola Tomassetti,&nbsp;Davide Campana,&nbsp;Francesco Minni","doi":"10.5402/2012/389385","DOIUrl":"https://doi.org/10.5402/2012/389385","url":null,"abstract":"<p><p>Aim. To identify factors related to survival in patients affected by well-differentiated PETs (benign, uncertain behavior, and carcinoma) who underwent R0 pancreatic resection. Methods. Retrospective study of 74 consecutive patients followed up from January 1980 to December 2011. Prognostic factors were sex, age, type of tumor, presence of symptoms, type of surgical procedure, size of tumor, lymph nodes status, WHO classification, and TNM stage. Overall survival was evaluated using the Kaplan-Meier method. Cox regression analyses were used to identify the factors associated with prognosis in univariate and multivariate analysis. Results. The mean follow-up of all the patients was 106 ± 89 months. The 5-10-year long-term survival was 90.9% and 79.1%, respectively. At univariate analysis, patient age <55 years was significantly related to a better long-term survival compared to patients age ≥55 years (307 ± 15 months versus 192 ± 25 months; P = 0.010). Multivariate analysis showed that female gender (P = 0.006), patients without comorbidities (P = 0.033), and patients affected by well-differentiated benign pancreatic endocrine tumors (P = 0.008 and P = 0.002 in relation to tumors with uncertain behavior and carcinomas, resp.) were factors significantly related to a better long-term survival. Conclusions. Patients factors were strongly related to a better long-term survival in patients observed. WHO classification is a very useful prognostic tool for well-differentiated PETs.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"389385"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/389385","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30774994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Resection for Small Cell Lung Cancer: Pneumonectomy versus Lobectomy.","authors":"Jiang Yuequan, Zhang Zhi, Xie Chenmin","doi":"10.5402/2012/101024","DOIUrl":"10.5402/2012/101024","url":null,"abstract":"<p><p>Background. There are some patients with SCLC that are diagnosed in the operating room by cryosection and surgeons had to perform surgical resection for these patients. The aim of this study is to compare the effective of pneumonectomy with lobectomy for SCLC. Methods. A retrospective study was undertaken in 75 patients with SCLC that were diagnosed by cryosection during surgery. 31 of them underwent pneumonectomy, 44 underwent lobectomy. Local recurrence rate and survival rate according to surgical procedures and cancer stages were analyzed. Results. There was significant difference in the overall survival rate between lobectomy and pneumonectomy groups (P = 0.044). For patients with stage II SCLC, the overall survival rate after pneumonectomy was significantly better than after lobectomy (P = 0.028). No significant difference in overall survival rate was found between the two surgical groups in patients with stage III SCLC (P = 0.933). The local recurrence rate in lobectomy group was significant higher that in pneumonectomy group (P = 0.0017). Conclusions. SCLC was responsive to surgical therapy. When surgeons have to select an appropriate method of operation for patients with SCLC during surgery, pneumonectomy may be the right choice for these patients. Pneumonectomy can result in significantly better local control and higher survival rate compare with lobectomy.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"101024"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3369481/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30692551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative Prognostic Value of Human Epidermal Growth Factor Receptor 2 (HER2) Expression in Operable Oesophagogastric Cancer.","authors":"David S Y Chan,&nbsp;Fiona Campbell,&nbsp;Paul Edwards,&nbsp;Bharat Jasani,&nbsp;Geraint T Williams,&nbsp;Wyn G Lewis","doi":"10.5402/2012/804891","DOIUrl":"https://doi.org/10.5402/2012/804891","url":null,"abstract":"<p><p>Aims. The aim of this study was to determine the prognostic significance of HER2 receptor expression in operable oesophagogastric adenocarcinoma. Methods. Eighty-five consecutive patients diagnosed with oesophagogastric adenocarcinoma [18 oesophageal (OC), 32 junctional (JC) and 35 gastric (GC)] undergoing potentially curative resection were studied retrospectively. Immunohistochemistry was used to determine HER2 status at endoscopic biopsy and resection specimen. The primary outcome measure was survival. Results. Twenty (24%) patients had HER2 positive tumours which was commoner in JC (14/32, 44% versus 2/18, 11% in OC and 4/35, 11% in GC, P = 0.003). The sensitivity, specificity, positive and negative predictive values of HER2 status at endoscopic biopsy were 56%, 93%, 63%, 91% respectively (weighted Kappa = 0.504, P < 0.0001). Five-year survival in OC HER2 positive negative was 100% and 36% (P = 0.167) compared with 14% and 44% (P = 0.0726) in JC and 50% and 46% (P = 0.942) in GC respectively. Conclusions. Endoscopic biopsy had a high specificity and negative predictive value in determining HER2 status. Patients with JC had a significantly higher rate of HER2 overexpression and this was associated with a nonsignificant poorer survival trend. A larger study is needed to confirm these findings because of the implications for neoadjuvant and adjuvant chemotherapy regimens.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"804891"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/804891","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30840626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stapled transanal rectal resection for the surgical treatment of obstructed defecation syndrome associated with rectocele and rectal intussusception.","authors":"Hesham M Hasan,&nbsp;Hani M Hasan","doi":"10.5402/2012/652345","DOIUrl":"https://doi.org/10.5402/2012/652345","url":null,"abstract":"<p><p>Obstructed defecation syndrome (ODS) is one of the most widespread clinical problems which frequently affects middle-aged females. There is a new surgical technique called stapled transanal rectal resection (STARR) that makes it possible to remove the anorectal mucosa circumferential and reinforce the anterior anorectal junction wall with the use of a circular stapler. This surgical technique developed by Antonio Longo was proposed as an effective alternative for the treatment of ODS. In this study we present our preliminary results with the STARR operation for the treatment of ODS. For this purpose, 40 consecutive female patients with ODS due to rectal intussusception (RI) and/or rectocele (RE) were recruited in this prospective clinical study, from May 2008 to October 2010. No major operative or postoperative complications were recorded, and after 12-month follow-up, significant improvement in the ODS score system was observed, and the symptoms of constipation improved in 90% of patients; 20% of patients judged their final clinical outcome as excellent, 55% as good, and 15% as moderate, with only 10% having poor results. After analyzing our results we can conclude that STARR is an effective and safe procedure for the treatment of obstructed defecation syndrome due to rectal intussusception and/or rectocele and can be performed safely without major morbidity.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"652345"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/652345","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30610227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central Venous Line Placement prior to Gastric Bypass Improves Operating Room Efficiency.","authors":"D Wayne Overby,&nbsp;Geoffrey P Kohn,&nbsp;Karen J Colton,&nbsp;Joseph M Stavas,&nbsp;Robert G Dixon,&nbsp;Anthony Passannante,&nbsp;Timothy M Farrell","doi":"10.5402/2012/816871","DOIUrl":"https://doi.org/10.5402/2012/816871","url":null,"abstract":"<p><p>Background. Bariatric surgery has increased across America. Venous access is difficult in these patients. Anesthesiologists often utilize valuable operating room (OR) time acquiring reliable intravenous lines. Our objective was to determine if outpatient central venous line (CVL) placement improves OR efficiency and professional reimbursement for CVL insertion. Methods. In our bariatric practice, selected surgery patients have outpatient CVLs placed during prophylactic vena cava filter placement. In a cohort of 268 gastric bypass patients operated between 1/01 and 11/06, we compared time-to-incision between 106 with pre-established CVLs and 162 without. In addition, we determined professional compensation rates for CVLs placed outpatient versus CVLs inserted in the OR. Results. Patients with preoperative (outpatient) CVLs required 35.6 ± 12.5 minutes to skin incision compared with 42.5 ± 13.9 minutes for controls (P < 0.0001), and 34.9% had skin incision in <30 minutes compared with 16.4% of controls. Radiologists collected 28.2% of outpatient billings for CPT code 36556, compared with anesthesiologists who collected <1% when placing CVLs in the OR. Conclusions. Outpatient CVLs prior to gastric bypass improve efficiency in the OR with earlier skin incision. Professional reimbursement is better for outpatient CVLs than intraoperative inpatient CVLs.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"816871"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/816871","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30787428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sentinel Lymph Node Biopsy in Pure DCIS: Is It Necessary?","authors":"D E Boler,&nbsp;N Cabioglu,&nbsp;U Ince,&nbsp;G Esen,&nbsp;C Uras","doi":"10.5402/2012/394095","DOIUrl":"https://doi.org/10.5402/2012/394095","url":null,"abstract":"Introduction. Sentinel lymph node biopsy (SLNB) in patients with pure ductal carcinoma in situ (DCIS) has been a matter of debate due to very low rate of axillary metastases. We therefore aimed to identify factors in a single institutional series to select patients who may benefit from SLNB. Material and Methods. Patients, diagnosed with pure DCIS (n = 63) between July 2000 and March 2011, were reviewed. All the sentinel lymph nodes were examined by serial sectioning (50 μm) of the entire lymph node and H&E staining, and by cytokeratin immunostaining in suspicious cases. Results. Median age was 51 (range, 30–79). Of 63 patients, 40 cases (63.5%) with pure DCIS underwent SLN, and 2 of them had a positive SLN (5%). In both 2 cases with SLN metastases, only one sentinel lymph node was involved with tumor cells. Patients who underwent SLNB were more likely to have a tumor size >30 mm or DCIS with intermediate and high nuclear grade or a mastectomy in univariate and multivariate analyses. Conclusion. In our series, we found a slightly higher rate of SLNB positivity in patients with pure DCIS than the large series reported elsewhere. This may either be due to the meticulous examination of SLNs by serial sectioning technique or due to our patient selection criteria or both.","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"394095"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/394095","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30666732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of hypocalcemia after thyroidectomy: results from the nationwide inpatient sample.","authors":"Randall L Baldassarre,&nbsp;David C Chang,&nbsp;Kevin T Brumund,&nbsp;Michael Bouvet","doi":"10.5402/2012/838614","DOIUrl":"https://doi.org/10.5402/2012/838614","url":null,"abstract":"<p><p>Hypocalcemia is a common complication following thyroidectomy. However, the incidence of postoperative hypocalcemia varies widely in the literature, and factors associated with hypocalcemia after thyroid surgery are not well established. We aimed to identify incidence trends and independent risk factors of postoperative hypocalcemia using the nationwide inpatient sample (NIS) database from 1998 to 2008. Overall, 6,605 (5.5%) of 119,567 patients who underwent thyroidectomy developed hypocalcemia. Total thyroidectomy resulted in a significantly higher increased incidence (9.0%) of hypocalcemia when compared with unilateral thyroid lobectomy (1.9%; P < .001). Thyroidectomy with bilateral neck dissection, the strongest independent risk factor of postoperative hypocalcemia (odds ratio, 9.42; P < .001), resulted in an incidence of 23.4%. Patients aged 45 years to 84 years were less likely to have postoperative hypocalcemia compared with their younger and older counterparts (P < .001). Hispanic (P = .003) and Asian (P = .027) patients were more likely, and black patients were less likely (P = .003) than white patients to develop hypocalcemia. Additional factors independently associated with postoperative hypocalcemia included female gender, nonteaching hospitals, and malignant neoplasms of thyroid gland. Hypocalcemia following thyroidectomy resulted in 1.47 days of extended hospital stay (3.33 versus 1.85 days P < .001).</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"838614"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/838614","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30798914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast-track surgery in gynaecology and gynaecologic oncology: a review of a rolling clinical audit.","authors":"Jonathan Carter","doi":"10.5402/2012/368014","DOIUrl":"10.5402/2012/368014","url":null,"abstract":"<p><p>Clinical audit is the process by which clinicians are able to demonstrate to themselves, their patients, hospital administrators, and healthcare financial providers the outcome and safety of their clinical practice. It is a process by which the public can be assured of safety and outcomes. A fast-track surgery program was initiated in January 2008, and this paper represents a rolling clinical audit of the outcomes of that program until the end of June 2012. Three hundred and eighty-nine patients underwent fast track surgical management after having a laparotomy for suspected or confirmed gynaecological cancer. There were no exclusions and the data presented represents the practice and outcomes of all patients referred to a single gynaecological oncologist. The majority of patients were deemed to have complex surgical procedures performed usually through a vertical midline incision. One third of patients had a nonzero performance status, median weight was 68 kilograms, and median BMI was 26.5 with 31% being classified as obese. Median operating time was 2.25 hours, and the median estimated blood loss was 175 mL. Overall the median length of stay (LOS) was 3 days with 95% of patients tolerating early oral feeding. Four percent of patients required readmission, and 0.5% were required to return to the operating room. Whilst the wound infection rate was 2.6%, there were no ureteric, bowel or neurovascular injuries. Overall there were 2 bladder injuries (0.5%), and the incidence of venous thromboembolism was 1%. Subset analysis was also undertaken. Whilst a number of variables were associated with reduced LOS, on multivariate analysis, benign pathology, shorter operating time, and the ability to tolerate early oral feeding were found to be significant. The data and experience presented is the largest and most extensive reported in the literature relating to fast-track surgery in gynaecology and gynaecologic oncology. The public can be reassured of the safety and improved outcomes that can be achieved after the introduction of such a program.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"368014"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31162773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Free microsurgical and pedicled flaps for oncological mandibular reconstruction: technical aspects and evaluation of patient comorbidities.","authors":"Victor J Hassid,&nbsp;Suhair Maqusi,&nbsp;Emmett Culligan,&nbsp;Mimis N Cohen,&nbsp;Anuja K Antony","doi":"10.5402/2012/792674","DOIUrl":"https://doi.org/10.5402/2012/792674","url":null,"abstract":"<p><p>Oncologic mandibular reconstruction has changed significantly over the years and continues to evolve with the introduction of newer technologies and techniques. Patient demographic, reconstructive, and complication data were obtained from a prospectively maintained clinical database of patients who underwent head and neck reconstruction at our institution. The free fibular flap is now considered the gold standard for mandibular reconstruction. However, in patients with multiple comorbidities, lengthy procedures may be less optimal and pedicled flaps, with specific modifications, can yield reasonable outcomes. Technical aspects and comorbidity profiles are examined in the oncological mandibular reconstruction cohort.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"792674"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/792674","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30585889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the place of intersphincteric resection when operating on low rectal cancer?","authors":"Satoshi Nagayama,&nbsp;Waheeb Al-Kubati,&nbsp;Yoshiharu Sakai","doi":"10.5402/2012/585484","DOIUrl":"https://doi.org/10.5402/2012/585484","url":null,"abstract":"<p><p>Operating on low rectal cancer by performing an intersphincteric resection (ISR) with coloanal anastomosis has been adopted as an alternative to abdominoperineal excision (APE) following Schiessel et al. report in 1994, as it preserves the sphincter and avoids the need for a permanent stoma. We undertook a review of the recent literature specifically focusing on long-term oncologic and functional outcomes of ISR to evaluate whether this operation is a valid alternative to an APE. In conclusion, younger patients with T1 or T2 rectal cancers who require no preoperative therapy are ideal candidates for ISR, given that preoperative chemoradiotherapy may cause long-term severe anal dysfunction after ISR.</p>","PeriodicalId":89400,"journal":{"name":"ISRN surgery","volume":"2012 ","pages":"585484"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5402/2012/585484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30840624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}