Accuracy of BRCA1/2 Mutation Prediction Models for Different Ethnicities and Genders: Experience in a Southern Chinese Cohort.

World J Surg. 2012 Jan 31;

Authors: Kwong A, Wong CH, Suen DT, Co M, Kurian AW, West DW, Ford JM

Abstract

BACKGROUND: BRCA1/2 mutation prediction models (BRCAPRO, Myriad II, Couch, Shattuck-Eidens, BOADICEA) are well established in western cohorts to estimate the probability of BRCA1/2 mutations. Results are conflicting in Asian populations. Most studies did not account for gender-specific prediction. We evaluated the performance of these models in a Chinese cohort, including males, before BRCA1/2 mutation testing. METHODS: The five risk models were used to calculate the probability of BRCA mutations in probands with breast and ovarian cancers; 267 were non-BRCA mutation carriers (247 females and 20 males) and 43 were BRCA mutation carriers (38 females and 5 males). RESULTS: Mean BRCA prediction scores for all models were statistically better for carriers than noncarriers for females but not for males. BRCAPRO overestimated the numbers of female BRCA1/2 mutation carriers at thresholds ≥20% but underestimated if <20%. BRCAPRO and BOADICEA underestimated the number of male BRCA1/2 mutation carriers whilst Myriad II underestimated the number of both male and female carriers. In females, BRCAPRO showed similar discrimination, as measured by the area under the receiver operator characteristic curve (AUC) for BRCA1/2 combined mutation prediction to BOADICEA, but performed better than BOADICEA in BRCA1 mutation prediction (AUC 93% vs. 87%). BOADICEA had the best discrimination for BRCA1/2 combined mutation prediction (AUC 87%) in males. CONCLUSIONS: The variation in model performance underscores the need for research on larger Asian cohorts as prediction models, and the possible need for customizing these models for different ethnic groups and genders.

PMID: 22290208 [PubMed - as supplied by publisher]

Slit Versus Non-Slit Mesh Placement in Total Extraperitoneal Inguinal Hernia Repair.

World J Surg. 2012 Jan 31;

Authors: Koeckerling F, Jacob DA, Lomanto D, Chowbey P, Bittner R

PMID: 22290209 [PubMed - as supplied by publisher]

Outcome of Surgery for Primary Hyperaldosteronism.

World J Surg. 2012 Jan 28;

Authors: Liao CH, Wu V, Jeff Chueh S, Sankari BR

PMID: 22286966 [PubMed - as supplied by publisher]

Evliya Celebi’s Description of the Removal of a Musket Ball From the Brain of a Habsburg Prince: An Interesting Excerpt From the “Seyahatname”

World J Surg. 2012 Jan 28;

Authors: Bilsel Y

Abstract

In the 17th century an Ottoman traveler, Evliya Celebi, was inspired by a dream to embark on a journey across the Ottoman Empire. He traveled far and wide across Europe and North Africa and wrote extensively about his adventures in the Seyahatname. The Seyahatname, or “Book of Travels,” is the longest and most detailed travel account in Islamic (if not world) literature. It is a vast panorama of the Ottoman world in the mid-17th century. This article is concerned with Celebi’s description of several surgeries that he claimed to have witnessed in Vienna during the year 1665. He describes several procedures, the first and most detailed of which is a fascinating brain operation that seems to be a highly unusual procedure for the time. His impressions of Central European medicine, as viewed by a Muslim from the East, offer an unexplored perspective. We examine what his description tells us about the perceptions and images of surgery and medicine.

PMID: 22286967 [PubMed - as supplied by publisher]

Surgical Management of Normocalcemic Primary Hyperparathyroidism.

World J Surg. 2012 Jan 28;

Authors: Wade TJ, Yen TW, Amin AL, Wang TS

Abstract

BACKGROUND: Primary hyperparathyroidism (pHPT), typically defined as elevated serum calcium levels associated with inappropriately elevated parathyroid hormone (PTH) levels, can occur also in patients with normal serum calcium levels. This study investigated the characteristics, workup, and surgical management of patients with normocalcemic pHPT. METHODS: A retrospective chart review of a prospectively collected, single-institution parathyroid database was performed on patients with sporadic pHPT who underwent parathyroidectomy between 12/99 and 12/08. RESULTS: In all, 93 of 771 (12%) pHPT patients had normal serum calcium levels 3 months prior to surgery. Ionized calcium (iCa) levels were available for 58 patients and were elevated in 50 (86%). Among those with elevated iCa levels 90% had single-gland disease (SGD), whereas 63% with normal iCa levels had SGD (p = 0.07). Preoperative imaging identified SGD in 60% of patients with normal iCa and in 66% with elevated iCa levels. Intraoperative PTH (IOPTH) monitoring identified cure in 51 of 58 (88%) patients including 6 (75%) with normal iCa. At a median follow-up of 358 days, postoperative calcium and PTH levels were similar in the groups. One (1%) patient had recurrent disease. CONCLUSIONS: Most patients with apparent normocalcemic pHPT have elevated ionized calcium levels. For patients with normocalcemic pHPT, we recommend measuring iCa levels preoperatively, performing localization studies, and utilizing IOPTH monitoring to guide a successful operation.

PMID: 22286968 [PubMed - as supplied by publisher]

How to Manage Thyroid Nodules With Two Consecutive Non-Diagnostic Results on Ultrasonography-Guided Fine-Needle Aspiration.

World J Surg. 2012 Jan 7;

Authors: Moon HJ, Kwak JY, Choi YS, Kim EK

Abstract

BACKGROUND: The aim of this study was to investigate the factors for considering surgery on thyroid nodules that had non-diagnostic results on two consecutive cytology examinations. METHODS: A total of 104 thyroid nodules with two consecutive non-diagnostic cytology examinations in 104 patients were investigated. Nodules with one or more suspicious ultrasonography (US) features of marked hypoechogenicity, a not well defined margin, microcalcifications, or a taller-than-wide shape were assessed as sonographically suspicious. Those without any suspicious features were assessed as sonographically benign. The clinicopathologic characteristics of patients and US features of the nodules were compared according to malignancy and benignity. The odds ratio for predicting malignancy was calculated. RESULTS: Altogether, 12 nodules were malignant, and 92 were benign. Age, sex, nodule size, and solidness were not associated with malignancy (P = 0.73, 0.92, 0.48, and 0.73, respectively). The malignancy rate of sonographically suspicious nodules was 25.7%, higher than the 4.3% of sonographically benign nodules (P = 0.002). The odds ratio of sonographically suspicious nodules for predicting malignancy was 16.01 (95% confidence interval 2.36-108.54, P = 0.005). CONCLUSIONS: Based on sonographic features, surgery can be performed selectively on nodules with two consecutive non-diagnostic cytology results.

PMID: 22228400 [PubMed - as supplied by publisher]

The Life of John Wishart (1850-1926): Study of an Academic Surgical Career Prior to the Flexner Report.

World J Surg. 2012 Jan 20;

Authors: Claydon E, McAlister VC

Abstract

BACKGROUND: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario. METHODS: Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his times. RESULTS: A fragmented biography can be assembled from family notes and obituaries with the help of contemporary documents compiled by early 20th century medical school historians. Wishart assisted Abraham Groves in the first reported operation for which aseptic technique was used (1874). He was considered locally to perform pioneering surgery, including an appendectomy in 1886. Wishart was a founding member of the medical faculty at Western University in 1881, initially as Demonstrator of Anatomy and subsequently as its first Professor of Clinical Surgery, which post he held until 1910. Comprehensive notes from his undergraduate lectures demonstrate his teaching style, which mixed organized didacticism with practical advice. The role of the Flexner review in the termination of his professorship is hinted at in minutes of Faculty of Medicine meetings. Wishart was a foundation fellow of the American College of Surgeons and a founding physician of London’s Catholic hospital, St. Joseph’s, despite his own Protestant background. CONCLUSIONS: Wishart’s career comprised all the elements of modern academic surgery, including pioneering service, research, and teaching. Surgery at Western owes as much to Wishart as it does to university reorganization in response to the Flexner report.

PMID: 22270978 [PubMed - as supplied by publisher]

Morbidity and Mortality Results From a Prospective Randomized Controlled Trial Comparing Billroth I and Roux-en-Y Reconstructive Procedures After Distal Gastrectomy for Gastric Cancer.

World J Surg. 2012 Jan 20;

Authors: Imamura H, Takiguchi S, Yamamoto K, Hirao M, Fujita J, Miyashiro I, Kurokawa Y, Fujiwara Y, Mori M, Doki Y

Abstract

BACKGROUND: Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed after distal gastrectomy. Which reconstruction procedure is superior remains controversial. We conducted a randomized controlled trial to compare the clinical efficacy of B-I and R-Y. METHODS: Between August 2005 and December 2008, a total of 332 patients with potentially curable gastric cancer enrolled from 18 institutions were intraoperatively randomized to either the B-I group or the R-Y group. Postoperative morbidity and hospital mortality were recorded prospectively in a fixed format and were compared between these two groups. RESULTS: The operating time was significantly longer in the R-Y group than in the B-I group (214 vs. 180 minutes, P < 0.0001). Regarding clinical symptoms during the postoperative hospital stay, the incidence of nausea, vomiting, and discontinuance of food intake was significantly higher in the R-Y group than in the B-I group (12.4% vs. 3.7%, P = 0.0027; 8.9% vs. 3.1%, P = 0.022; and 12.4% vs. 4.3%, P = 0.0064, respectively). There was no significant difference in the overall operative morbidity rate between the R-Y and B-I groups (13.6% vs. 8.6%, respectively, P = 0.14). Anastomotic leakage occurred in two patients (1.2%) in the B-I group and in none in the R-Y group; the difference did not reach statistical significance (P = 0.09). Postoperative hospital stay was significantly longer in the R-Y group than in the B-I group (16.4 vs. 14.1 days, P = 0.019). CONCLUSIONS: We concluded that B-I reconstruction was superior to R-Y reconstruction in terms of perioperative complications.

PMID: 22270979 [PubMed - as supplied by publisher]

Partial Pathologic Response and Nodal Status as Most Significant Prognostic Factors for Advanced Rectal Cancer Treated With Preoperative Chemoradiotherapy.

World J Surg. 2012 Jan 20;

Authors: Huebner M, Wolff BG, Smyrk TC, Aakre J, Larson DW

Abstract

BACKGROUND: This study evaluated the impact of tumor regression grading (TRG) and other pathologic variates in a cohort of rectal carcinoma patients treated with neoadjuvant chemoradiotherapy (CRT). The value of a grading less than pCR for predicting survival is unknown. Tumor budding has not been systematically studied in rectal cancer after neoadjuvant therapy. METHODS: Pathologic risk factors for survival were evaluated on surgical specimens of 237 patients with stages I, II, and III rectal cancer treated between 1996 and 2006. All patients underwent preoperative CRT followed by surgical resection 6-8 weeks later. TRG, tumor grade, budding, venous invasion, radial margin, and nodal status were evaluated. The prognostic value of TRG categories was calculated with Cox regression models and validated with resampling methods. RESULTS: TRG of <25% occurred in 61 (25.7%) and a complete response in 39 (16.4%) of the resected specimens. TRG of <25% was shown to be a statistically significant predictor for cancer-specific survival (CSS) and recurrence-free survival (RFS) compared to TRG ≥25% (P = 0.013). Tumor budding was present in 24 (10.1%) of the patients and was negatively associated with CSS (P = 0.013). Lymph node involvement was observed in 83 (35.0%) patients. TRG and nodal status (P < 0.001) were the most significant predictors associated with outcome. CONCLUSION: Partial pathologic response ≥25% was a superior predictor compared to pCR for improved survival after preoperative CRT. CSS and RFS were adversely affected by the presence of lymph node metastases.

PMID: 22270980 [PubMed - as supplied by publisher]

Pediatric Non-Wilms’ Renal Tumors: A Third World Experience.

World J Surg. 2012 Jan 20;

Authors: Saula PW, Hadley GP

Abstract

BACKGROUND: Pediatric non-Wilms’ renal tumors (NWRT) are poorly understood owing to their heterogeneity and relative rarity. This study aimed at auditing the outcome of the management of NWRT in a tertiary hospital in the Third World. METHODS: Records of all patients (n = 68) treated for NWRT over a 32-year period (1978-2010) were reviewed retrospectively. RESULTS: The major histological groups included clear cell sarcoma of the kidney (CCSK) (33.8%), mesoblastic nephroma (17.6%), cystic partially differentiated nephroblastoma (CPDN) (17.6%), intrarenal neuroblastoma (8.8%), malignant rhabdoid tumor (MRT) (7.4%), and renal cell carcinoma (RCC) (5.9%). Sixteen (69.7%) patients with CCSK and 11 (91.7%) with CPDN were aged 1-4 years. Ten (83.3%) patients with mesoblastic nephroma were aged <1 year and three (60.0%) with RCC were aged 10-14 years. Ten (43.5%) patients with CCSK and four (80.0%) with RCC had metastases at diagnosis. The sensitivity of a pretreatment Tru-Cut biopsy was 100% for MRT. All the patients with CCSK, mesoblastic nephroma, CPDN, and RCC had radical nephrectomy. Only eight (34.8%) patients with CCSK received radiotherapy. The overall 1-10-year survival rates were 52.2%, 91.7%, 75.0%, 40.0% and 0.0% for CCSK, mesoblastic nephroma, CPDN, RCC, and MRT, respectively. The overall 1-10-year survival for the entire cohort was 51.5%. CONCLUSIONS: The demography and clinical presentation of pediatric NWRT, which comprises 13.6% of pediatric renal tumors in the Third World, were similar to those in the Developed World. The overall 1-10-year survival for pediatric NWRT was low.

PMID: 22270981 [PubMed - as supplied by publisher]

Validation of the “Perrier” Parathyroid Adenoma Location Nomenclature.

World J Surg. 2012 Jan 21;

Authors: Mazeh H, Stoll SJ, Robbins JB, Sippel RS, Chen H

Abstract

BACKGROUND: In 2009, the “Perrier” nomenclature was introduced to enhance communications among surgeons and specialists regarding the location of parathyroid adenomas. The purpose of this study was to validate the utility of the nomenclature in a prospective manner at a different institution. METHODS: A prospective database was created from June 2010 through January 2011 evaluating 108 consecutive patients. In each case, the location of the parathyroid adenoma according to the nomenclature was predicted individually by an attending physician and a resident based on preoperative imaging studies. A radiologist interpreted the images retrospectively. These predictions were compared to the operative findings. RESULTS: The mean age of the patients was 61 ± 1 years, and 82% were women. The distribution using the nomenclature was as follows: A (adherent to posterior thyroid capsule) 20%; B (tracheoesophageal groove) 27%; C (tracheoesophageal groove but close to the clavicle) 12%; D (directly over the recurrent laryngeal nerve) 2%; E (easy to identify, inferior thyroid pole) 35%; F (fallen into the thymus) 4%. The overall predicting accuracy was significantly higher for the attending physicians than for the residents or the radiologist (78% vs. 64% vs. 25%, P < 0.001). It was 73-92%, 55-77%, and 12-46%, respectively, for locations with more than four patients. The accuracy was not affected by parathyroid hormone or and calcium levels, or the gland weight. CONCLUSIONS: The “Perrier” nomenclature is reproducible. The most common adenoma locations were B and E in our study, similar to the initial studies. Nevertheless, there is a wide range of preoperative predicting accuracy based on the imaging studies obtained and the interpreter’s experience.

PMID: 22270982 [PubMed - as supplied by publisher]

Invasion of the Hepatic Artery is a Crucial Predictor of Poor Outcomes in Gallbladder Carcinoma.

World J Surg. 2012 Jan 20;

Authors: Kobayashi A, Oda T, Fukunaga K, Sasaki R, Ohkohchi N

Abstract

BACKGROUND: In the present study we undertook a retrospective analysis of gallbladder carcinoma to assess whether histologically determined hepatic artery (HA) invasion and portal vein (PV) invasion can be considered prognostic factors. METHODS: Seventy-one patients who had undergone radical resection for gallbladder carcinoma between 1995 and 2008 at University of Tsukuba were selected from the database for analysis. Patients who required extended surgery for para-aortic lymph node metastasis were also included. Correlation between invasion of the HA and the PV and prognosis and other clinicopathologic factors were analyzed. RESULTS: There were two postoperative deaths among the 71 patients. Pathological invasion of the HA was confirmed in 16 (22.5%) cases and PV invasion was confirmed in 15 patients. Patients with invasion of the HA had a significantly poorer prognosis than those without HA invasion (P < 0.0001). Additionally, in univariate analysis, gender (male), positive para-aortic lymph node metastasis, PV invasion, and HA invasion were identified as significant poor prognostic factors. In multivariate analysis, only HA invasion was an independent prognostic factor (Odds Ratio 0.323; P = 0.029). CONCLUSIONS: Invasion of the HA is a crucial prognostic factor in patients with gallbladder carcinoma.

PMID: 22270983 [PubMed - as supplied by publisher]

Log Odds of Positive Lymph Nodes in Colon Cancer: A Meaningful Ratio-based Lymph Node Classification System.

World J Surg. 2012 Jan 20;

Authors: Persiani R, Cananzi FC, Biondi A, Paliani G, Tufo A, Ferrara F, Vigorita V, D’Ugo D

Abstract

BACKGROUND: The log odds of positive lymph nodes (LODDS), defined as the log of the ratio between the numbers of positive and negative lymph nodes, has recently been proposed as a new prognostic index in surgical oncology. The aim of the present study was to investigate whether the LODDS system of lymph node classification was a more accurate prognostic tool than the tumor node metastasis (TNM) and lymph node ratio (LNR) classifications in colon cancer patients. MATERIALS AND METHODS: Clinicopathologic data from 258 colon cancer patients who had undergone surgical resection were reviewed. Lymph node parameters were categorized according to the Internation Union Against Cancer/American Joint Cancer Commission (UICC/AJCC) TNM staging system, the LNR (LNR0 with ratio ≤ 0.05, LNR1 with 0.05 < ratio ≤ 0.20, LNR2 with ratio > 0.20), and the log odds ratio (LODDS0 ≤ -1.36, -1.36 < LODDS1 ≤ -0.53, and LODDS2 > -0.53). RESULTS: The LODDS was able to identify patients who would have been included in different prognostic categories, according to both the TNM and LNR. In addition, LODDS was significantly related to the number of positive and negative lymph nodes, as well as the number of examined lymph nodes. In multivariate analysis, LODDS classification (LODDS0: HR 1; LODDS1: HR 3.687, p = 0.003; LODDS2: HR 9.440, p < 0.001) was identified as an independent prognostic factor. DISCUSSION: The LODDS system is a highly reliable staging system with strong predictive ability for patient outcome. Compared with other nodal staging systems, the prognostic power of LODDS is less influenced by the number of lymph nodes dissected and examined.

PMID: 22270984 [PubMed - as supplied by publisher]

Comparison of Outcomes of Laparoscopic Versus Open Appendectomy in Children: Data from The Nationwide Inpatient Sample (NIS), 2006-2008.

World J Surg. 2012 Jan 20;

Authors: Masoomi H, Mills S, Dolich MO, Ketana N, Carmichael JC, Nguyen NT, Stamos MJ

Abstract

BACKGROUND: The benefits of laparoscopic appendectomy (LA) remain undefined as compared to open appendectomy (OA) in children, particularly in cases of perforated appendicitis. The purpose of the present study was to evaluate the outcomes of LA versus OA in perforated and nonperforated appendicitis in children. METHODS: Using the Nationwide Inpatient Sample database, we evaluated the clinical data of children (<18 years old) who underwent LA and OA from 2006 to 2008. Incidental and elective appendectomies were excluded. RESULTS: A total of 212,958 children underwent urgent appendectomy in the United States during these years. The overall rate of perforated appendicitis was 27.7, and 56.9% of all cases were performed laparoscopically. In nonperforated cases, LA was associated with comparable overall complication rate (LA: 2.56 vs. OA: 2.66%; p = 0.26), shorter length of hospital stay (LOS, LA: 1.6 vs. OA: 2.0 days; p < 0.01), comparable mortality (LA: 0.01 vs. OA: 0.02%; p = 0.25); and higher hospital charges (LA: $20,328 vs. OA: $16,830; p < 0.01) compared to OA. In perforated cases, LA had a lower overall complication rate (LA: 16.03 vs. OA: 18.07%; p < 0.01), shorter LOS (LA: 5.1 vs. OA: 5.8 days; p < 0.01), lower mortality (LA: 0.0% versus OA: 0.06%; p < 0.01), and similar hospital charges (LA: $33,361 versus OA: $33, 662; p = 0.71) compared to OA. CONCLUSIONS: LA is safe in children with acute perforated and nonperforated appendicitis, and is associated with shorter hospital stay than OA. The laparoscopic approach is associated with lower morbidity and mortality in perforated cases. However, in nonperforated cases, these benefits are modest and are associated with higher hospital charges.

PMID: 22270985 [PubMed - as supplied by publisher]

Long-term Results with the Modified Sugiura Procedure for the Management of Variceal Bleeding: Standing the Test of Time in the Treatment of Bleeding Esophageal Varices.

World J Surg. 2012 Jan 21;

Authors: Voros D, Polydorou A, Polymeneas G, Vassiliou I, Melemeni A, Chondrogiannis K, Arapoglou V, Fragulidis GP

Abstract

BACKGROUND: The surgical approaches to the treatment of bleeding esophageal varices in cirrhotic patients have been reduced since the clinical development of endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt (TIPS), and liver transplantation. However, when acute sclerotherapy fails, and in cases where no further treatment is accessible, emergency surgery may be life saving. In the present study we retrospectively analyzed the results of the modified Sugiura procedure, performed as emergency and semi-elective treatment in the patient with bleeding esophageal varices. METHODS: Ninety patients with cirrhosis and portal hypertension were managed in our department for variceal esophageal bleeding between January 1985 and December 1992. The modified Sugiura procedure was performed in 46 patients on an emergency (25 patients) or semi-elective (21 patients) basis. Liver cirrhosis stage according to Child classification was A in 4 patients, B in 16 patients, and C in 26 patients. RESULTS: Acute bleeding was controlled in all patients. Postoperative mortality was 23.9% (11 of 46 patients). The mortality rate was 34.6% in Child class C patients (9 of 26 patients), and 12.5% in Child class B patients (2 of 16 patients). Twenty-four patients had long-term follow-up extending from 14 months to 22 years (mean 83.1 months). Ten of 24 patients (41.6%) did not develop rebleeding for 5-22 years (mean 10.3 years). Overall 5-year survival in these 24 patients was 62.5%. CONCLUSIONS: The modified Sugiura procedure remains an effective rescue therapy for patients with bleeding esophageal varices when alternative treatments fail or are not indicated. Moreover, it can be a life-saving procedure in patients with anatomy unsuitable for shunt surgery or for patients treated in nonspecialized centers where surgical expertise for a shunt operation is not available.

PMID: 22270986 [PubMed - as supplied by publisher]

Trauma and Burn Education: A Global Survey.

World J Surg. 2012 Jan 20;

Authors: Zonies D, Maier RV, Civil I, Eid A, Geisler BP, Guerrero A, Mock C

Abstract

BACKGROUND: The World Health Assembly recently adopted a resolution to urge improved competency in the provision of injury care through medical education. This survey sought to investigate trauma education experience and competency among final year medical students worldwide. METHODS: An Internet survey was distributed to medical students and conducted from March 2008 to January 2009. Demographic data and questions pertaining to both instruction and attainment of specific skills in burn and trauma care were assessed. RESULTS: There were 776 responses from final year medical students in 77 countries, with at least 10 countries from each economic stratum. Over 93% of final year students reported receiving some form of trauma or burn training, with 79% reporting a minimum compulsory requirement. Students received theoretical instruction without practical exposure. Few felt prepared to undertake basic procedures, such as laceration repair (19%), vascular access (8%), or endotracheal intubation (21%). Over 99% agreed that trauma education should be mandatory, but only half felt prepared to provide basic care. Those from low income and low middle income countries felt better prepared to provide trauma care than students from high middle and high income countries. CONCLUSIONS: Trauma education and experience varies among medical students in different countries. Many critical concepts are not formally taught and practical experience with many basic procedures is often lacking. The present study confirms that the trauma care training received by medical students needs to be strengthened in countries at all economic levels.

PMID: 22270987 [PubMed - as supplied by publisher]

Metastasis-associated Protein 1 Nuclear Expression is Closely Associated with Tumor Progression and Angiogenesis in Patients with Esophageal Squamous Cell Cancer.

World J Surg. 2012 Jan 21;

Authors: Li SH, Tian H, Yue WM, Li L, Gao C, Li WJ, Hu WS, Hao B

Abstract

BACKGROUND: The purposes of the present study were to detect the expression of metastasis-associated protein 1 (MTA1) in patients with esophageal squamous cell cancer (ESCC), and to evaluate the relevance of MTA1 protein expression to the tumor progression, angiogenesis, and prognosis. METHODS: Both MTA1 protein and intratumoral microvessels were examined by immunohistochemical staining in 131 ESCC patients who successfully underwent subtotal esophagectomy and esophagogastric anastomosis at Qilu Hospital between Jan 2004 and Dec 2005. Intratumoral microvessel density (MVD) was recorded by counting CD-34 positive immunostained endothelial cells. All statistical analyses were performed with SPSS 13.0 statistical software. RESULTS: High expression of MTA1 protein was detected in 57 cases and significantly correlated with tumor invasion depth (P = 0.041), lymph node metastasis (P = 0.021), pathologic stage (P = 0.003), and MVD (P = 0.044). Survival analysis showed that patients with MTA1 protein high expression had significantly poor overall 5-year survival (P = 0.002), and the factor found on multivariate analysis to significantly affect overall survival was only pathologic stage (P = 0.040). Further stratified survival analysis split by pathologic stage demonstrated that MTA1 protein high expression significantly predicted unfavorable prognosis among patients with pathologic stage II disease (P = 0.006). CONCLUSIONS: High expression of the MTA1 protein is common in ESCC, and is closely associated with tumor progression, increased tumor angiogenesis, and poor survival. These findings indicate that MTA1 protein has clinical potentials as a useful indicator of progressive phenotype, a promising prognostic predictor to identify patients with poor prognosis, and a potential novel therapeutic target of antiangiogenesis for patients with ESCC.

PMID: 22270988 [PubMed - as supplied by publisher]

Trainees, Trainers, and Training; Where Does Their Destiny Lie ?

World J Surg. 2012 Jan 20;

Authors: Brand M, Thomas W

PMID: 22270989 [PubMed - as supplied by publisher]

Prognostic Factors for Recurrence of Papillary Thyroid Carcinoma in the Lymph Nodes, Lung, and Bone: Analysis of 5,768 Patients with Average 10-year Follow-up.

World J Surg. 2012 Jan 20;

Authors: Ito Y, Kudo T, Kobayashi K, Miya A, Ichihara K, Miyauchi A

Abstract

BACKGROUND: Papillary thyroid carcinoma (PTC) frequently recurs to the lymph nodes, which may not be fatal immediately but is a stressor for physicians and patients. Recurrence to the distant organs, although less frequent, is often life-threatening, and the lung and bone are organs to which PTC is likely to recur. In the present study we investigated factors predicting recurrence of PTC to the lymph nodes, lung, and bone in a large number of patients undergoing long-term follow-up. METHODS: A total of 5,768 PTC patients (608 males and 5,159 females) without distant metastasis at diagnosis who underwent initial surgery between 1987 and 2004 in Kuma Hospital were enrolled in this study. The postoperative follow-up ranged from 12 to 280 months, and was 129 months (10.8 years) on average. RESULTS: To date, node, lung, and bone recurrences have been detected in 389 (7%), 118 (2%), and 33 patients (0.6%), respectively, and 57 patients (1%) have died of PTC. We examined the prognostic significance of the tumor size (T), extrathyroid extension (Ex), age 55 years or older (Age), male gender (Gender), clinical node metastasis (N), and extranodal tumor extension (LN-Ex) for each outcome on multivariate analysis. Age, Gender, T > 2 cm, N, and Ex were independent predictors of lymph node recurrence. Age, Ex, T > 2 cm, and N were independent prognostic factors for lung recurrence. Ex, T > 4 cm, and N independently predicted bone recurrence. Of these, N ≥ 3 cm had the strongest prognostic value for lymph node, lung, and bone recurrences. In contrast, Age was the strongest predictor for carcinoma death. LN-Ex also had a prognostic value for carcinoma death, although it was not a predictor of carcinoma recurrence. Ex, N ≥ 3 cm, and T > 2 cm also had a prognostic impact on carcinoma death. CONCLUSIONS: Large lymph node metastasis showed a strong prognostic impact on carcinoma recurrence not only to the lymph nodes but also to the lung and bone, and carcinoma death. Extrathyroid extension also independently predicted these recurrences and carcinoma death, although hazard ratios were lower than for large node metastasis. Age 55 years or older, in contrast, was the strongest predictor of carcinoma death. Extranodal tumor extension did not independently affect recurrence, but it had prognostic significance for carcinoma death. These findings suggest that recurring PTC lesions of older patients and/or extranodal tumor extensions are difficult to control and very progressive.

PMID: 22270990 [PubMed - as supplied by publisher]

No Impact of Perioperative Blood Transfusion on Recurrence of Hepatocellular Carcinoma after Hepatectomy.

World J Surg. 2012 Jan 20;

Authors: Kuroda S, Tashiro H, Kobayashi T, Oshita A, Amano H, Ohdan H

Abstract

BACKGROUND: Although several studies have shown that perioperative blood transfusion is a poor prognostic factor of outcome after hepatectomy for hepatocellular carcinoma (HCC), the impact of perioperative blood transfusion on the prognosis of HCC remains unknown. METHODS: Data from 835 patients (76 transfused patients and 759 nontransfused patients) who underwent curative hepatectomy for HCC were retrospectively collected and analyzed. To overcome bias due to the different distribution of covariates for the two groups, a one-to-one match was created using propensity score analysis. After matching, patient outcomes were analyzed. RESULTS: After one-to-one matching, 60 transfused patients and 60 nontransfused patients had the same preoperative and operative characteristics (excluding operative blood loss). Although the morbidity rate of hepatectomy was significantly higher in the transfused group than in the nontransfused group (P = 0.016), there was no significant difference in mortality rate (P = 0.242). Additionally, the overall survival rate of transfused patients was similar to that of nontransfused patients (P = 0.466), and the difference in disease-free survival rate between the two groups was insignificant (P = 0.621). CONCLUSIONS: Perioperative blood transfusion did not influence the overall and disease-free survival rate in the HCC patients studied. Perioperative blood transfusion may not be considered a poor prognostic factor for patients with HCC.

PMID: 22270991 [PubMed - as supplied by publisher]

Early Data from the First Population-Wide Breast Cancer-Specific Registry in Hong Kong.

World J Surg. 2012 Jan 20;

Authors: Cheung P, Hung WK, Cheung C, Chan A, Wong TT, Li L, Chan SW, Chan KW, Choi P, Kwan WH, Yau CC, Chan EY, Law SC, Kwan D

Abstract

BACKGROUND: Current measures for breast cancer prevention and options for treatment adopted in Hong Kong are mainly based on research data and clinical evidence from overseas. It is essential to establish a cancer-specific registry to monitor the status of breast cancer in Hong Kong. OBJECTIVES: We summarized the current status of breast cancer in Hong Kong based on the data collected from Hong Kong Breast Cancer Registry (HKBCR). METHODS: Prevalent and newly diagnosed breast cancers (including in situ and invasive breast cancers) were registered in the HKBCR. Information on patient demographics, risk factors, medical information, and survival were analyzed and reported in this study. RESULTS: Data of 2,330 breast cancer patients were analyzed. We observed an earlier median age at diagnosis in Hong Kong than those reported in other countries. Distribution of cancer stage was: stage 0 (11.4%), stage I (31.4%), stage II (41%), stage III (12.5%), stage IV (0.8%), and unclassified (2.9%). The percentages of patients who received surgery, chemotherapy, radiation therapy, and endocrine therapy were 98.7, 67.9, 64.8, and 64.1%, respectively. At a median follow-up of 1.2 years, locoregional recurrence was recorded at 2%, distant recurrence at 2.8%, and breast-cancer-related mortality at 0.3%. CONCLUSIONS: The HKBCR serves as a surveillance program to monitor disease and treatment patterns. It is pivotal to support research for more effective breast cancer prevention and treatment strategies in Hong Kong.

PMID: 22270992 [PubMed - as supplied by publisher]

Not the Number but the Location of Lymph Nodes Matters for Recurrence Rate and Disease-Free Survival in Patients with Differentiated Thyroid Cancer.

World J Surg. 2012 Jan 20;

Authors: de Meer SG, Dauwan M, de Keizer B, Valk GD, Borel Rinkes IH, Vriens MR

Abstract

BACKGROUND: Several Japanese studies have focused on identifying prognostic factors in patients with positive lymph nodes to predict recurrence rate and disease-free survival (DFS). However, different treatment protocol is followed in Japan compared with the European and American approach. This study was designed to investigate whether the number and/or location of lymph nodes predicts prognosis in patients with DTC treated with total thyroidectomy, lymph node dissection, and postoperative radioactive iodine ablation. METHODS: All 402 patients who were treated at the Department of Nuclear Medicine between 1998 and 2010 for DTC were reviewed. Patients were treated with (near) total thyroidectomy, lymph node dissection on indication, and postoperative I-131 ablation. Median follow-up was 49 (range, 10-240) months. Outcome measures were recurrence rate, disease-free survival, and mean time to recurrence. RESULTS: Ninety-seven patients had proven lymph node metastases. Recurrence rate was significantly higher in patients with positive lymph nodes in the lateral compartment vs. patients with lymph node metastasis in the central compartment (60 vs. 30%, p = 0.007). Disease-free survival and mean time to recurrence also were significantly shorter (30 vs. 52 months, p = 0.035 and 7 vs. 44 months, p = 0.004, respectively). The number of lymph nodes and extranodal growth were not significantly associated with the outcome measures used. CONCLUSIONS: The location of positive lymph nodes was significantly correlated with the risk of recurrence and a shorter DFS. Hence, the TNM criteria are useful in subdividing patients based on risk of recurrence and DFS.

PMID: 22270993 [PubMed - as supplied by publisher]

Involvement of Surgical Residents in the Management of Trauma Patients in the Emergency Room: Does the Presence of an Attending Physician Affect Outcomes?

World J Surg. 2012 Jan 20;

Authors: Cohen R, Adini B, Radomislensky I, Givon A, Rivkind AI, Peleg K

Abstract

BACKGROUND: Few studies have investigated whether the presence or absence of attending physicians (AP) in the emergency department (ED) during the management of trauma patients by residents. METHODS: Six level 1 trauma center admissions for years 2006-2008 were analyzed to determine whether presence of an AP affected the time spent in the ED, post-ED disposition, and in-hospital mortality. RESULTS: Patient demographics differed in relation to the presence of APs (P < 0.01). Patients with ISS > 25 who died during hospitalization were more often managed when APs were present. Male patients, those <65, and patients with Injury Severity Score (ISS) > 16 were more often treated in the presence of an AP (P < 0.01). Penetrating, terror trauma, motor vehicle collision and assaults were more often managed in the presence APs. Presence of APs differed by hospital (P < 0.0001). Adjusted logistic regression revealed that patients spent less time in the ED, went directly to the operating room or the ICU for definitive care, if an AP was present. CONCLUSIONS: Presence of an attending physician improved and focused patient triage, disposition decisions, and outcomes.

PMID: 22270994 [PubMed - as supplied by publisher]

Multivariable Analysis of Cholecystectomy after Gastrectomy: Laparoscopy is a Feasible Initial Approach even in the Presence of Common Bile Duct Stones or Acute Cholecystitis.

World J Surg. 2012 Jan 25;

Authors: Kim J, Cho JN, Joo SH, Kim BS, Lee SM

Abstract

BACKGROUND: When performing cholecystectomy after gastrectomy, we often encounter problems, such as adhesions, nutritional insufficiency, and bowel reconstruction. The purpose of this study was to identify the factors related to surgical outcome of these associated procedures, with emphasis on the use of a laparoscopic approach. METHODS: We retrospectively analyzed data from 58 patients who had a history of cholecystectomy after gastrectomy. Differences between subgroups with respect to operation time, length of postoperative hospital stay, and complications were analyzed. To identify the factors related with outcomes of cholecystectomy after gastrectomy, we performed multivariable analysis with the following variables: common bile duct (CBD) exploration, laparoscopic surgery, gender, acute cholecystitis, history of stomach cancer, age, body mass index, period of surgery, and interval between cholecystectomy and gastrectomy. RESULTS: We found one case (2.9%) of open conversion. The CBD exploration was the most significant independent factor (adjusted odds ratio (OR), 45.15; 95% confidence interval (CI), 4.53-450.55) related to longer operation time. Acute cholecystitis also was a significant independent factor (adjusted OR, 14.66; 95% CI, 1.46-147.4). The laparoscopic approach was not related to operation time but was related to a shorter hospital stay (adjusted OR, 0.057; 95% CI, 0.004-0.74). Acute cholecystitis was independently related to the occurrence of complications (adjusted OR, 27.68; 95% CI, 1.15-666.24); however, CBD exploration and laparoscopic surgery were not. A lower BMI also was an independent predictor of the occurrence of complications (adjusted OR, 0.41; 95% CI, 0.2-0.87). CONCLUSIONS: The laparoscopic approach is feasible for cholecystectomy after gastrectomy, even in cases with CBD stones or acute cholecystitis. This approach does not appear to increase operation time or complication rate and was shown to decrease the length of postoperative hospital stay.

PMID: 22270995 [PubMed - as supplied by publisher]

Prevalence of Germline Mutations in Patients with Pheochromocytoma or Abdominal Paraganglioma and Sporadic Presentation: A Population-Based Study in Western Sweden.

World J Surg. 2012 Jan 20;

Authors: Muth A, Abel F, Jansson S, Nilsson O, Ahlman H, Wängberg B

Abstract

BACKGROUND: Germline mutations in the susceptibility genes RET, SDHB, SDHD, and VHL have been reported in 7.5-24% of patients with pheochromocytoma (Pheo) or paraganglioma (PGL) and sporadic presentation. The purpose of the present study was to establish population-based data on the frequency of germline mutations in patients with apparently sporadic Pheo or abdominal PGL in Western Sweden. METHODS: From the Swedish National Cancer Registry, all patients with Pheo or PGL in Western Sweden (population 1.72 million) registered between 1958 and 2009 were identified (n = 256). Patients were characterized using register data, hospital records, and clinical interviews. All living patients with Pheo or abdominal PGL and sporadic presentation (n = 81) were invited to genetic screening; 71 patients accepted. Germline mutations were investigated by using direct sequencing for point mutations in RET, SDHB, SDHD, and VHL, and multiplex ligation-dependent probe amplification for gross deletions in SDHB, SDHC, SDHD, and VHL. Plasma or urinary metanephrines and/or urinary catecholamines were used for biochemical follow-up. RESULTS: The prevalence of germline mutations was 5.6%. Mutations were only seen in RET (n = 1) and SDHB (n = 3). Notably, in the patients with SDHB mutations, no malignant phenotype was observed during a mean follow-up of 23.3 years. CONCLUSIONS: The frequency of germline mutations in patients with apparently sporadic Pheo and abdominal PGL in Western Sweden was lower than in previous studies. Variations in reported frequencies of germline mutations in patients with clinically sporadic Pheo/PGL may reflect geographical differences or patient selection.

PMID: 22270996 [PubMed - as supplied by publisher]

Evaluation of Postoperative Radioactive Iodine Scans in Patients who Underwent Prophylactic Central Lymph Node Dissection.

World J Surg. 2012 Jan 20;

Authors: Laird AM, Gauger PG, Miller BS, Doherty GM

Abstract

BACKGROUND: Prophylactic central lymph node dissection (CLND) accompanying total thyroidectomy for papillary thyroid cancer (PTC) remains controversial. Our hypothesis is that CLND may help select patients who benefit from postoperative radioactive iodine (RAI). METHODS: A total of 119 patients who were clinically node-negative underwent total thyroidectomy/bilateral CLND for papillary thyroid cancer (PTC) > 1 cm during 2002-2010. Pathology results, RAI results, and outcomes were compared between node-positive (NP) and node-negative (NN) patients. RESULTS: NP and NN patients were similar in age, gender, tumor size, and MACIS score. Median number of nodes excised was six. The rate of permanent hypocalcemia was 1.7% without permanent recurrent laryngeal nerve injuries. Thirteen of 52 (25%) NN patients and 24 of 67 (36%) NP patients had suspicious nodes by intraoperative inspection. The node assessment negative predictive value was 75%; positive predictive value was 36%. Fifty-six percent (67/118) were NP; 100 patients were treated with RAI. Fourteen of 62 NP patients had abnormal postoperative RAI scans aside from the thyroid remnant versus 4 of 38 NN patients (23 vs. 11%, p = 0.18). Median 1-year stimulated thyroglobulin (Tg) level was 0.0 for both (range 0.0-1.2, NN; 0.0-22.7, NP; p = 0.1). NP patients received higher doses of RAI (150 vs. 30 mCi, p < 0.001). Rate of recurrent or persistent disease was 3.4%. CONCLUSIONS: Few node-negative patients have abnormal RAI scans outside of the thyroid bed. Node-positive patients had greater variability in stimulated 1-year Tg levels after higher doses of RAI. CLND may identify the patients most likely to have persistently elevated stimulated Tg after initial therapy for PTC.

PMID: 22270997 [PubMed - as supplied by publisher]

Retromuscular Mesh Repair of Midline Incisional Hernia with Polyester Standard Mesh: Monocentric Experience of 261 Consecutive Patients with a 5-year Follow-up.

World J Surg. 2012 Jan 20;

Authors: Poghosyan T, Veyrie N, Corigliano N, Helmy N, Servajean S, Bouillot JL

Abstract

BACKGROUND: Midline incisional hernia (MIH) repair remains a major challenge for surgeons. Multiple procedures and types of mesh to treat incisional hernia are available. We evaluated outcomes of MIH treated by retromuscular mesh repair (RMR) using a polyester standard prosthesis. PATIENTS: A total of 262 patients were treated for MIH by RMR between June 2000 and November 2007 in an academic tertiary referral center using the same standardized surgical technique and one type of mesh. The early complications and recurrence rate were evaluated. RESULTS: The average patient age was 57 years; 51% were women. The mean width was 7.8 cm and defect size was 61 cm². Previous MIH repair had been performed in 23% of the patients. Average hospital stay was 7 days. Of the 262 patients studied, 34 patients (13%) developed early complications, and 16 required reoperation for various indications. Early mesh infection occurred in 2 patients (0.8%) requiring mesh removal. The mean follow-up was 58 months. Recurrence was observed in 8 patients (3%) with an average delay of 19 months. There was a significant difference in terms of recurrence in patients with mesh infection versus the group who did not develop infection (2/2 patients versus 6/259; P < 0.001). CONCLUSIONS: Our results suggest that RMR with a polyester standard prosthesis for MIH remains a safe “classic” treatment with a moderate complication rate and a low infection and recurrence rate, even in large incisional hernia.

PMID: 22270998 [PubMed - as supplied by publisher]

Nine years of Experience with the Sentinel Lymph Node Biopsy in a Single Italian Center: A Retrospective Analysis of 1,050 Cases.

World J Surg. 2012 Jan 25;

Authors: Bernardi S, Bertozzi S, Londero AP, Giacomuzzi F, Angione V, Dri C, Carbone A, Petri R

Abstract

BACKGROUND: This study aims to determine the prevalence and predictive factors for recurrence after sentinel lymph node biopsy (SLNB) and for sentinel lymph node positivity by SLNB in our population. METHODS: We followed up all SLNBs performed between 2002 and 2010 and analyzed data by R (version2.10.1), considering p < 0.05 significant. RESULTS: Among 1,050 patients with SLNB, 23% (245/1050) underwent secondary axillary dissection (CALND). Axillary recurrence prevalence among patients with negative SLNB was 1% (6/805) at a mean follow-up of 54 months (±14), and 1.7% (95% CI 0.2-3.1%) after 6 years of follow-up, as all recurrences developed between the 3rd and the 6th years of follow-up. By multivariate analysis, axillary recurrence results correlated with large tumor size, high number of excised nodes, lymphovascular invasion, high grading, multifocality, Her-2 positivity, intraductal histology, and comedo-like necrosis. Moreover, SLNB positivity results correlated with young age, large tumor size, high number of excised nodes, negative history for second primary malignancies, lymphovascular invasion, and high grading. CONCLUSIONS: Cancer characteristics represent important predictive factors for SLNB positivity, as well as for axillary recurrence in patients with negative SLNB, independently, by surgical and nonsurgical treatment. Therefore, cancer biological behavior and the patient’s hormonal profile should be evaluated with care to better tailor the follow-up of women with breast cancer.

PMID: 22274810 [PubMed - as supplied by publisher]

Controversies Concerning the Use of Neoadjuvant Systemic Therapy for Primary Breast Cancer.

World J Surg. 2012 Jan 26;

Authors: Kaufmann M, Karn T, Ruckhäberle E

Abstract

The major aim of neoadjuvant systemic therapy is to improve prognosis by individualizing treatment. The proven benefits of neoadjuvant systemic therapy include reducing tumor burden, higher breast-conserving surgery, and the possibility of in vivo monitoring of response to treatment. Other goals of neoadjuvant treatment are the detection of new prognostic and predictive biomarkers and the investigation of new drugs and imaging modalities. Although many prospective trials have answered important questions regarding neoadjuvant systemic therapy, several topics remain controversial.

PMID: 22278605 [PubMed - as supplied by publisher]

Preoperative Serum Osteocalcin may Predict Postoperative Elevated Parathyroid Hormone in Patients with Primary Hyperparathyroidism.

World J Surg. 2012 Jan 26;

Authors: Rianon N, Alex G, Callender G, Jimenez C, Hu M, Grubbs E, Moreno M, Wathoo C, Petak S, Perrier N

Abstract

BACKGROUND: Persistent postoperative elevation of parathyroid hormone (POePTH) following successful parathyroidectomy for primary hyperparathyroidism (PHPT) is presumed to result from bone remineralization. Predicting which patients may need treatment is difficult. This study investigated whether preoperative serum osteocalcin (OC), a bone turnover marker involved in mineralization, can predict POePTH. METHODS: A total of 198 patients (155 women and 43 men) with parathyroidectomy from November 2007 to October 2009 in MD Anderson Cancer Center, Houston, TX, USA, were included in our analysis. Separate multivariate regression models determined associations between preoperative OC and POePTH at 6 and 12 months postoperatively. Regression models were adjusted for demographics (age, gender, race, height, weight, BMI), preoperative BMD and bisphosphonate use, adenoma weight, serum levels of PTH, calcium, vitamin D, creatinine, and phosphate. Patients with baseline GFR <60 ml/min/1.73 m(2) and postoperative serum calcium >10.14 mg/dl at 6 and 12 months were excluded. RESULTS: Patients’ mean age (±SD) was 60 (±14) years. POePTH (>80 pg/ml) occurred in 13 and 12% patients at 6 and 12 months, respectively. Preoperative serum creatinine and bisphosphonate use were positively associated with POePTH (p < 0.05) both at 6 and 12 months. Preoperative OC was predictive of POePTH (p < 0.05) at 6 months (β 0.35; 95% confidence interval (CI), 0.11-0.58) and at 12 months (β 0.79; 95% CI, 0.27-1.31). CONCLUSIONS: Preoperative OC may help to predict risk of POePTH in patients with PHPT. Research with longer follow-up in patients with no known baseline chronic kidney disease stratified by high versus normal preoperative serum creatinine is recommended.

PMID: 22278606 [PubMed - as supplied by publisher]

Case-Based Learning in Surgery: Lessons Learned.

World J Surg. 2012 Jan 6;

Authors: Nordquist J, Sundberg K, Johansson L, Sandelin K, Nordenström J

Abstract

BACKGROUND: The aim of the study was to obtain a deepened understanding of the implementation process of case-based learning (CBL) during a surgical semester at the Undergraduate Medical Program at Karolinska Institutet. The objectives are to identify the level of success of the implementation and to identify practical and theoretical implications of importance in connection to the process. METHODS: Based on a qualitative study design, the study explores students’ and teachers’ perceptions of the educational intervention CBL in context. Five faculty members involved in the entire reform and five students from the second cohort were interviewed 1 year into the implementation phase. Narrative data from the semistructured interviews were coded using a blend of an inductive and deductive approach to derive the coding categories. RESULTS: The results of the study reflect two overarching themes: the importance of a well-functioning implementation process and the misalignment between the student/faculty Teaching Learning Regime and the attributes of CBL. The findings have resulted in a checklist for implementation of CBL in a surgical curriculum. CONCLUSIONS: The implementation of CBL was not satisfactory. Still, exposure of the weaknesses of the implementation process, the misalignment between CBL and the reigning teaching and learning regime, and promotion of the future use of the checklist are key to future successful implementation of CBL in any surgical undergraduate curriculum.

PMID: 22223292 [PubMed - as supplied by publisher]

Correlation Between the Pretherapeutic Neutrophil to Lymphocyte Ratio and the Pathologic Response to Neoadjuvant Chemotherapy in Patients With Advanced Esophageal Cancer.

World J Surg. 2012 Jan 6;

Authors: Sato H, Tsubosa Y, Kawano T

Abstract

BACKGROUND: An elevation in the neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with a poorer prognosis in patients with various tumors. The aim of this retrospective study was to clarify the correlation of the pretherapeutic NLR with the prognostic value of the pathologic response to neoadjuvant chemotherapy (NAC) in patients with advanced esophageal cancer. METHODS: This study was a retrospective review of 83 patients undergoing NAC for advanced esophageal cancer following esophagectomy. The NLR was measured before NAC, and the pathologic responses to NAC were evaluated. RESULTS: A comparison was performed for those whose pathology responded (responders) (G3/G2/G1b) and nonresponders (G1a/G0). In a univariate analysis, the cStage (P = 0.005), cN (P = 0.0001), and NLR (P = 0.005) were statistically significant parameters. A multivariate analysis revealed that the factors independently associated with pathologic responses were the pretreatment NLR (<2.2/≥2.2) (P = 0.043) and lymph nodes metastasis (P = 0.002). The pretreatment NLR (<2.2/≥2.2) was found to be a statistically significant useful predictive marker for a pathologic response (P = 0.001). The pathologic response rates were 56% in the patients with an NLR <2.2 and 21% in patients with an NLR of ≥2.2. CONCLUSIONS: Our study is the first to demonstrate that the pretherapeutic NLR can be used as a predictor for chemosensitivity of thoracic esophageal cancer. Preoperative evaluation based on the clinical N stage and NLR may be easily used in routine clinical practice.

PMID: 22223293 [PubMed - as supplied by publisher]

Erratum to: Single-Photon-Emission Computed Tomography (SPECT) with Technetium-99m Sestamibi in the Diagnosis of Small Breast Cancer and Axillary Lymph Node Involvement.

World J Surg. 2012 Jan 5;

Authors: Decesare A, Devincentis G, Gervasi S, Crescentini G, Fiori E, Bonomi M, Crocetti A, Sterpetti AV

PMID: 22218492 [PubMed - as supplied by publisher]

Inguinal Hernia Repair under Local Anaesthesia in Patients with Cirrhosis.

World J Surg. 2012 Jan 5;

Authors: Bernhardt GA

PMID: 22218493 [PubMed - as supplied by publisher]

Primary Surgery in Rural Areas of Southern Sudan.

World J Surg. 2012 Jan 4;

Authors: Cometto G, Belgrano E, De Bonis U, Giustetto G, Kiss A, Taliente P, Meo G

Abstract

BACKGROUND: We report through a retrospective analysis our experience of providing surgical care and on-the-job training through mobile surgical missions in southern Sudan during the post conflict period between 2005 and 2009. METHODS: Three surgical teams conducted 23 missions in 5 primary health care centers sited in remote areas of southern Sudan. King’s analytical framework for surgical care in developing countries is adopted to evaluate the appropriateness of services rendered. Exact logistic regression was performed to investigate differences in mortality depending on the level of training of the operators and anesthetists. RESULTS: A total of 1,543 patients were operated on during a 5 year period, of which 9 (0.58%) died. The majority of operations were elective surgery cases (which may help contextualize the exceptionally low mortality rate). Several adaptations to surgical techniques adopted and preoperative and postoperative care were required. There were no statistically significant differences in mortality between operations performed by expatriate specialists and local midlevel providers with lower level training. CONCLUSIONS: This experience in southern Sudan demonstrates that surgical services can be established utilizing simple facilities and equipment and employing local personnel selected and trained on-the-job by teams composed of a consultant surgeon, anesthetist, and scrub nurse. Delegation of tasks relating to anesthesia and surgery to midlevel health providers is an appropriate approach in developing countries facing shortage and maldistribution of more qualified health workers.

PMID: 22215385 [PubMed - as supplied by publisher]

Lymph Node Recurrence in Patients With N1b Papillary Thyroid Carcinoma Who Underwent Unilateral Therapeutic Modified Radical Neck Dissection.

World J Surg. 2011 Dec 30;

Authors: Ito Y, Kudo T, Takamura Y, Kobayashi K, Miya A, Miyauchi A

Abstract

BACKGROUND: Therapeutic modified radical neck dissection (MND) is a mandatory surgical procedure for patients with papillary thyroid carcinoma (PTC) having clinical lateral node metastasis (N1b). However, N1b PTC is still likely to recur in regional lymph nodes after surgery. We investigated the clinicopathological features predicting recurrence in nodes in previously dissected compartments (ipsilateral lateral compartment or central compartment) and nodes in the contralateral lateral compartment for N1b patients who underwent unilateral therapeutic MND. METHODS: A total of 744 N1b PTC patients who underwent thyroidectomy with unilateral therapeutic MND between 1987 and 2004 were enrolled in the study. The patient ages ranged from 12 to 88 years (average 50.2 years). The average postoperative follow-up period was 113 months. RESULTS: To date, 87 (12%) and 49 (7%) patients showed recurrence in previously dissected compartments and the contralateral lateral compartment, respectively. On univariate analysis, age >55 years, node metastasis >3 cm, extranodal tumor extension, and extrathyroid extension affected recurrence in previously dissected compartments. Also, the former two were independent predictors on multivariate analysis (P = 0.0170 and <0.0001, respectively). In contrast, only extrathyroid extension and tumor size >4 cm influenced recurrence in the contralateral lateral compartment on univariate analysis. On multivariate analysis, the former was an independent predictor (P = 0.0015), and the latter was of marginal significance (P = 0.0909). To date, 13% of patients having both of these characteristics showed recurrence in the contralateral lateral compartment. CONCLUSIONS: Extremely careful therapeutic MND is required for N1b patients with age >55 years or node metastasis >3 cm because of the likelihood of recurrence in previously dissected compartments. Bilateral MND (therapeutic for ipsilateral side and prophylactic for contralateral side) may be a therapy option for N1b PTC >4 cm and having extrathyroid extension.

PMID: 22207493 [PubMed - as supplied by publisher]

Fungating Thyroid Cancer: A Complex Clinical Scenario.

World J Surg. 2011 Dec 30;

Authors: Nabawi AS, Al Wagih HF, Hemeida MA, Koraitim TY, Moussa M, Ezzat T

Abstract

BACKGROUND: Most research reporting the management of advanced thyroid cancer focuses on major aerodigestive system or vessel involvement. In the present study, we investigated patients with locally advanced thyroid cancers who presented with malignant skin infiltration. The term fungating thyroid cancer (fTC) has been used to describe such a condition. METHODS: The study was based on prospective collection of clinical, laboratory, imaging, and pathological data of all patients admitted to the head and neck and endocrine surgery unit, Main University Hospital, Alexandria School of Medicine, during the period April 2005-March 2011. RESULTS: Eleven patients were referred with fTC, eight of whom had undergone subtotal thyroidectomy for an undiagnosed well-differentiated thyroid cancer (DTC) in another institution. The final pathological diagnosis showed (DTC, n = 3), poorly differentiated thyroid cancer (n = 5), anaplastic cancer (n = 2), and medullary thyroid cancer (n = 1). Extensive resections and reconstruction using flaps (pectoralis major, n = 6; deltopectoral, n = 1; sternocleidomastoid, n = 1) were undertaken. Complete tumor clearance (R0) was achieved in one patient and the others had microscopic (R1, n = 6) or macroscopic (R2, n = 1) residual disease. The three patients who did not undergo operation died within one month of presentation. The latest review of the eight patients who did undergo operation ranged from 3 to 6 months, but their survival remains unknown as access for follow-up was limited.

PMID: 22207494 [PubMed - as supplied by publisher]

Breast Radiation Correlates with Side of Parathyroid Adenoma.

World J Surg. 2011 Dec 30;

Authors: Woll ML, Mazeh H, Anderson BM, Chen H, Sippel RS

Abstract

BACKGROUND: Prior head and neck irradiation is a known risk factor for hyperparathyroidism. It is not clear whether irradiation for breast cancer, which may expose the neck to radiation, is also a risk factor for hyperparathyroidism. The present study analyzes the association between the side of radiation to the chest following breast surgery and the side of subsequent parathyroid adenoma development. METHODS: We analyzed a prospective database of 1,428 consecutive patients who underwent parathyroidectomy at our institution between November 2000 and August 2010. Patients who had previously undergone breast surgery were identified. Patients with multigland disease were excluded. Patients with bilateral breast surgery were counted as having had two separate procedures; one on each side. Patients who had radiation therapy following breast surgery (RadRx) were compared to those who had breast surgery without radiation treatment (No RadRx). RESULTS: A total of 146 breast procedures were performed in 121 patients. Forty procedures were in the RadRx group versus 106 cases in the No RadRx group. Patients with radiation therapy were older (68 ± 1.8 years versus 63 ± 1.2 years; P = 0.02) and had higher preoperative calcium levels (11.3 ± 0.1 mg/dl versus 10.9 ± 0.1 mg/dl; P = 0.001). However, there was no significant difference in either parathyroid hormone (PTH) level or gland weight. The latency period between breast irradiation and parathyroid surgery was 8 ± 0.9 years. Interestingly, the side of radiation therapy was associated with the side of the parathyroid adenoma in 76% of cases, compared to only 44% in those who had breast surgery without radiation exposure (P = 0.0004). CONCLUSIONS: The present study demonstrates that, similar to prior head and neck radiation, prior breast irradiation correlates with the development of parathyroid disease. Specifically, there is a strong correlation between the side of the radiation therapy and the side of a subsequent parathyroid adenoma. Breast irradiation should therefore be considered a risk factor for the development of parathyroid adenomas.

PMID: 22207495 [PubMed - as supplied by publisher]

Impact of Clinical and Pathohistological Characteristics on the Incidence of Recurrence and Survival in Elderly Patients with Gastric Cancer.

World J Surg. 2011 Dec 29;

Authors: Dittmar Y, Rauchfuss F, Götz M, Scheuerlein H, Jandt K, Settmacher U

Abstract

BACKGROUND: Gastric cancer is one of the most frequent malignant tumors worldwide. Despite improvements in diagnostic procedures, as well as the introduction of multimodal treatment strategies, the overall prognosis remains poor. The role of gastric resection in elderly patients with gastric cancer has not been clearly defined as yet. The goal of the present study was to assess whether specific pathohistological features result in different outcomes for younger patients and elderly patients. METHODS: A total of 272 patients with advanced gastric cancer treated surgically in our hospital between 1998 and 2009 were included in the study. Data were analyzed from a prospectively maintained database. RESULTS: Median overall survival was 84 months in the younger subgroup and 37 months in the elderly subgroup (P = 0.038), whereas local recurrence occurred more frequently in younger patients (33% vs. 23%). We identified positive lymph nodes at the contralateral curvature, perilymphonodular tumor cells, and positive lymph node conglomerates as strong negative prognostic factors. There were few pathohistological characteristics that affected survival and the incidence of tumor recurrence differently in elderly and younger patients. Although only a few elderly patients underwent chemotherapy plus gastric resection (7% vs. 28% of the younger patients), there was a trend toward longer survival for those who received multimodal treatment. CONCLUSIONS: Our results suggest that there is no tumor-related prognostic difference between young and elderly patients that would preclude radical surgery in elderly patients, as long as they are generally fit for surgery.

PMID: 22205105 [PubMed - as supplied by publisher]

Technical Feasibility of a Robotic-Assisted Ventral Hernia Repair.

World J Surg. 2011 Dec 29;

Authors: Beldi G

PMID: 22205106 [PubMed - as supplied by publisher]

Multiple Lymphatic Basin Drainage from Cutaneous Melanoma as a Prognostic Factor.

World J Surg. 2011 Dec 29;

Authors: Piñero A, de Torre C, Martínez-Escribano J, Campillo J, Canteras M, Nicolás F

Abstract

BACKGROUND: There is some controversy in the literature regarding the possible prognostic value of cases of multiple lymphatic basin drainage (MLBD). The purpose of this work was to study the differences in prognosis depending on whether there is MLBD from primary cutaneous melanoma. METHODS: We conducted a cohort analysis from a prospective database, and 112 consecutive patients with cutaneous melanoma were included. Sentinel lymph node biopsy (SLNB) was done in all of them. MLBD was defined as the occurrence of two or more different nodal basins from the same lesion. The demographic and clinical data for cases with a single nodal drainage basin and MLBD were statistically compared using Fisher’s exact test, the χ(2) test, or Mann-Whitney’s test according to the type of variables studied. Multivariate analysis also was performed on the disease-free survival rate using logistic regression analysis. The distribution of disease-free survival was determined using a Cox proportional risk model. RESULTS: Only gender (27% men and 8% women; P = 0.01) and the localization of the primary tumor in the trunk (P < 0.001) were associated with the presence of MLBD. It also was observed that the cases with a high Breslow thickness or with MLBD were only associated with a worse disease-free survival rate in cases with positive (P < 0.01 and P = 0.047, respectively) and negative (P < 0.011 and P = 0.019, respectively) SLNB. CONCLUSIONS: This study suggests that both Breslow thickness and the presence of MLBD are statistically significant independent prognostic factors of disease-free survival in patients with cutaneous melanoma.

PMID: 22205107 [PubMed - as supplied by publisher]

Thoracoscopic Removal of Mediastinal Parathyroid Lesions: Selection of Surgical Approach and Pitfalls of Preoperative and Intraoperative Localization.

World J Surg. 2011 Dec 29;

Authors: Iihara M, Suzuki R, Kawamata A, Horiuchi K, Okamoto T

Abstract

BACKGROUND: Thoracoscopic surgery has replaced conventional sternotomy or thoracotomy for resection of mediastinal parathyroid lesions. We review our experience with this type of surgery with reference to selection of the appropriate approach and the pitfalls of lesion localization before and during surgery. METHODS: During a 14-year period, we treated 14 patients with hyperparathyroidism, in whom a mediastinal lesion had been localized preoperatively by sestamibi scan. Primary hyperparathyroidism was present in 12 patients (single adenoma in 11, associated with MEN 1 in one) and secondary hyperparathyroidism in 2. Thoracoscopic procedures were performed by the three-port method. RESULTS: The thoracoscopic procedure was successful in eight patients who were shown preoperatively to have a deep-seated (5 anterior, 3 middle) mediastinal lesions. Intraoperative visual confirmation of parathyroid adenoma was difficult only in a 19-year-old patient with a tumor embedded in the thymus, necessitating partial thymectomy. One of the eight mediastinal lesions resected thoracoscopically was a sestamibi-positive thymoma. Secondary hyperparathyroidism recurred 4 years after thoracoscopic mediastinal parathyroidectomy in one patient, necessitating additional thoracoscopic removal of this supernumerary lesion. However, seven patients with mediastinal parathyroid lesions localized at the aortic arch or upper region were treated successfully via a cervical approach. None of the patients suffered any surgical complications. CONCLUSIONS: Thoracoscopic surgery is safe and feasible for resection of deep mediastinal parathyroid lesions. Such lesions localized preoperatively at the aortic arch or upper region can be treated via a cervical approach. Preoperative sestamibi scan can sometimes give a false-positive result in cases of concurrent thymoma.

PMID: 22205108 [PubMed - as supplied by publisher]

Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism.

World J Surg. 2011 Dec 28;

Authors: Schneider R, Slater EP, Karakas E, Bartsch DK, Schlosser K

Abstract

BACKGROUND: The aim of the present study was to evaluate the outcome of different surgical procedures for patients on permanent dialysis who underwent initial parathyroidectomy for renal hyperparathyroidism (rHPT). METHODS: Out of a prospective database of patients who underwent parathyroid surgery for rHPT between 1976 and 2009, patients on permanent dialysis who underwent initial parathyroidectomy were further analyzed regarding perioperative biochemical changes and postoperative outcome. RESULTS: A total of 606 patients were analyzed. Total parathyroidectomy with autotransplantation (group A) was performed in 504 patients, total parathyroidectomy without autotransplantation in 32 (group B), subtotal parathyroidectomy in 21 (group C), and incomplete parathyroidectomy in 49 (group D). After surgery, mean calcium levels dropped from 2.76 to 1.91 mmol/l in group A, from 2.67 to 2.11 mmol/l in group B, from 2.70 to 2.09 mmol/l in group C, and from 2.65 to 1.94 mmol/l in group D. The parathyroid hormone level dropped from 1,371.4 pg/ml to 28.8 pg/ml in group A, from 1,078.4 pg/ml to 27.0 pg/ml in group B, from 2,377.9 pg/ml to 61.4 pg/ml in group C, and from 1,010.2 pg/ml to 99.5 pg/ml in group D. Persistent rHPT occurred in 2/504 patients from group A (0.4%), 0/32 patients from group B (0%), 1/21 patients from group C (4.8%), and 2/49 patients from group D (4.1%). After a mean follow-up of 57.6 months, recurrent rHPT occurred in 27/504 patients from group A (5.4%), in 0/32 patients from group B (0%), in 2/21 patients from group C (9.5%), and in 3/49 patients from group D (6.1%). CONCLUSIONS: Total parathyroidectomy with or without autotransplantation is a feasible and safe surgical procedure for patients on permanent dialysis with otherwise uncontrollable rHPT.

PMID: 22202993 [PubMed - as supplied by publisher]

Axillary and Supraclavicular Recurrences are Rare after Axillary Lymph Node Dissection in Breast Cancer.

World J Surg. 2011 Dec 28;

Authors: Siponen ET, Vaalavirta LA, Joensuu H, Leidenius MH

Abstract

BACKGROUND: This study was designed to evaluate the incidence of and risk factors for axillary recurrence (AR) and supraclavicular recurrence (SR) in breast cancer patients with axillary lymph node dissection. METHODS: The study was based on 1,180 patients with unilateral invasive breast cancer operated between January 2000 and December 2003. The median duration of follow-up was 78 months. RESULTS: The 7-year AR incidence was 0.7% and SR incidence was 1.3%. Twelve of the 14 SR patients and 4 of the 8 AR patients had concomitant distant recurrences. No risk factors for AR were identified. Histological tumor grade III as well as estrogen and progesterone negativity were risk factors for SR. SR, but not AR, was an independent risk factor for poor breast cancer-specific survival [hazard ratio, 10.116; P < 0.0001]. Among N1 patients, the extent of radiotherapy (RT) had no influence on regional recurrences. Among N2-N3 patients, the 7-year regional recurrence rates were 34.3% in patients without RT, 0% in patients with local RT, and 1.2% in patients with locoregional RT (P < 0.0001). CONCLUSIONS: AR and SR are rare events that often are detected concomitantly with distant metastases. SRs are associated with aggressive disease and poor survival. Our results also suggest that regional RT reduces regional recurrences in N2-N3 patients but not in N1 patients, but the retrospective, nonrandomized study setting renders this conclusion as uncertain.

PMID: 22202994 [PubMed - as supplied by publisher]

Tuberculous Peritonitis: The Closer You Go, the More Confused You Get.

World J Surg. 2011 Dec 28;

Authors: Garg PK, Jain BK, Mohanty D

PMID: 22202995 [PubMed - as supplied by publisher]

BRAF(V600E) Mutation is Associated with Tumor Aggressiveness in Papillary Thyroid Cancer.

World J Surg. 2011 Dec 22;

Authors: Kim SJ, Lee KE, Myong JP, Park JH, Jeon YK, Min HS, Park SY, Jung KC, Koo DH, Youn YK

Abstract

BACKGROUND: The BRAF(V600E) mutation is the most common genetic alteration found in papillary thyroid cancer (PTC). Recent studies show that this mutation occurs more frequently in patients with PTC showing aggressive clinicopathologic features. The aim of the present study was to evaluate the prevalence of the BRAF(V600E) mutation in tumor samples and its association with high-risk clinicopathologic features prospectively. PATIENTS AND METHODS: From February 2009 to January 2010, 547 PTC patients who underwent surgery in Seoul National University Hospital were enrolled in the study. Polymerase chain reaction was used to amplify exon 15 of the BRAF gene from paraffin-embedded thyroid tumor specimens, followed by direct sequencing to detect the BRAF(V600E) mutation. Both univariate and multivariate analyses were performed to analyze associations between the BRAF(V600E) mutation and clinicopathologic features. RESULTS: The BRAF(V600E) mutation was found in 381/547 (69.7%) patients with primary PTC. The BRAF(V600E) mutation was significantly associated with age (≥45 years), tumor size (>1 cm), extrathyroidal extension, and cervical lymph node metastases (P < 0.05). Multiple logistic regression showed that it was significantly associated with gender (OR = 1.834; 95% CI 1.021-3.463), tumor size (OR = 1.972; 95% CI 1.250-3.103), and extra-thyroidal extension (OR = 2.428; 95% CI 1.484-3.992), but not with age, multifocality, lymph node metastases, and advanced disease stage. The proportion of BRAF(V600E) mutation was significantly associated with the number of high-risk factors of tumor recurrence (P < 0.001). CONCLUSIONS: The BRAF(V600E) mutation was associated with high-risk clinicopathologic characteristics in patients with PTC. The BRAF(V600E) mutation may be a potential prognostic factor in PTC patients.

PMID: 22190222 [PubMed - as supplied by publisher]

Technical Feasibility of Robot-Assisted Ventral Hernia Repair.

World J Surg. 2011 Dec 23;

Authors: Allison N, Tieu K, Snyder B, Pigazzi A, Wilson E

Abstract

BACKGROUND: The da Vinci robotic laparoscopic incisional hernia repair with intracorporeal closure of the fascial defect and circumferential suturing of the mesh may offer an alternative to current fascial closure and transabdominal sutures and tackers. METHODS: From 2009 to 2011, a retrospective review of 13 patients with a mean age of 51 years, median body mass index (BMI) of 31.53 kg/m(2), and small and medium-sized ventral hernias (mean fascial defect 37.39 cm(2)) were treated with the da Vinci robot system using intracorporeal primary closure of the fascial defect with a running O-absorbable suture followed by underlay mesh fixation using a continuous running, circumferential, nonabsorbable suture. This study aimed to assess the technical feasibility of the procedure. In addition, the operating time and specific morbidity of postoperative pain, and long-term recurrence were recorded. RESULTS: The mean operating time was 131 min. There were no conversions to open or standard laparoscopic techniques. There were no postoperative deaths. The overall morbidity rate was 13%. One patient remained in hospital for pain control, and another experienced urinary retention that required a Foley catheter. The mean hospital stay was 2.4 days. During a median follow-up period of 23 months, one of the patients experienced a recurrent hernia. None experienced chronic suture site pain or discomfort. CONCLUSIONS: This is a retrospective series review of robot-assisted ventral hernia repair using intracorporeal primary closure followed by continuous running, circumferential fixation. The findings show that this technique is feasible and may not be associated with chronic postoperative pain. Further evaluation is needed, and long-term data are lacking to assess the benefit to the patient, but this series can be the basis for future studies.

PMID: 22194031 [PubMed - as supplied by publisher]

Erratum to: Controlled Tissue Expansion in the Initial Management of the Short Bowel State.

World J Surg. 2011 Dec 21;

Authors: Murphy F, Khalil BA, Gozzini S, King B, Bianchi A, Morabito A

PMID: 22187128 [PubMed - as supplied by publisher]

Value of the Metastatic Lymph Node Ratio for Predicting the Prognosis of Non-Small-Cell Lung Cancer Patients.

World J Surg. 2011 Dec 21;

Authors: Wang CL, Li Y, Yue DS, Zhang LM, Zhang ZF, Sun BS

Abstract

BACKGROUND: The aim of this study was to investigate the relation between the metastatic lymph node ratio (LNR) and the prognosis of non-small-cell lung cancer (NSCLC). METHODS: A total of 301 patients with N1 or N2 NSCLC who underwent complete pulmonary resection were analyzed retrospectively. The correlations between the LNR and clinical and pathologic data were analyzed using χ(2) test analysis. The prognostic value of the LNR was calculated by univariate Kaplan-Meier survival analysis and multivariate Cox proportional hazard model analysis. The risk groups were classified by a combination of the LNR and pN stage. RESULTS: The LNR was correlated with age, smoking status, pathologic type, subcarinal lymph node, clinical staging, N stage (P < 0.05), and the number of positive lymph nodes and positive lymph node stations (P < 0.0001). In the univariate analysis, the LNR played an important role in predicting overall survival (OS) (P < 0.0001) and disease-free survival (P < 0.0001) by Kaplan-Meier survival analysis. In the multivariate analysis, high LNR (>18%) was an independent poor prognostic factor for OS [hazard ratio (HR) 2.5034, 95% confidence interval (CI) 1.6096-3.8933, P < 0.0001] and DFS (HR 1.9023, 95% CI 1.2465-2.9031, P = 0.0031). Stratification into high-, medium-, and low-risk groups-based on high-risk factors (LNR > 18%, N2) intermediate-risk factors (LNR > 18%, N1 or LNR < 18%, N2), and low-risk factors (LNR < 18%, N1)-could efficiently predicted outcomes (P < 0.0001) of patients with lymph node-positive NSCLC. CONCLUSIONS: The combination of the LNR and pN status provides a valuable help with prognosis. However, these results must be evaluated further in a large prospective randomized clinical trial.

PMID: 22187129 [PubMed - as supplied by publisher]

Risk Factors for Postoperative Recurrence in Patients with Pathologically T1 Colorectal Cancer.

World J Surg. 2011 Dec 21;

Authors: Iida S, Hasegawa H, Okabayashi K, Moritani K, Mukai M, Kitagawa Y

Abstract

BACKGROUND: The evolution of diagnostic procedures has resulted in an increase in early detection of pathologically T1 (pT1) colorectal cancer (CRC). However, the risk factors affecting long-term outcomes of patients with pT1 CRCs have been unclear. The aim of the present study was to identify risk factors for postoperative recurrence and overall survival in patients with pT1 CRC. METHODS: Between January 1990 and January 2003, a total of 284 patients with pT1 CRC underwent radical surgery in the authors’ institution. The impact of clinicopathological factors on postoperative recurrence and overall survival was estimated by univariate and multivariate analysis. RESULTS: The median follow-up period was 55 months (interquartile range: 47.1 months). Postoperative recurrence occurred in 8 (2.8%) patients. The overall 5-year and 10-year disease-free survival rates were 98.4 and 92.7%. Multivariate analysis showed the presence of lymphatic invasion only was an independent risk factor for postoperative recurrence in pT1 CRC patients (hazard ratio: 11.622; P = 0.003). The 5-year and 10-year disease-free survival rates of the patients in N-ly- group, the N-ly + group, and the N+ group were 99.5%/98.2% and 96.3%/75.2%, and 93.3%/93.3%, respectively. Additionally, 4 of the 8 recurrences were found more than 5 years after the operation. CONCLUSIONS: Lymphatic invasion was an independent risk factor for recurrence in pT1 CRC patients.

PMID: 22187130 [PubMed - as supplied by publisher]

Effects of Seat Belt Usage on Injury Pattern and Outcome of Vehicle Occupants After Road Traffic Collisions: Prospective Study.

World J Surg. 2011 Dec 21;

Authors: Abu-Zidan FM, Abbas AK, Hefny AF, Eid HO, Grivna M

Abstract

BACKGROUND: Injury and death from road traffic collisions (RTCs) is a major health problem worldwide. The seat belt is the most important RTC safety innovation to reduce injury severity and death from RTCs. We aimed to study the effects of seat belt usage on injury patterns and outcomes of restrained vehicle occupants compared with unrestrained occupants after RTCs. METHODS: RTC trauma patients who were vehicle occupants and admitted to Al-Ain and Tawam Hospitals, or who died after arrival at the emergency departments were prospectively studied during the period of April 2006 to October 2007. Demography of patients, position in the vehicle, usage of seat belts, injury severity markers, Glasgow Coma Scale (GCS), hospital stay, need for surgery, injured body regions, and mortality were analyzed. RESULTS: Of 783 vehicle occupants, 766 (98%) patients with known seat belt status were studied. Among them, the 631 (82.4%) who were unrestrained were significantly younger than the restrained patients (P < 0.0001). The Abbreviated Injury Scale (AIS) scores for the thorax, back, and lower extremity were significantly higher in unrestrained than in restrained patients (P = 0.001, P = 0.036, and P = 0.045 respectively). The GCS was significantly lower in unrestrained than in restrained patients (P = 0.006). More surgical operations were performed in the unrestrained patients (P = 0.027). CONCLUSIONS: Seat belt usage reduces the severity of injury, hospital stay, and number of operations in injured patients. Seat belt compliance is low in our community. More legal enforcement of seat belt usage is mandatory to reduce the severity of injury caused by RTCs.

PMID: 22187131 [PubMed - as supplied by publisher]

Successful Gastric Submucosal Tumor Resection Using Laparoscopic and Endoscopic Cooperative Surgery.

World J Surg. 2011 Dec 21;

Authors: Tsujimoto H, Yaguchi Y, Kumano I, Takahata R, Ono S, Hase K

Abstract

BACKGROUND: Laparoscopic wedge resections are increasingly utilized to treat gastric submucosal tumors (SMTs). However, laparoscopic wedge resection is not applicable for tumors located near the gastric inlet or outlet and requires resection of relatively large sections of healthy stomach, particularly if laparoscopic linear staplers are used. METHODS: Twenty consecutive patients underwent laparoscopic and endoscopic cooperative surgery (LECS) for resection of gastric SMTs. The procedure was performed under general anesthesia. The mucosal and submucosal layers around the tumor were circumferentially dissected using endoscopic submucosal dissection via intraluminal endoscopy. Subsequently, the seromuscular layer involving three-fourths of the line of the incision around the tumor was laparoscopically dissected. The submucosal tumor was then exteriorized to the abdominal cavity and dissected with an endoscopic linear stapling device. RESULTS: In all cases, the LECS procedure was successful in dissecting the gastric SMT. The tumor was located in the upper third of the stomach in eight cases, in the middle third in eight cases, and in the lower third in four cases. The mean operating time was 157.0 ± 68.4 minutes, and the mean intraoperative blood loss was 3.5 ± 6.4 ml. The postoperative course was uneventful in all cases. CONCLUSIONS: We demonstrated the feasibility and satisfactory surgical outcomes after LECS for gastric SMT. With LECS, relatively small sections of healthy gastric wall are resected without postoperative morbidity or mortality. Thus, LECS is safe, easy, and beneficial for laparoscopic resection of SMTs, although care should be taken to avoid gastric juice contamination.

PMID: 22187132 [PubMed - as supplied by publisher]

A Predictive Model of Suitability for Minimally Invasive Parathyroid Surgery in the Treatment of Primary Hyperthyroidism.

World J Surg. 2011 Dec 15;

Authors: Kavanagh DO, Fitzpatrick P, Myers E, Kennelly R, Skehan SJ, Gibney RG, Hill AD, Evoy D, McDermott EW

Abstract

BACKGROUND: Improved preoperative localizing studies have facilitated minimally invasive approaches in the treatment of primary hyperparathyroidism (PHPT). Success depends on the ability to reliably select patients who have PHPT due to single-gland disease. We propose a model encompassing preoperative clinical, biochemical, and imaging studies to predict a patient’s suitability for minimally invasive surgery. METHODS: For the purposes of the present study, 180 consecutive patients were included for analysis. A 5-variable model based on preoperative ionized serum calcium (>1.4 mmol/l), intact parathyroid hormone level (≥2 times the upper limit of normal), positive sestamibi scan for a single affected gland, positive ultrasound scan for a single gland, and concordance between the two imaging modalities for single-gland disease at a similar location was employed, where a score of 1 was allocated for each variable present. RESULTS: Of the 180 patients, 62 (34%) underwent bilateral exploration, 63 (36%) underwent unilateral exploration, and 55 (30%) underwent minimally invasive parathyroidectomy. The results showed that 92% had single-gland disease, 3% had double adenomas, and 5% had hyperplasia. Biochemical cure was achieved in 98.9%. Mean follow-up was 153 days (range: 80-342 days). With the predictive scoring model, a score of ≥3 had a positive predictive value of 100% for single-gland disease. CONCLUSIONS: A scoring model encompassing preoperative biochemical and imaging data can be successfully employed to predict suitability for minimally invasive surgery in the majority of patients with single-gland disease.

PMID: 22170475 [PubMed - as supplied by publisher]

A Quarter Century Experience in Liver Trauma: A Plea for Early Computed Tomography and Conservative Management for all Hemodynamically Stable Patients.

World J Surg. 2011 Dec 15;

Authors: Petrowsky H, Raeder S, Zuercher L, Platz A, Simmen HP, Puhan MA, Keel MJ, Clavien PA

Abstract

BACKGROUND: Advances in diagnostic imaging and the introduction of damage control strategy in trauma have influenced our approach to treating liver trauma patients. The objective of the present study was to investigate the impact of change in liver trauma management on outcome. METHODS: A total of 468 consecutive patients with liver trauma treated between 1986 and 2010 at a single level 1 trauma center were reviewed. Mechanisms of injury, diagnostic imaging, hepatic and associated injuries, management (operative [OM] vs. nonoperative [NOM]), and outcome were evaluated. The main outcome analysis compared mortality for the early study period (1986-1996) versus the later study period (1997-2010). RESULTS: 395 patients (84%) presented with blunt liver trauma and 73 (16%) with penetrating liver trauma. Of these, 233 patients were treated with OM (50%) versus 235 with NOM (50%). The mortality rate was 33% for the early period and 20% for the later period (odds ratio 0.19; 95% CI 0.07-0.50, P = 0.001). A significantly increased use of computed tomography (CT) as the initial diagnostic modality was observed in the late period, which almost completely replaced peritoneal lavage and ultrasound. There was a significant shift to NOM in the later period (early 15%, late 63%) with a low conversion rate to OM of 4.2%. Age, degree of hepatic and head injury, injury severity, intubation at admission, and early period were independent predictors of mortality in the multivariate analysis. CONCLUSIONS: Integration of CT in early trauma-room management and shift to NOM in hemodynamically stable patients resulted in improved survival and should be the gold standard management for liver trauma.

PMID: 22170476 [PubMed - as supplied by publisher]

The Necessity and Reliability of Intraoperative Parathyroid Hormone (PTH) Testing in Patients with Mild Hyperparathyroidism and PTH Levels in the Normal Range: Reply.

World J Surg. 2011 Dec 16;

Authors: Alhefdhi A, Chen H

PMID: 22173590 [PubMed - as supplied by publisher]

Effects of Emptying Function of Remaining Stomach on QOL in Postgastrectomy Patients.

World J Surg. 2011 Dec 16;

Authors: Hayami M, Seshimo A, Miyake K, Shimizu S, Kameoka S

Abstract

BACKGROUND: Attention has recently focused on decreased quality of life (QOL) that occurs in postgastrectomy patients. We verified how gastric emptying function affected QOL. METHODS: Subjects were 72 consecutive patients after gastrectomy for cancer, including 25 after distal gastrectomy (DG), 18 after proximal gastrectomy (PG), 16 after pylorus-preserving gastrectomy (PpG), and 13 after total gastrectomy (TG). Using the (13)C breath test method, (13)CO(2) levels in breath were measured over 2 h, and T (max) was determined. Questionnaires (Japanese versions of the Short-Form 36 [SF-36] and Gastrointestinal Symptom Rating Scale [GSRS]) were used to analyze QOL and correlations between questionnaire results and T (max). RESULTS: Mean T (max) (min) for each procedure was 15.4 for DG, 21.1 for PG, 41.3 for PpG, and 10.4 for TG. T (max) differed between procedures, but not between survey periods. SF-36 was not correlated with T (max), whereas GSRS showed a difference in diarrhea and total score between procedures, but not between survey periods. In addition, GSRS correlated with T (max) for abdominal pain, indigestion, and total score. The total scores showed a significant symptom aggregation in patients with T (max) less than 21 min. CONCLUSIONS: Gastrointestinal symptoms in postgastrectomy patients were associated with the function of the remaining stomach. The (13)C breath test is useful for objectively assessing such symptoms.

PMID: 22173591 [PubMed - as supplied by publisher]

Development of a Surgical Capacity Index: Opportunities for Assessment and Improvement.

World J Surg. 2011 Dec 16;

Authors: Kwon S, Kingham TP, Kamara TB, Sherman L, Natuzzi E, Mock C, Kushner A

Abstract

BACKGROUND: Significant gaps exist in the provision of surgical care in low- and middle-income countries (LMICs). The purpose of this study was to develop a metric to monitor surgical capacity in LMICs. METHODS: The World Health Organization developed a survey called the Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Using this tool, we developed a surgical capacity scoring index and assessed its usefulness with data from Sierra Leone, Liberia, and the Solomon Islands. RESULTS: There were data from 10 hospitals in Sierra Leone, 16 hospitals in Liberia, and 9 hospitals in the Solomon Islands. The levels of surgical capacity were created using our scoring index based on a possible 100 points: level 1 for hospitals with <50 points, level 2 with 50-70 points, level 3 with 70-80 points, and level 4 with >80 points. In Sierra Leone, 44% of the hospitals had a surgical capacity rating of level 1, 50% level 2, and 10% level 3. In Liberia, 37.5% of the hospitals had a surgical capacity rating of level 1, 56.3% level 2, and only one hospital level 3. For Sierra Leone and Liberia, two factors-infrastructure and personnel-had the greatest deficits. In the Solomon Islands, 44.4% of the hospitals had their surgical capacity rated at level 1, 22.2% at level 2, 11.1% at level 3, and 22.2% at level 4. CONCLUSIONS: Pending pilot testing for reliability and validity, it appears that a systematic hospital surgical capacity index can identify areas for improvement and provide an objective measure for monitoring changes over time.

PMID: 22173592 [PubMed - as supplied by publisher]

Lateral Incision Surgery for Pilonidal Sinus: Death of a Dogma.

World J Surg. 2011 Dec 16;

Authors: Cheetham M

PMID: 22173593 [PubMed - as supplied by publisher]

Reappraisal of Percutaneous Transhepatic Biliary Drainage Tract Recurrence After Resection of Perihilar Bile Duct Cancer.

World J Surg. 2011 Dec 8;

Authors: Hwang S, Song GW, Ha TY, Lee YJ, Kim KH, Ahn CS, Sung KB, Ko GY, Kim MH, Lee SK, Moon DB, Jung DH, Park GC, Lee SG

Abstract

BACKGROUND: The high incidence of percutaneous transhepatic biliary drainage (PTBD) tract recurrence after resection of perihilar bile duct cancer (BDC) at a reference single center has suggested the need for endoscopic biliary drainage (EBD) to prevent PTBD-related tumor recurrence. To determine the general applicability of these findings, we validated the risk of PTBD tract recurrence in patients with resected BDC in our high-volume center. METHODS: The medical records of 306 patients with perihilar BDC who underwent hepatobiliary resection with curative intent over 10 years were reviewed retrospectively. RESULTS: Of the 306 patients, 293 (95.8%) underwent biliary decompression, 171 (56.1%) by preoperative PTBD, 62 (20.3%) by EBD alone, and 60 (19.7%) by both. Of the 231 patients who underwent PTBD, 160 (69.3%), 62 (26.8%), and 9 (3.9%) had one, two, or three catheters, respectively (mean of 1.3 catheters per patient for a median 23 days). No patient experienced synchronous PTBD tract metastasis, whereas 4 (1.7%) experienced PTBD tract recurrence a median 13.5 months after surgery, with 3 of these patients having an intraabdominal recurrence soon afterward. Only one patient had a solitary tract recurrence without intraabdominal metastasis. These patients survived for a median 25 months, which is comparable to survival outcomes after noncurative resection. No risk factor was significantly associated with PTBD tract recurrence. CONCLUSIONS: We think that the risk of PTBD tract recurrence after resection of perihilar BDC is not negligible but is much lower than previously reported. There is no definitive reason to avoid PTBD when it is indicated.

PMID: 22159824 [PubMed - as supplied by publisher]

Renal Vein Lengthening Using Gonadal Vein Reduces Surgical Difficulty in Living-Donor Kidney Transplantation.

World J Surg. 2011 Dec 9;

Authors: Scott D

PMID: 22159876 [PubMed - as supplied by publisher]

Erratum to: Temporary Closure of the Open Abdomen: A Systematic Review on Delayed Primary Fascial Closure in Patients with an Open Abdomen.

World J Surg. 2011 Dec 9;

Authors: Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Goslings JC

PMID: 22159877 [PubMed - as supplied by publisher]

Erratum to: Preservation of Genital Innervation in Women During Total Mesorectal Excision: Which Anterior Plane?

World J Surg. 2011 Dec 9;

Authors: Peschaud F, Moszkowicz D, Alsaid B, Bessede T, Penna C, Benoit G

PMID: 22159878 [PubMed - as supplied by publisher]

Chest X-ray after Tracheostomy Is Not Necessary Unless Clinically Indicated.

World J Surg. 2011 Dec 14;

Authors: Tobler WD, Mella JR, Ng J, Selvam A, Burke PA, Agarwal S

Abstract

BACKGROUND: Chest radiography is routinely used post-tracheostomy to evaluate for complications. Often, the chest X-ray findings do not change clinical management. The present study was conducted to evaluate the utility of post-tracheostomy X-rays. METHOD: This retrospective review of 255 patients was performed at a single-center, university, level I trauma center. All patients underwent tracheostomy and were evaluated for postprocedure complications. RESULTS: Of the 255 patients, 95.7% had no change in postprocedure chest X-ray findings. New significant chest X-ray findings were found in 4.3% of patients, including subcutaneous emphysema, pneumothorax, and new significant consolidation. Only three of these patients required change in clinical management, and all changes were based on clinical presentation alone. CONCLUSIONS: Routine chest X-ray following tracheostomy fails to provide additional information beyond clinical examination. Therefore radiographic examination should be performed only after technically difficult procedures or if the patient experiences clinical deterioration. Significant cost savings and minimization of radiation exposure can be achieved when chest radiography after tracheostomy is performed exclusively for clinical indications.

PMID: 22167261 [PubMed - as supplied by publisher]

Survival after Lung Metastasectomy in Colorectal Cancer Patients with Previously Resected Liver Metastases.

World J Surg. 2011 Dec 14;

Authors: Gonzalez M, Robert JH, Halkic N, Mentha G, Roth A, Perneger T, Ris HB, Gervaz P

Abstract

BACKGROUND: Resection of hepatic metastases is indicated in selected stage IV colorectal cancer (CRC) patients. A minority will eventually develop pulmonary metastases and may undergo lung surgery with curative intent. The aims of the present study were to assess clinical outcome and identify parameters predicting survival after pulmonary metastasectomy in patients who underwent prior resection of hepatic CRC metastases. METHODS: We performed a retrospective analysis of 27 consecutive patients (median age 62 years; range: 33-75 years) who underwent resection of pulmonary metastases after previous hepatic metastasectomy from CRC in two institutions from 1996 to 2009. All patients underwent complete resection (R0) for both colorectal and hepatic metastases. RESULTS: Median follow-up was 32 months (range: 3-69 months) after resection of lung metastases and 65 months (range: 19-146 months) after resection of primary CRC. Three- and 5-year overall survival rates after lung surgery were 56 and 39%, respectively, and median survival was 46 months (95% CI 35-57). Median disease-free survival after pulmonary metastasectomy was 13 months (95% CI 5-21). At the time of last follow-up, seven patients (26%) had no evidence of recurrent disease and 6 of these 7 patients presented initially with a single lung metastasis. CONCLUSIONS: Resection of lung metastases from CRC patients may result in prolonged survival, even after previous hepatic metastasectomy. Yet, prolonged disease-free survival remains the exception, and seems to occur only in patients with a single lung lesion.

PMID: 22167262 [PubMed - as supplied by publisher]

Epiploic Appendagitis: Is There Need for Surgery to Confirm Diagnosis in Spite of Clinical and Radiological Findings?

World J Surg. 2011 Dec 14;

Authors: Hasbahceci M, Erol C, Seker M

Abstract

BACKGROUND: The present retrospective study was conducted to review the authors’ experience and describe clinical and radiologic features of epiploic appendagitis (EA), which is an uncommon, self-limiting clinical entity mimicking acute appendicitis and diverticulitis. Awareness of the features of EA would allow a correct diagnosis and avoid unnecessary surgical interventions. METHODS: Patients diagnosed as EA in one regional medical center between June 2006 and June 2010 were included. Clinical, laboratory, and imaging features of EA were studied, with particular attention to its unique radiologic appearances. RESULTS: Twenty patients (13 men and 7 women; average age 43.2 years) diagnosed with EA were included in the study. Localized abdominal pain without nausea, vomiting, and fever were the major presenting symptoms for all patients. Laboratory blood tests were normal, except in one patient with leukocytosis and two patients with increased serum C-reactive protein (CRP) levels. A noncompressible hyperechoic ovoid mass with hypoechoic border and without central blood flow on Doppler ultrasound (US) was detected in five of six patients. In all patients, the computed tomography (CT) scans revealed an ovoid fatty mass with hyperattenuating rim and disproportionate adjacent fat stranding. Central dot sign, concomitant old infarct, and lobulation were present in 75%, 20%, and 10% of the patients, respectively. All of the patients were treated conservatively. No recurrences occurred during the follow-up period (average: 24.8 months) in 18 (90%) of the patients. CONCLUSIONS: In patients with localized abdominal pain without other symptoms, diagnosis of EA should be considered. Recognizing the US and CT features of EA may allow an accurate diagnosis and avoid unnecessary surgery.

PMID: 22167263 [PubMed - as supplied by publisher]

Value of Diagnostic and Therapeutic Laparoscopy for Abdominal Stab Wounds: Reply.

World J Surg. 2011 Dec 3;

Authors: Lin HF, Wu JM, Tu CC, Chen HA, Shih HC

PMID: 22139326 [PubMed - as supplied by publisher]

Changing Pattern of Intestinal Obstruction in Northern Jordan.

World J Surg. 2011 Dec 3;

Authors: Omari AH, Alkhatib LL, Khammash MR

Abstract

BACKGROUND: Obstructed abdominal wall hernias have been reported to be the leading cause of mechanical intestinal obstruction (MIO) among adults in developing countries. In the developed countries, postoperative adhesions are the commonest cause. With the worldwide improvements in health services and education, especially in developing countries, we aimed to determine the effects of these improvements on the patterns and outcomes of management of MIO in Jordan METHODS: The records of all patients who were treated for MIO between the years 2005 and 2010 were reviewed retrospectively. Causes of MIO, presenting symptoms, the main imaging study performed, and the results of management are described. The pattern was compared with that in a previous 1993 report from Jordan. RESULTS: A total of 88 patients were treated for MIO. Postoperative adhesions in 52.5%, gastrointestinal tumors in 21.0%, and obstructed abdominal wall hernias in 9.5% were the three major causes of MIO. Three patients developed surgical-site infections (3.3%), and one developed a minor anastomotic leak that was treated accordingly (1.1%). There were no mortalities. In 1993, obstructed hernias accounted for 30% of the MIOs followed by postoperative adhesions and tumors (27 and 14%, respectively). There was a 7% mortality rate. CONCLUSIONS: Our data confirmed that improved health education programs and services changed the pattern of causes improved the outcomes of management of MIO in Jordan.

PMID: 22139327 [PubMed - as supplied by publisher]

Clarifying Assumptions about Intraoperative Stress during Surgical Performance: More Than a Stab in the Dark: Reply.

World J Surg. 2011 Dec 3;

Authors: Wilson M, Malhotra N, Poolton J, Masters R

PMID: 22139328 [PubMed - as supplied by publisher]

Enhanced Recovery Program following Colorectal Resection in the Elderly Patient.

World J Surg. 2011 Dec 7;

Authors: Pawa N, Cathcart PL, Arulampalam TH, Tutton MG, Motson RW

Abstract

BACKGROUND: The enhanced recovery program (ERP) aims to reduce the metabolic response to surgery, hastening recovery and shortening hospital stay. Concerns exist regarding morbidity and hospital stay in elderly patients. The present study aimed to compare the outcomes and compliance of elderly patients managed by an ERP protocol with a younger group. METHODS: A review was performed of a prospective database of patients undergoing colorectal resection managed under the ERP protocol between 2005 and 2010. Patients were grouped into <80 years and ≥80 years, and perioperative data were collated. The postoperative outcomes were compared with the goals set out by the ERP protocol. RESULTS: A total of 688 patients were included, 558 were <80 years (median: 66 years; range: 17-79 years) and 130 were ≥80 years (median: 83 years; range: 80-95 years). Some 96% of operations were planned laparoscopically. Median total length of hospital stay was 6 days (range: 1-108 days) for the <80 year group and 8 days (range: 1-167 days; P 0.363) for the elderly group, with a 30 day readmission rate of 8.6% for the population and no significant differences between groups. The 30 day mortality was 5%, with a significant difference between the two groups (P < 0.0001). Differences in protocol adherence were identified in the discontinuation of intravenous fluids, catheter removal, and early mobilization. CONCLUSIONS: An enhanced recovery program is feasible for colorectal surgery patients ≥80 years of age, with similar compliance as the younger group to some aspects of the protocol and an acceptable readmission rate. Attention to improving compliance in the postoperative phase is necessary, particularly in such high-risk patients, as such improvement may reduce the morbidity and mortality.

PMID: 22146943 [PubMed - as supplied by publisher]

Clinical Implication of Serosal Change in Pathologic Subserosa-Limited Gastric Cancer.

World J Surg. 2011 Dec 7;

Authors: Kim JM, Jung H, Lee JS, Lee HH, Song KY, Park CH, Jeon MH

Abstract

BACKGROUND: The aim of this study was to evaluate the clinical implication of serosal change in pathologic subserosa-limited gastric cancer based on a retrospective analysis. METHODS: A total of 285 patients who were diagnosed with pathologically subserosa-limited gastric cancer were included. The patients were divided into two groups: the accordance group, with subserosa-limited cancer without macroscopic serosa change (n = 124); the discordance group, with subserosa-limited cancer showing macroscopic serosal change (n = 161). RESULTS: Tumor size, number of metastatic lymph nodes, and pathologic N stage were significantly associated with macroscopic serosal change. Serosal change patients presented a higher recurrence rate compared with patients without serosal change (38.0 vs. 20.2% for the 5-year recurrence rate, P = 0.002), and peritoneal seeding presented frequently in serosal-change patients with significance (41.1%). Likewise, the overall survival of serosal-change patients was significantly worse than that for those without serosal change (66.9 vs. 81.4% for the 5-year survival rate, P = 0.002). Serosal change was an independent prognostic factor for overall survival (relative risk 1.784, P = 0.039). CONCLUSIONS: Serosal change in pathologic subserosa-limited gastric cancer is related to poor survival. Therefore, adjuvant chemotherapy should be considered for these patients, and adequate follow-up programs instituted for early detection of peritoneal seeding.

PMID: 22146944 [PubMed - as supplied by publisher]

Management of Delayed Presentation of a Right-Side Traumatic Diaphragmatic Rupture.

World J Surg. 2011 Dec 7;

Authors: Guner A, Ozkan OF, Bekar Y, Kece C, Kaya U, Reis E

Abstract

BACKGROUND: Right-side diaphragmatic rupture is an unusual condition after blunt trauma. The diagnosis may be missed during the early period of trauma and may lead to progressive herniation of intraabdominal contents into the thorax. In this study, we aimed to evaluate the diagnosis and treatment options for the late diagnosis of cases of right-side traumatic diaphragmatic rupture. METHODS: We evaluated the patients with diaphragmatic hernia who were admitted to the hospital during an 8-year period. Only patients with a right-side diaphragmatic hernia and a history of high-energy trauma were included in the study. Patients with left-side diaphragmatic hernia or those who were subjected to emergency operation due to diaphragmatic rupture were excluded from the study. Patient characteristics, clinical presentations, diagnostic tools, and treatment options were evaluated. RESULTS: Eight patients (five men, three women) were enrolled in the study. The most common trauma type was a traffic accident, and the average interval between the trauma and diagnosis was 10 years. Thoracoabdominal computed tomography had high sensitivity and specificity for visualizing the diaphragmatic hernia. No predisposing factor was found to add laparotomy to thoracotomy. There was no postoperative mortality, and no late complications were observed at the assessments during the 45-month follow-up. CONCLUSIONS: Clinical presentation of late diagnosed diaphragmatic hernia, which is encountered only rarely on the right side, requires diagnostic and therapeutic approaches different from those associated with acute diaphragmatic rupture. It should not be forgotten during the differential diagnosis in patients with a history of trauma.

PMID: 22146945 [PubMed - as supplied by publisher]

Combination of Dexamethasone and Tropisetron Before Thyroidectomy to Alleviate Postoperative Nausea, Vomiting, and Pain: Randomized Controlled Trial.

World J Surg. 2011 Dec 7;

Authors: Zhou H, Xu H, Zhang J, Wang W, Wang Y, Hu Z

Abstract

BACKGROUND: Nausea, vomiting, and pain frequently occur after thyoidectomy. Little evidence exists regarding the effects of administrating a combination of dexamethasone and tropisetron to patients undergoing thyroidectomy. We aimed to evaluate the effects of dexamethasone and tropisetron on thyroidectomy outcomes. METHODS: A total of 150 patients undergoing thyroidectomy were included in this prospective randomized, controlled, three-arm study (group D: 8 mg dexamethasone; group T: 5 mg tropisetron; group D+T: 8 mg dexamethasone and 5 mg tropisetron). There were 50 patients in each group. Nausea, vomiting, pain, and the amount of antiemetic and analgesic agents required were recorded 2, 4, 8, 16, 24, 36, and 48 h postoperatively. RESULTS: The complete response rate of nausea and vomiting was significantly higher in group D+T (78%, 39/50), compared with that in group D (58%, 29/50) or group T (66%, 33/50) (P = 0.01). The incidence and severity of nausea in group D+T were significantly lower than in group D and group T, with the difference mainly occurring in the late postoperative period (6-48 h). The severity of postoperative pain was significantly less in the dexamethasone-containing groups (D and D+T groups) than in the tropisetron group. CONCLUSIONS: The combination of dexamethasone and tropisetron offers better prophylaxis for nausea, vomiting, and pain than either drug alone in patients undergoing thyroidectomy, especially during the late period (6-48 h).

PMID: 22146946 [PubMed - as supplied by publisher]

Parathyroid Four-Dimensional Computed Tomography: Evaluation of Radiation Dose Exposure During Preoperative Localization of Parathyroid Tumors in Primary Hyperparathyroidism.

World J Surg. 2011 Dec 7;

Authors: Mahajan A, Starker LF, Ghita M, Udelsman R, Brink JA, Carling T

Abstract

BACKGROUND: Parathyroid four-dimensional computed tomography (4DCT) provides greater sensitivity than sestamibi with single photon emission CT (SPECT, or SeS) for preoperative localization of parathyroid tumors in patients with primary hyperparathyroidism (PHPT). The radiation dose imparted to the patient during preoperative parathyroid imaging, however, has not been analyzed. METHODS: Patients with biochemically unequivocal PHPT referred for minimally invasive parathyroidectomy underwent 4DCT or SeS. 4DCT was performed using a 64 detector row CT scanner, and SeS used a standardized protocol of 20 mCi of technetium-99m followed by planar and SPECT imaging. The CT radiation dose was estimated using the Imaging Performance Assessment of CT Scanners (ImPACT) calculator, and the SeS dose was estimated using the US Nuclear Regulatory Commission Regulation (NUREG) method. RESULTS: The calculated effective doses of 4DCT and SeS were 10.4 and 7.8 mSv, respectively, in contrast to an estimated annual background radiation exposure of approximately 3 mSv. The dose to the thyroid with 4DCT, however, was about 57 times higher (92.0 vs. 1.6 mGy) than that with SeS. Based on age- and sex-dependent risk factors, the calculated risk of 4DCT-related thyroid cancer developing in a 20 year old woman was 1,040/million (i.e., about 0.1%). CONCLUSIONS: 4DCT, a superior preoperative imaging modality for locating parathyroid tumors, imparts a significantly higher thyroid radiation dose than SeS. Given the enhanced risk of thyroid cancer in individuals with radiation exposure at a young age, 4DCT should be used judiciously in young PHPT patients.

PMID: 22146947 [PubMed - as supplied by publisher]

Suppressor of Cytokine Signaling 4 Detected as a Novel Gastric Cancer Suppressor Gene using Double Combination Array Analysis.

World J Surg. 2011 Nov 30;

Authors: Kobayashi D, Nomoto S, Kodera Y, Fujiwara M, Koike M, Nakayama G, Ohashi N, Nakao A

Abstract

BACKGROUND: Molecular mechanisms behind the oncogenesis of gastric cancer (GC) have yet to be identified. METHODS: A novel candidate tumor-suppressor gene, which is also associated with inhibition of epidermal growth factor (EGF), was sought by means of double combination array analysis for use as a prognostic marker of GC. This consisted of expression array and single nucleotide polymorphism array analysis, along with a literature search. Cancerous and noncancerous tissues from an 82-year-old man with GC were analyzed simultaneously. RESULTS: The expression array and literature search identified that the suppressor of cytokine signaling 4 (SOCS4), a negative feedback regulator of EGF signaling, had significantly attenuated expression in tumor tissue. Although chromosomal deletion was not found at 14q22 where SOCS4 is located, numerous CpG sites were observed in the promoter region of the SOCS4 gene. Several GC cell lines showed reactivation of SOCS4 mRNA expression after treatment with 5-aza-2′-deoxycytidine. Using surgically resected specimens, we found that 40 of 50 (80%) tumor tissues exhibited promoter hypermethylation of the SOCS4 gene. Consequently, SOCS4 expression in tumor tissues was significantly weaker than in noncancerous counterparts (P < 0.0001). In the survival analysis, SOCS4 hypermethylation was associated with a poor prognosis of GC patients (P = 0.0320). CONCLUSIONS: Double combination array analysis suggested that SOCS4 could be a novel candidate for further exploration as a tumor-suppressor gene in GC. Hypermethylation was the mechanism by which SOCS4 was silenced and was implicated in the development of GC. SOCS4 methylation might be an informative marker in predicting the prognosis.

PMID: 22127425 [PubMed - as supplied by publisher]

Living Donor Right Hepatectomy Using the Hanging Maneuver by Glisson’s Approach Under the Upper Midline Incision.

World J Surg. 2011 Nov 30;

Authors: Kim SH, Kim YK

Abstract

BACKGROUND: The purpose of this study was to introduce an advanced technique for the best living donor right hepatectomy (LDRH) using the hanging maneuver by Glisson’s approach under an upper midline incision. METHODS: From January 2005 to February 2010, a total of 196 consecutive LDRHs have been performed at the National Cancer Center, Korea. To assess the overall outcomes of LDRH done with two significant technical developments-the upper midline incision and the initial Glisson’s approach-we performed a comparative analysis involving all consecutive living donors, who we divided into three groups based on the two technical modifications over 5 years. RESULTS: Compared with the previous two groups, the third group of 32 consecutive living donors, from September 2009 to February 2010, demonstrated shorter operative time, shorter duration of hospital stay, and lower complication rate with no operative mortality, major morbidity, blood transfusion, or reoperation. All donors were fully recovered and returned to their previous activities. CONCLUSIONS: This LDRH using the hanging maneuver by Glisson’s approach can be completed safely and effectively with good outcomes through an upper midline incision above the umbilicus, which may be a new milestone toward the best LDRH that donor surgeons can pursue.

PMID: 22127424 [PubMed - as supplied by publisher]

Novel Integrated Robotic Approach for Suprapancreatic D2 Nodal Dissection for Treating Gastric Cancer: Technique and Initial Experience.

World J Surg. 2011 Dec 1;

Authors: Uyama I, Kanaya S, Ishida Y, Inaba K, Suda K, Satoh S

Abstract

BACKGROUND: Robotic surgery for the treatment of gastric cancer has been reported, but the technique is not yet established. The objective of this study was to assess the feasibility and safety of our novel integrated procedure for robotic suprapancreatic D2 nodal dissection during distal gastrectomy. METHODS: At our hospital from January 2009 to December 2010, a total of 25 consecutive cases of gastric cancer were treated by robotic distal gastrectomy with intracorporeal Billroth I reconstruction. These patients were enrolled in a prospective study to assess the safety and feasibility of robotic distal gastrectomy with nodal dissection by our novel integrated approach, which consists of three elements: arm formation, the surgical approach, a cutting device. To evaluate the learning curves involved in this approach, clinicopathologic features and surgical outcomes were compared between the initial (n = 12) and late (n = 13) phases. RESULTS: All operations were completed without the need for open or conventional laparoscopic surgery. The mean operating time was 361 ± 58.1 min (range 258-419 min), and blood loss recorded was 51.8 ± 38.2 ml (range 4-123 ml). The median number of retrieved lymph nodes was 44.3 ± 18.4 (range 26-95). R0 resection was accomplished in all cases. There were no deaths or complications related to pancreatic damage. Operating time and surgeon console time for the late phase were significantly shorter than those for the initial phase. CONCLUSIONS: Our novel robotic approach for D2 nodal dissection in gastric cancer is feasible and safe.

PMID: 22131088 [PubMed - as supplied by publisher]

An Elixir for the Troubled Future of General Surgery in South Africa.

World J Surg. 2011 Dec 1;

Authors: Favara DM, Kahn D

PMID: 22131089 [PubMed - as supplied by publisher]

Adverse Outcomes in Patients with Postoperative Ascites after Liver Resection for Hepatocellular Carcinoma.

World J Surg. 2011 Dec 1;

Authors: Chan KM, Lee CF, Wu TJ, Chou HS, Yu MC, Lee WC, Chen MF

Abstract

BACKGROUND: Postoperative ascites (POA) is a common complication after liver resection (LR). The aim of the present study was to identify the risk factors for developing POA and to evaluate its clinical significance in the prognosis of patients with hepatocellular carcinoma (HCC). METHODS: We performed a retrospective analysis of data obtained from 651 patients who underwent LR for the treatment of HCC between January 2001 and July 2005. The patients selected for the study were categorized and analyzed on the basis of the presence or absence of POA. RESULTS: Overall, 166 (25.5%) patients developed POA. A multivariate logistic regression analysis identified that five significant factors-cirrhotic liver, high indocyanine green retention, portal hypertension, hypoalbuminemia, and extent of LR-were associated with the development of POA. The recurrence-free survival and overall survival of patients with POA were significantly lower than those of patients without POA. The 5-year recurrence-free survival rates of patients with intractable POA over those of patients without POA were 31.7% versus 36.1%, and the corresponding 5-year overall survival rates were 17.4% versus 57.0%. The relative risk of mortality within 1 year in patients with POA was 2.4 times (95% confidence interval, 1.76-3.27; p < 0.001) higher than that in patients without POA. CONCLUSIONS: A nomogram for predicting the probability of POA after LR for HCC was constructed on the basis of the identified risk factors, which may be used for risk-stratifying patients who may or may not benefit from surgical resection. Because patients with POA after LR show a high incidence of HCC recurrence and mortality risk, those with intractable ascites should be considered for prompt liver transplantation.

PMID: 22131090 [PubMed - as supplied by publisher]

Should Surgeons Work in Rural District Hospitals in Africa?

World J Surg. 2011 Dec 1;

Authors: Chu K

PMID: 22131091 [PubMed - as supplied by publisher]

Noninvasive Positive Pressure Ventilation in the Management of Post-thyroidectomy Tracheomalacia.

World J Surg. 2011 Dec 1;

Authors: Sabaretnam M, Mishra A

PMID: 22131092 [PubMed - as supplied by publisher]

Male Gender Is a Risk Factor for Recurrent Appendicitis following Nonoperative Treatment: Reply.

World J Surg. 2011 Dec 1;

Authors: Lien WC, Chen CJ

PMID: 22131093 [PubMed - as supplied by publisher]

Preoperative 18F-FDG Uptake is Strongly Correlated with Malignancy, Weiss Score, and Molecular Markers of Aggressiveness in Adrenal Cortical Tumors.

World J Surg. 2011 Dec 1;

Authors: Gust L, Taieb D, Beliard A, Barlier A, Morange I, de Micco C, Henry JF, Sebag F

Abstract

BACKGROUND: Adrenal incidentaloma are frequent in the general population. It can be difficult to diagnose adrenocortical carcinomas among them, even with the progress of imaging techniques. We studied the results of PET-FDG in the diagnosis of such tumours. METHODS: We studied patients referred to the Department of Endocrine Surgery at La Timone Hospital, Marseilles, France, between June 2006 and October 2010 for adrenal tumours. All patients underwent a complete work-up (biological tests and imagery), completed with PET-FDG. We compared the results of PET-FDG and molecular analysis with Weiss score and clinical follow-up. We calculated correlations with the Pearson test. RESULTS: A total of 51 patients were studied. We found that PET-FDG had a sensitivity of 95% and specificity of 97% for the diagnosis of adrenocortical carcinoma. The correlation between PET-FDG and Weiss score was 77% (P ≤ 0.0001). Molecular analyses were correlated as well with Weiss score and malignancy (P < 0.05). CONCLUSIONS: The nature of atypical adrenal masses can be difficult to define during preoperative investigations. For undetermined tumours smaller than 6 cm, characterization with PET-FDG can be one more diagnostic argument pointing to malignancy. It could potentially change the therapeutic strategy and surgical management. In our experience, molecular analyses are available after surgery and have less impact on the therapeutic strategy than PET-FDG. Preoperative PET-FDG can be an asset in the management of adrenal incidentaloma and adrenocortical carcinoma.

PMID: 22131094 [PubMed - as supplied by publisher]

Duration of Time on Intensive Insulin Therapy Predicts Severe Hypoglycemia in the Surgically Critically Ill Population.

World J Surg. 2011 Nov 24;

Authors: Mowery NT, Gunter OL, Kauffmann RM, Diaz JJ, Collier BC, May AK

Abstract

BACKGROUND: Hypoglycemia has emerged as a barrier to the practice of intensive insulin therapy. Current literature suggests that hypoglycemia occurs at variable rates and has different effects on outcomes in surgical and medical populations. We sought to determine the incidence, independent predictors, and effect on outcome of severe hypoglycemia (≤ 40 mg/dl) in a surgical population. METHODS: A retrospective analysis was performed on all critically ill surgical patients treated with IIT from October 2004 to February 2007. Euglycemia (goal 80-110 mg/dl) was maintained using automated computerized titration of an insulin infusion. The primary outcome of interest was any episode of severe hypoglycemia (≤40 mg/dl). Multivariate logistic regression was used to determine the independent predictors of developing severe hypoglycemia. RESULTS: A total of 60,298 data entries (1,118 patients) for glucose were analyzed. There were 64 severe hypoglycemic episodes in 52 patients (4.6% of the patients). There was a significant increase in deaths among patients who experienced at least one episode of hypoglycemia when compared with those who did not (26.9% vs. 15.3%, P = 0.03). Logistic regression revealed that the time spent on the protocol was the best predictor of developing a hypoglycemic event when controlling for other known risk factors of hypoglycemia. CONCLUSIONS: Intensive insulin therapy can be implemented with a low percentage of patients (4.6%) experiencing severe hypoglycemia. Mortality rate was higher for patients experiencing hypoglycemia. The duration of the time spent on the protocol was the best predictor of hypoglycemia, suggesting that hypoglycemia is a mathematic probability of prolonged illness, not a reflection of illness severity or demographic features.

PMID: 22113844 [PubMed - as supplied by publisher]

Emergency Surgery in Patients Who Have Undergone Recent Radiotherapy is Associated With Increased Complications and Mortality: Review of 536 Patients.

World J Surg. 2011 Nov 15;

Authors: Sullivan MC, Roman SA, Sosa JA

Abstract

BACKGROUND: There is a paucity of data regarding patients undergoing emergency surgery following radiotherapy. This study examines the morbidity and mortality of patients having emergent surgery ≤90 days after irradiation. METHODS: We identified patients ≥18 years of age in the American College of Surgeons National Surgical Quality Improvement Program (Radiation group) who underwent irradiation ≤90 days before emergency surgery. Patients receiving concomitant chemotherapy were excluded. Subjects were compared to a Control group that did not have preoperative irradiation but underwent similar emergent procedures (matched 1:1 on age and procedure). Demographic and clinical characteristics, including patient co-morbidities, functional status, and preoperative laboratory values, were assessed. Primary outcomes included 30-day postoperative morbidity and mortality. Log-transformed data, bivariate and multivariate linear and conditional logistic regression were used. RESULTS: A total of 536 patients were included, 268 per group. Patient demographics and preoperative co-morbidities were similar between groups. The Radiation group had more mortality [23.9% vs. 11.6%, P < 0.001; odds ratio (OR) 2.4], major complications (45.1% vs. 34.7%, P = 0.014; OR 1.55), and a greater likelihood of sustaining a complication (48.1% vs. 38.1%, P = 0.019; OR 1.51). Days from admission to operation, operating time, likelihood of reoperation, days from operation to death, and length of hospital stay were not statistically different. By conditional logistic regression, death was independently associated with irradiation, chronic obstructive pulmonary disease (COPD), impaired preoperative functional status, and thrombocytopenia; and a major complication was associated with COPD, hypoalbuminemia, and preoperative wound infection. CONCLUSIONS: Patients who require emergent surgery ≤90 days after irradiation sustain increased morbidity and mortality. Optimizing the nutritional and functional status of these patients may improve surgical outcomes.

PMID: 22083433 [PubMed - as supplied by publisher]

Risk Factors for Prolonged Postoperative Ileus After Colorectal Cancer Surgery.

World J Surg. 2011 Nov 15;

Authors: Millan M, Biondo S, Fraccalvieri D, Frago R, Golda T, Kreisler E

Abstract

BACKGROUND: The aim of this study was to analyze factors contributing to prolonged postoperative ileus (POI) after elective bowel resection in patients with colorectal cancer. METHODS: This was a retrospective review of a prospectively maintained database of patients operated on for colorectal cancer during 2006-2009. Patients with abdominal procedures and bowel resection without anastomotic leakage were included. Prolonged POI was defined as no flatus by postoperative day (POD) 6, with or without intolerance to oral intake by POD 6. Variables studied included demographics, prior medical conditions, details of the surgical procedure, and hospital stay. RESULTS: A total of 773 patients met the inclusion criteria. POI occurred in 15.9%. The mean hospital stay was 11 days without POI and 20 days for POI patients (P < 0.001). Factors associated with POI in the univariate analysis were ASA III-IV (P < 0.005), male sex (P < 0.004), smoking (P < 0.015), chronic pulmonary disease (COPD) (P < 0.002), rectal cancer (P < 0.02), and ileostomy (P < 0.001). Multivariate logistic regression analysis showed male sex [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.04-3.5]; COPD (OR 1.9, 95% CI 1.25-31.0), and ileostomy (OR 1.9; 95% CI 1.23-3.07) as risk factors for POI. CONCLUSIONS: The risk of POI seems increased in patients with preoperative COPD and patients with an ileostomy, especially in men. Consideration of these factors could be important for the prevention and treatment of POI.

PMID: 22083434 [PubMed - as supplied by publisher]

Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Patients Undergoing Thyroidectomy: Meta-analysis of Randomized Controlled Trials.

World J Surg. 2011 Nov 15;

Authors: Chen CC, Siddiqui FJ, Chen TL, Chan ES, Tam KW

Abstract

BACKGROUND: Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes. METHODS: We conducted a systematic review of randomized controlled trials (RCTs) that compared preoperative single-dose administration of dexamethasone with no dexamethasone in patients undergoing thyroidectomy. The primary outcome was occurrence of PONV within 24 h, and the secondary outcomes were pain, use of analgesics, and steroid-related complications. RESULTS: Five RCTs were included with a total of 497 patients. A statistically and clinically significant difference in the incidence of PONV was found in favor of dexamethasone [relative risk (RR) 0.38; 95% confidence interval (CI) 0.30-0.49). The visual analog pain score was significantly diminished (weighted mean difference, WMD)-1.50; 95% CI-2.54 to -0.46) at 24 h. The incidence of analgesics use was also reduced (RR 0.61; 95% CI 0.41-0.90) in the dexamethasone group. No steroid-related complications were noted. CONCLUSIONS: A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.

PMID: 22083435 [PubMed - as supplied by publisher]

The Importance of Preoperative Laryngeal Examination Before Thyroidectomy and the Usefulness of a Voice Questionnaire in Screening.

World J Surg. 2011 Nov 15;

Authors: Nam IC, Bae JS, Shim MR, Hwang YS, Kim MS, Sun DI

Abstract

BACKGROUND: The objectives of this study were to emphasize the importance of preoperative laryngeal examination before thyroidectomy by investigating the incidence of coincident abnormal laryngeal conditions that impair the quality of voice, and evaluate the usefulness of the “thyroidectomy-related voice questionnaire” as a screening tool. METHODS: Five hundred consecutive patients scheduled to undergo thyroidectomy underwent preoperative laryngeal examination and voice analysis and completed the questionnaire. According to the laryngeal examination results, patients were classified into normal and abnormal groups. Acoustic-analysis results and questionnaire scores were compared between the two groups, and correlations between acoustic parameters and questionnaire scores were evaluated. The cutoff score of the questionnaire that can effectively discriminate between the two groups was also determined. RESULTS: The incidence of abnormal laryngeal conditions was 35.8%. The most common finding was laryngopharyngeal reflux (27.2%) followed by vocal nodule (4.8%), vocal polyp (1.8%), vocal cord palsy (1.2%), Reinke’s edema (0.4%), vocal cyst (0.2%), and vocal sulcus (0.2%). The perceptual grade of voice quality (0.33 ± 0.49 for normal group vs. 0.65 ± 0.62 for abnormal group, P = 0.000) and the questionnaire scores (3.21 ± 5.47 for normal group vs. 13.41 ± 11.67 for abnormal group, P = 0.000) of the two groups were significantly different, and there was a significant correlation between objective voice parameters and questionnaire scores. A questionnaire score of 5 showed the best sensitivity (74%) and specificity (71%) in discriminating between the two groups. CONCLUSIONS : The incidence of coincident abnormal laryngeal conditions is relatively high; therefore, voice screening before thyroidectomy is important. The “thyroidectomy-related voice questionnaire” is a simple and effective screening tool to detect preexisting laryngeal disorders that can affect the quality of voice.

PMID: 22083436 [PubMed - as supplied by publisher]

Influence of Preoperative Chemotherapy on the Intraoperative and Postoperative Course of Liver Resection for Colorectal Cancer Metastases.

World J Surg. 2011 Nov 16;

Authors: Spelt L, Hermansson L, Tingstedt B, Andersson R

Abstract

BACKGROUND: Liver resection is a possibly curative treatment for colorectal cancer (CRC) liver metastases. Preoperative chemotherapy may make initially irresectable tumors resectable. The aim of this study was to compare perioperative course and short-term mortality after liver resection for CRC metastases between patients who were and were not treated with preoperative chemotherapy. METHODS: Patients who had undergone liver resection for CRC metastases were included. A total of 97 patients treated with preoperative chemotherapy (group A) were compared with 136 who were not (group B). Intraoperative bleeding, operating time, complications, duration of stay, and mortality were compared using Pearson’s χ(2) test, Fisher’s exact test, and the Mann-Whitney U-test. RESULTS: Mean intraoperative bleeding, duration of stay, and operating time were not significantly different. Complications occurred in 62.9% and 63.2% in groups A and B, respectively. The 30- and 90-day mortality rates were zero in group A, comparable to 1.5% in group B. CONCLUSIONS: There were no significant differences in the perioperative course or postoperative mortality when comparing CRC patients with or without chemotherapy prior to liver resection. Consequently, this study suggests that preoperative chemotherapy before liver resection for CRC metastases does not negatively influence perioperative outcome and can therefore be applied if “downstaging” is indicated.

PMID: 22086255 [PubMed - as supplied by publisher]

Primary Closure Following Laparoscopic Common Bile Duct Exploration Combined with Intraoperative Cholangiography and Choledochoscopy.

World J Surg. 2011 Nov 16;

Authors: Cai H, Sun D, Sun Y, Bai J, Zhao H, Miao Y

Abstract

BACKGROUND: Laparoscopic common bile duct exploration (LCBDE) has become one of the main options for treating choledocholithiasis associated with cholelithiasis. Our objective was to assess the short-term outcomes of patients undergoing laparoscopic primary closure of the common bile duct (CBD) compared with laparoscopic choledochotomy plus T-tube drainage. METHODS: We retrospectively studied 137 patients undergoing primary closure following LCBDE (group A) compared with 102 cases with laparoscopic choledochotomy plus T-tube drainage (group B) between January 2007 and January 2010. Intraoperative cholangiography (IOC) and choledochoscopy were performed in all patients. RESULTS: Three patients in group A (2.2%) were converted to open surgery and two (2.0%) in group B because of serious adherence. According to routine IOC, unexpected CBD stones were found in 16 cases (6.8%). The duration of the operation in group A was shorter than in group B (92.4 ± 15.2 vs. 125.7± 32.6 min, P < 0.05), as was length of postoperative stay (3.1± 2.4 vs. 5.7± 4.3 days, P < 0.05). Postoperative bile leakage occurred in six patients (4.5%) in group A and four cases (4.0%) in group B; all of the patients recovered after simple drainage without reoperation. Bile peritonitis was seen in one case after T-tube removal. The median follow-up was 26 months. There were no recurrences. CONCLUSIONS: Laparoscopic primary closure of the CBD is safe and successful for the management of CBD stones. Application of IOC and choledochoscopy to ensure clearance of the CBD and careful suturing are essential for primary closure.

PMID: 22086256 [PubMed - as supplied by publisher]

Erratum to: Plastic and Reconstructive Surgery in Zambia: Epidemiology of 16 Years of Practice.

World J Surg. 2011 Nov 17;

Authors: Jovic G, Scott Corlew D, Bowman KG

PMID: 22089918 [PubMed - as supplied by publisher]

Long-Term Outcome in Patients with Primary Hyperparathyroidism who Underwent Minimally Invasive Parathyroidectomy.

World J Surg. 2011 Nov 17;

Authors: Venkat R, Kouniavsky G, Tufano RP, Schneider EB, Dackiw AP, Zeiger MA

Abstract

BACKGROUND: Minimally invasive parathyroidectomy (MIP) has become a well-accepted treatment for selected patients with primary hyperparathyroidism (PHPT). However, few studies have evaluated long-term outcomes for this operative approach. We therefore chose to examine both the long-term symptom resolution and biochemical cure following MIP for PHPT. METHODS: A total of 460 PHPT patients who underwent a MIP between 2004 and 2009 were successfully mailed a questionnaire that assessed preoperative and postoperative Parathyroidectomy Assessment of Symptoms (PAS) scores, most recent calcium and parathyroid hormone (PTH) levels, and information about any reoperation for PHPT. Long-term evaluation of symptomatic and biochemical cure was performed. RESULTS: A total of 200 patients (43.5%) responded to our correspondence. The mean age of the patients was 58.7 ± 11.9 years, 74.5% were female, and 78.5% were Caucasian. The mean follow-up was 37 ± 19 months. The mean PAS scores fell by 117 ± 14 at long-term follow-up after MIP (P < 0.0001). All 13 symptoms comprising the PAS score diminished, of which ten did so significantly (P < 0.01). There was a significant drop in the mean serum calcium (preop. 11.1 mg/dl, postop. 9.6 mg/dl; P < 0.0001) and PTH (preop. 130.9 pg/ml, postop. 45.7 pg/ml; P < 0.0001) at long-term follow-up. Five patients (2.5%) developed recurrent disease (calcium > 10.5 mg/dl), and one (0.5%) underwent a reoperation for persistent disease and was subsequently cured. CONCLUSIONS: This study demonstrates that MIP has long-term benefits in terms of excellent symptom resolution and a high biochemical cure rate (97%) in selected patients who have PHPT, preoperative localization with sestamibi scans, and assessment of intraoperative PTH level.

PMID: 22089919 [PubMed - as supplied by publisher]

Prognostic Relevance of Survivin in Pancreatic Endocrine Tumors.

World J Surg. 2011 Nov 17;

Authors: Ekeblad S, Lejonklou MH, Stålberg P, Skogseid B

Abstract

BACKGROUND: Better prognostic markers are needed for pancreatic endocrine tumors. Survivin is an apoptosis inhibitor that is suggested to have a negative prognostic impact in several tumor types. Contradictory data exist, especially regarding the significance of a nuclear versus cytoplasmic location of survivin. The prognostic relevance of nuclear and cytoplasmic survivin expression in pancreatic endocrine tumors-controlled for the tumor Ki-67 index, World Health Organization classification, and TNM stage-was investigated. METHODS: A total of 111 patients treated at a tertiary referral center were retrospectively evaluated. Clinical data were gathered from medical records. Immunohistochemistry for survivin and Ki-67 was performed on paraffin-embedded tissue. Univariate and multivariate Cox analyses were performed. RESULTS: Patients with tumors that had <5% survivin-positive nuclei had a mean survival of 225 months [95% confidence interval (CI) 168-281]. The corresponding figure for patients with 5 to 50% survivin-positive tumor cell nuclei was 101 months [95% CI 61-140; hazard ratio (HR) 2.4; P < 0.01) and with >50% survivin-positive nuclei 47 months (95% CI 24-71; HR 4.9; P < 0.001). Nuclear survivin expression in >50% of the tumor cells was an independent marker of a poor prognosis (HR 5.7; P < 0.01). Cytoplasmic survivin was not a significant prognostic factor in the multivariate analysis (HR 0.94; P = 0.90). CONCLUSIONS: High expression of nuclear survivin is a significant marker of a poor prognosis in patients with a pancreatic endocrine tumor.

PMID: 22089920 [PubMed - as supplied by publisher]

Preoperative Brain Natriuretic Peptide (BNP) Is a Better Predictor of Adverse Cardiac Events Compared to Preoperative Scoring System in Patients Who Underwent Abdominal Surgery.

World J Surg. 2011 Nov 17;

Authors: Mercantini P, Di Somma S, Magrini L, Kazemi Nava A, Scarinci A, La Torre M, Ferri M, Ferri E, Petrucciani N, Ziparo V

Abstract

BACKGROUND: Cardiovascular disease is the leading cause of perioperative death in surgical patients. A variety of clinical scoring systems have been developed to predict adverse cardiovascular events. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. We present a prospective, single-center, observational cohort study of patients undergoing major abdominal surgery and evaluate the role of BNP in predicting adverse cardiac events. METHOD: A total of 205 patients were included in the study. All patients were assessed by a cardiological clinical evaluation, a 12-lead ECG report, and a preoperative and postoperative blood sample for plasmatic BNP assessment. The primary end point was the predictive power of preoperative BNP levels for adverse cardiac events until 30 days after discharge. RESULTS: Thirty-one of 205 (15%) patients had adverse cardiac events in the postoperative period up to 30 days after discharge. Five patients (2.4%) of these died of cardiac events. Preoperative BNP values were significantly increased in the 31 patients compared to the other patients in the postoperative period [mean = 112.93 pg/ml (range = 5-2,080) vs. 178.99 pg/ml (range = 5-3,980); median = 117 vs. 23 pg/ml; 95% CI = 49-181; p < 0.0001]. At logistic regression, a preoperative BNP value of >36 pg/ml was the only effective predictor of adverse cardiac events. CONCLUSION: We have demonstrated that elevated preoperative BNP levels are independent predictors of adverse cardiac events in a cohort of patients undergoing major abdominal surgery in a general surgery department, and this is the first study about this specific cohort of patients.

PMID: 22089921 [PubMed - as supplied by publisher]

A Unique Method for Repairing Intraoperative Pulmonary Air Leakage with Both Polyglycolic Acid Sheets and Fibrin Glue.

World J Surg. 2011 Nov 17;

Authors: Yano T, Haro A, Shikada Y, Okamoto T, Maruyama R, Maehara Y

Abstract

BACKGROUND: In the present study we present a unique maneuver, using both fibrin glue and polyglycolic acid (PGA) sheets, for repairing intraoperative pulmonary air leakage, and report our clinical results. METHODS: Based on the results from in vitro experiments, we retrospectively investigated the clinical effects of our method for repairing intraoperative pulmonary air leakage in 377 consecutive patients, who underwent a pulmonary resection for primary lung cancer or metastatic lung tumors from 2004 to 2009. From April 2004 through September 2007, repair of intraoperative pulmonary air leakage was performed in 204 patients using only fibrin glue. From October 2007 through December 2009, the repair was performed in 173 patients with a unique application of both fibrin glue and PGA sheets, i.e., (1) rubbing fibrin glue A solution, (2) applying a PGA sheet cut to an appropriate size, (3) rubbing fibrin glue B solution on the PGA sheet, and (4) reapplying fibrin glue A solution and rubbing. RESULTS: The mean duration of postoperative pleural drainage was significantly shorter in the latter time period when both fibrin glue and PGA sheets were used than in the former period when fibrin glue was used alone. The incidence of prolonged air leakage longer than 1 week was also significantly lower in the latter era than in the former era. CONCLUSION: Our unique application of both fibrin glue and PGA sheets for the intraoperative repair of pulmonary air leakage effectively resulted in a shortening of the duration of postoperative pleural drainage.

PMID: 22089922 [PubMed - as supplied by publisher]

Enhanced Recovery After Surgery (ERAS) Program Attenuates Stress and Accelerates Recovery in Patients After Radical Resection for Colorectal Cancer: A Prospective Randomized Controlled Trial.

World J Surg. 2011 Nov 19;

Authors: Ren L, Zhu D, Wei Y, Pan X, Liang L, Xu J, Zhong Y, Xue Z, Jin L, Zhan S, Niu W, Qin X, Wu Z, Wu Z

Abstract

BACKGROUND: The aim of this trial was to compare the Enhanced Recovery After Surgery (ERAS) program with conventional perioperative management in patients who underwent radical resection for colorectal cancer. METHODS: A combination of evidence-based and consensus methodology was used to develop the ERAS protocol. Five hundred ninety-seven consecutive patients who underwent elective colorectal resection were randomized to either the ERAS (n = 299) or the control group (n = 298). Outcomes relating to nutrition and metabolism index, stress index, and recovery index were measured and recorded. RESULTS: Demographic and operative data were similar between the two groups. Patients in the ERAS group showed improved nutritional status when compared with those of the control group. On postoperative day (POD) 1, the HOMA-IR (insulin resistance index) of the ERAS group was lower than that of the control group (p < 0.001). The cortisol level of the control group was elevated on both POD 1 (p = 0.007) and POD 5 (p = 0.002) compared to the preoperative level. However, the cortisol level of the ERAS group was not increased until POD 5 (p = 0.001). Reduced levels of TNF-α, IL-1β, IL-6, and IFN-γ in the ERAS group indicated less postoperative stress responses. In addition, ERAS was associated with accelerated recovery of gastrointestinal function. The postoperative length of stay (p < 0.001) and expense (p < 0.001) for the ERAS group were reduced in comparison to the controls. Twenty-eight cases in the control group and twenty-nine in the ERAS group suffered complications, which was not significantly different. CONCLUSION: The ERAS protocol attenuates the surgical stress response and accelerates postoperative recovery without compromising patient safety.

PMID: 22102090 [PubMed - as supplied by publisher]

Is Pretreatment Endoscopic Biopsy a Good Predictor of Signet Ring Cell Histology in Gastric Carcinoma?

World J Surg. 2011 Nov 19;

Authors: Piessen G, Amielh D, Messager M, Vinatier E, Leteurtre E, Triboulet JP, Mariette C

Abstract

BACKGROUND: Signet ring cell (SRC) carcinoma is defined as an adenocarcinoma in which >50% of the total operative specimen consists of isolated or small groups of malignant cells containing intracytoplasmic mucins (hSRCs). We previously demonstrated that hSRCs are a predictor of poor prognosis with specific tumoral characteristics suggesting the need for a dedicated therapeutic strategy before surgery. However diagnostic accuracy and prognostic value of SRCs on pretreatment biopsies (bSRCs) is unknown. The aim of the study was to determine if bSRCs can accurately predict hSRCs and survival. METHODS: A retrospective analysis was performed among 254 patients with an adenocarcinoma. We performed pretreatment endoscopic biopsies and histopathologic analysis of the surgical specimen. Pretreatment endoscopic biopsy results were compared with definitive pathologic results and were correlated with long-term survival. RESULTS: From 254 patients enrolled, 96 had bSRCs (37.8%), and 101 (39.8%) had hSRCs. Pretreatment biopsy results were correct in 89 of 101 patients with hSRC (sensitivity 88.1%) and in 146 of 153 with histologic non-SRCs (hNSRCs) (specificity 95.4%). The positive and negative predictive values for the biopsies were 92.7, and 92.4%, respectively, with an overall accuracy of 92.5%. When compared to the biopsy results, non-SRCs (bNSRCs), bSRCs were associated with poorer survival and were identified as an independent factor for poor prognosis (hazard ratio 1.89 with 95% confidence interval 1.35 to 2.64, P < 0.001). CONCLUSIONS: The presence of signet ring cells in samples obtained from routine pretreatment endoscopic biopsies accurately predicts SRC histology and poor prognosis. The specific therapeutic strategy can consequently be considered from the initial diagnosis.

PMID: 22102091 [PubMed - as supplied by publisher]

Implications of HER2 Amplification in Small, Node-Negative Breast Cancers: Do Asians Differ?

World J Surg. 2011 Nov 22;

Authors: Wong FY, Yip CS, Chua ET

Abstract

BACKGROUND: We investigated the implications of HER2 amplification in Asian women with small, node-negative breast cancer in low- and middle-income countries (LMCs). METHODS: We reviewed the charts patients treated between 1989 and 2009 with breast conservation therapy for node-negative breast cancers measuring ≤2 cm. Disease-free survival (DFS), ipsilateral breast tumor recurrence (IBTR), distant disease-free survival (DDFS), and overall survival (OS) rates were estimated using the Kaplan-Meier method and were compared by the log-rank test. Potential covariates-age, tumor grade, hormone receptor status-were analyzed by multivariate analysis. RESULTS: A total of 519 patients were studied including 204 (39%) and 315 (61%) patients diagnosed with pT1ab and pT1c tumors, respectively. Median follow-up was 57 months. HER2 amplification was found in 17.1% of all patients and in 16.7% patients with pT1ab tumors. Among patients with T1ab tumors, 73.0 and 9.3% underwent adjuvant hormonal and chemotherapy, respectively; 3 of 34 T1ab patients with HER2-amplified tumors received trastuzumab. HER2 amplification was associated with poorer 5-year DFS (83.7% vs. 95.5%, P < 0.0001), DDFS (87.5% vs. 97.9%, P < 0.0001), and IBTR (8.6% vs. 2.1%, P < 0.0001) rates in patients with pT1 tumors. Multivariate analysis showed that HER2 amplification remained a significant negative prognostic factor for DFS [hazard ratio (HR) 4.1, 95% confidence interval (CI) 2.1-7.8, P < 0.0001], DDFS (HR 6.3, 95% CI 2.4-17.0, P < 0.0001), and IBTR (HR 4.5, 95% CI 2.0-10.0, P < 0.0001) rates. In the pT1ab subgroup, univariate analysis showed that HER2 amplification prognosticated for DFS (85.1% vs. 95.7%, P = 0.022) and IBTR (14.9% vs. 3.5%, P = 0.004) rates but not for the OS (100% vs. 99.2%, P = 0.487) rate. Similar results were obtained after excluding patients given trastuzumab. CONCLUSIONS: The decision to use trastuzumab in HER2-amplified pT1ab tumors must balance their poor outcome against intrinsic financial limitations in LMCs. Patient selection criteria needs fine-tuning, and resource-sensitive regimens must be explored.

PMID: 22105650 [PubMed - as supplied by publisher]

2011 Acknowledgements.

World J Surg. 2011 Nov 22;

Authors:

PMID: 22105651 [PubMed - as supplied by publisher]

Prizes & Awards International Surgical Week ISW 2011.

World J Surg. 2011 Nov 11;

Authors:

PMID: 22075977 [PubMed - as supplied by publisher]

Ghrelin Agonist TZP-101/Ulimorelin Accelerates Gastrointestinal Recovery Independently of Opioid Use and Surgery Type: Covariate Analysis of Phase 2 Data.

World J Surg. 2011 Nov 10;

Authors: Bochicchio G, Charlton P, Pezzullo JC, Kosutic G, Senagore A

Abstract

BACKGROUND: Delayed recovery of gastrointestinal (GI) motility is a common complication following surgery. TZP-101/ulimorelin is a macrocyclic peptidomimetic ghrelin receptor agonist with GI promotility effects that significantly accelerates time to recovery of GI motility compared to placebo following partial colectomy. It is also well tolerated. The objectives of this analysis were to identify predictors of GI motility recovery in patients undergoing partial colectomy and to evaluate whether these factors affect ulimorelin acceleration of GI recovery. METHODS: Covariate analysis assessed the effect of eight variables-age, sex, body mass index, type of surgery (right colectomy, left colectomy, other), duration of surgery, blood loss, total opioid consumption, country-on recovery of GI motility in 236 patients randomized to ulimorelin (n = 168) or placebo (n = 68). The primary endpoint was the recovery of GI function (time from the end of surgery to first bowel movement). Stepwise regression identified a parsimonious model of the smallest subset of variables best predicting GI recovery. RESULTS: Recovery was shorter for segmental/subtotal colectomies vs. right colectomies (P = 0.016) and longer with increased total opioid use (P = 0.037). The remaining variables had no statistically significant effect on GI recovery. Effects of ulimorelin 480 μg/kg (the most effective dose) on time to GI tract recovery remained statistically and clinically significant (hazard ratio = 1.81, P = 0.014) when adjusted for surgery type and/or total opioid use. CONCLUSIONS: Two factors, type of surgery and total opioid use, independently modified times to recovery of GI motility following partial large bowel resection surgery. Acceleration of recovery of GI motility by ulimorelin was independent of these factors.

PMID: 22072430 [PubMed - as supplied by publisher]