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[PMID]:29201295
[Au] Autor:Kim YK; Ahn JH; Yoo JD
[Ad] Endereço:Department of Orthopaedic Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
[Ti] Título:A Comparative Study of Clinical Outcomes and Second-Look Arthroscopic Findings between Remnant-Preserving Tibialis Tendon Allograft and Hamstring Tendon Autograft in Anterior Cruciate Ligament Reconstruction: Matched-Pair Design.
[So] Source:Clin Orthop Surg;9(4):424-431, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: This study aimed to compare stability, functional outcome, and second-look arthroscopic findings after anterior cruciate ligament reconstruction between remnant-preserving tibialis tendon allograft and remnant-sacrificing hamstring tendon autograft. Methods: We matched two groups (remnant-preserving tibialis tendon allograft group and hamstring tendon autograft group) in terms of demographic characteristics, associated injury, and knee characteristics. Each group consisted of 25 patients. Results: Operation time was longer in the remnant-preserving tibialis tendon allograft group, but there was no significant intergroup difference in stability, clinical outcome, and second-look arthroscopic findings. Conclusions: When an autograft is not feasible in anterior cruciate ligament reconstruction, the remnant-preserving technique can produce comparable results in terms of restoration of function, stability of the knee, and degree of synovium coverage at second-look arthroscopy compared to remnant-sacrificing hamstring autograft.
[Mh] Termos MeSH primário: Lesões do Ligamento Cruzado Anterior/cirurgia
Reconstrução do Ligamento Cruzado Anterior/métodos
Instabilidade Articular/etiologia
Articulação do Joelho/cirurgia
Tendões/transplante
[Mh] Termos MeSH secundário: Adolescente
Adulto
Aloenxertos
Lesões do Ligamento Cruzado Anterior/complicações
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos
Artroscopia
Autoenxertos
Feminino
Seres Humanos
Imagem Tridimensional
Instabilidade Articular/diagnóstico por imagem
Articulação do Joelho/diagnóstico por imagem
Articulação do Joelho/fisiopatologia
Escore de Lysholm para Joelho
Masculino
Análise por Pareamento
Meia-Idade
Duração da Cirurgia
Estudos Retrospectivos
Cirurgia de Second-Look
Tomografia Computadorizada por Raios X
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.424


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[PMID]:29173761
[Au] Autor:Matsumura Y; Suzuki H; Ohira T; Shiono S; Abe J; Sagawa M; Sakurada A; Katahira M; Machida Y; Takahashi S; Okada Y
[Ad] Endereço:Department of Chest Surgery, Fukushima Medical University, School of Medicine, Fukushima, Japan. Electronic address: yukimatsumura1980@gmail.com.
[Ti] Título:Matched-pair analysis of a multi-institutional cohort reveals that epidermal growth factor receptor mutation is not a risk factor for postoperative recurrence of lung adenocarcinoma.
[So] Source:Lung Cancer;114:23-30, 2017 Dec.
[Is] ISSN:1872-8332
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: It is unclear whether epidermal growth factor receptor (EGFR) mutation status is a risk factor for postoperative recurrence of surgically resected lung adenocarcinoma (ADC). Therefore, we conducted a multi-institutional study employing matched-pair analysis to compare recurrence-free survival (RFS) and overall survival (OS) of patients with lung ADC according to EGFR mutation status. METHODS: We collected the records of 909 patients who underwent surgical resection for lung ADC between 2005 and 2012 at five participating institutions and were also examined their EGFR mutation status. For each patient with an EGFR mutation, we selected one with the wild-type EGFR sequence and matched them according to institution, age, gender, smoking history, pathological stage (pStage), and adjuvant treatment. We compared RFS and OS of the matched cohort. RESULTS: The patients were allocated into groups (n=181 each) with mutated or wild-type EGFR sequences. Both cohorts had identical characteristics as follows: institution, median age (68 years), men (85, 47%), ever smokers (77, 43%), and pStage (IA, 108, 60%; IB, 48, 27%; II, 14, 8%; III, 11, 6%). The 3- and 5-year RFS rates of patients with mutated or wild-type EGFR sequence were 79%, 68% and 77%, 68%, respectively (p=0.557). The respective OS rates were 92%, 81%, and 89%, 79% (p=0.574). CONCLUSION: Matched-pair and multi-institutional analysis reveals that an EGFR mutation was not a significant risk factor for recurrence of patients with surgically resected lung adenocarcinoma.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Neoplasias Pulmonares/cirurgia
Análise por Pareamento
Mutação
Recidiva Local de Neoplasia/genética
Receptor do Fator de Crescimento Epidérmico/genética
[Mh] Termos MeSH secundário: Adenocarcinoma/genética
Adenocarcinoma/patologia
Adulto
Idoso
Idoso de 80 Anos ou mais
Intervalo Livre de Doença
Feminino
Seres Humanos
Neoplasias Pulmonares/genética
Neoplasias Pulmonares/patologia
Masculino
Meia-Idade
Recidiva Local de Neoplasia/epidemiologia
Estadiamento de Neoplasias
Pneumonectomia/métodos
Período Pós-Operatório
Receptor do Fator de Crescimento Epidérmico/metabolismo
Fatores de Risco
Fumar/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
EC 2.7.10.1 (EGFR protein, human); EC 2.7.10.1 (Receptor, Epidermal Growth Factor)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180131
[Lr] Data última revisão:
180131
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE


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[PMID]:28871992
[Au] Autor:Markovina S; Youssef F; Roy A; Aggarwal S; Khwaja S; DeWees T; Tan B; Hunt S; Myerson RJ; Chang DT; Parikh PJ; Olsen JR
[Ad] Endereço:Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri; Siteman Cancer Center, 4921 Parkview Place, St. Louis, Missouri.
[Ti] Título:Improved Metastasis- and Disease-Free Survival With Preoperative Sequential Short-Course Radiation Therapy and FOLFOX Chemotherapy for Rectal Cancer Compared With Neoadjuvant Long-Course Chemoradiotherapy: Results of a Matched Pair Analysis.
[So] Source:Int J Radiat Oncol Biol Phys;99(2):417-426, 2017 Oct 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To compare treatment and toxicity outcomes between a phase 2 institutional trial of near total neoadjuvant therapy (nTNT) for locally advanced rectal cancer and a similar historical control cohort treated at Washington University in St. Louis with the current US standard of care, defined as neoadjuvant chemoradiotherapy (NCRT), total mesorectal excision (TME), and adjuvant FOLFOX chemotherapy; to expand the comparison to an additional institution, patients treated with similar NCRT at Stanford University were included. METHODS AND MATERIALS: Sixty-nine patients with cT3-4N0-2M0 rectal adenocarcinoma enrolled on the Washington University in St. Louis phase 2 study of nTNT were included for analysis. Patients treated at the same institution with conventional NCRT and adjuvant FOLFOX were matched for exact cTNM stage. Forty-one patients treated with NCRT at Stanford University were included in a second analysis. Kaplan-Meier analysis with log-rank test was used to compare local control, distant metastasis-free survival, disease-free survival, and overall survival. RESULTS: Median follow-up was 49 and 54 months for nTNT and NCRT, respectively. Pathologic complete response and T-downstaging rates were 28% versus 16% (P=.21) and 75% versus 41% (P<.001) in the nTNT and NCRT cohorts, respectively. Three-year disease-free survival (85% vs 68%, P=.032) was significantly better in the nTNT group. Actuarial 3-year local control (92% vs 96%, P=.36) and overall survival (96% vs 88%, P=.67) were similar. The Stanford cohort had significantly lower clinical stage. After controlling for clinical stage, age, tumor location, institution, and number of chemotherapy cycles, nTNT treatment remained significantly associated with lower risk of recurrence (P=.006). CONCLUSIONS: Patients treated with nTNT had higher T-downstaging and superior distant metastasis-free survival and disease-free survival compared with conventional NCRT when matched for tumor location and exact cTNM stage. Near total neoadjuvant therapy remained a significant multivariate predictor for improved outcome when including patients treated with NCRT at another institution.
[Mh] Termos MeSH primário: Adenocarcinoma/terapia
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Quimiorradioterapia/métodos
Terapia Neoadjuvante/métodos
Recidiva Local de Neoplasia/mortalidade
Neoplasias Retais/terapia
[Mh] Termos MeSH secundário: Adenocarcinoma/patologia
Adulto
Idoso
Idoso de 80 Anos ou mais
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Quimiorradioterapia/efeitos adversos
Intervalo Livre de Doença
Feminino
Fluoruracila/administração & dosagem
Fluoruracila/efeitos adversos
Seres Humanos
Estimativa de Kaplan-Meier
Leucovorina/administração & dosagem
Leucovorina/efeitos adversos
Masculino
Análise por Pareamento
Meia-Idade
Terapia Neoadjuvante/efeitos adversos
Compostos Organoplatínicos/administração & dosagem
Compostos Organoplatínicos/efeitos adversos
Cuidados Pré-Operatórios
Radioterapia/métodos
Neoplasias Retais/mortalidade
Neoplasias Retais/patologia
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE II; COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY
[Nm] Nome de substância:
0 (Organoplatinum Compounds); Q573I9DVLP (Leucovorin); U3P01618RT (Fluorouracil)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170906
[St] Status:MEDLINE


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[PMID]:28847412
[Au] Autor:Routman DM; Funk RK; Tangsriwong K; Lin A; Keeney MG; García JJ; Zarka MA; Lewis JT; Stoddard DG; Moore EJ; Day CN; Zhai Q; Price KA; Lukens JN; Swisher-McClure S; Weinstein GS; O'Malley BW; Foote RL; Ma DJ
[Ad] Endereço:Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota. Electronic address: routman.david@mayo.edu.
[Ti] Título:Relapse Rates With Surgery Alone in Human Papillomavirus-Related Intermediate- and High-Risk Group Oropharynx Squamous Cell Cancer: A Multi-Institutional Review.
[So] Source:Int J Radiat Oncol Biol Phys;99(4):938-946, 2017 Nov 15.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To evaluate whether historic risk categories and indications for adjuvant therapy in the pre-human papillomavirus (HPV) and pre-transoral surgery (TOS) era were associated with clinically significant relapse rates in HPV+ oropharyngeal squamous cell cancer patients undergoing TOS. METHODS AND MATERIALS: A multi-institutional retrospective review of intermediate- and high-risk HPV+ oropharyngeal squamous cell cancer patients not receiving adjuvant therapy after TOS was performed. Perineural invasion, lymphovascular invasion, T3-T4, or ≥N2 disease were considered to be intermediate-risk factors, and extracapsular extension or positive margins were considered to be high-risk features, according to established risk categories. RESULTS: Median follow-up was 42.9 months. Among all 53 patients, the 3-year cumulative incidence of relapse was 26.0%. The 3-year cumulative incidence was 11.8% in the 37 intermediate-risk patients and 52.4% in the 16 high-risk patients. On univariate analysis only high-risk status was significantly associated with an increased risk of relapse (hazard ratio 3.9; P=.018). The salvage rate for relapse was 77%, with 10 of 13 patients undergoing salvage therapy. CONCLUSIONS: Risk category was associated with clinically significant relapse rates after TOS alone in HPV+ oropharyngeal cancer, comparable to historical data and traditional indications for adjuvant therapy for all oropharyngeal cancer.
[Mh] Termos MeSH primário: Carcinoma de Células Escamosas/cirurgia
Carcinoma de Células Escamosas/virologia
Recidiva Local de Neoplasia/cirurgia
Neoplasias Orofaríngeas/cirurgia
Neoplasias Orofaríngeas/virologia
Papillomaviridae
Infecções por Papillomavirus
[Mh] Termos MeSH secundário: Idoso
Carcinoma de Células Escamosas/epidemiologia
Carcinoma de Células Escamosas/patologia
Seguimentos
Seres Humanos
Incidência
Análise por Pareamento
Meia-Idade
Cirurgia Endoscópica por Orifício Natural
Invasividade Neoplásica
Recidiva Local de Neoplasia/epidemiologia
Recidiva Local de Neoplasia/virologia
Neoplasias Orofaríngeas/epidemiologia
Neoplasias Orofaríngeas/patologia
Estudos Retrospectivos
Fatores de Risco
Terapia de Salvação/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171109
[Lr] Data última revisão:
171109
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE


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[PMID]:28816139
[Au] Autor:Shin YS; Yu CS; Park JH; Kim JC; Lim SB; Park IJ; Kim TW; Hong YS; Kim KP; Yoon SM; Joo JH; Kim JH
[Ad] Endereço:Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
[Ti] Título:Total Mesorectal Excision Versus Local Excision After Favorable Response to Preoperative Chemoradiotherapy in "Early" Clinical T3 Rectal Cancer: A Propensity Score Analysis.
[So] Source:Int J Radiat Oncol Biol Phys;99(1):136-144, 2017 Sep 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To compare oncological outcomes of total mesorectal excision (TME) and local excision (LE) in patients with "early" clinical T3 rectal cancer who received preoperative chemoradiotherapy (PCRT). METHODS AND MATERIALS: "Early" clinical T3 rectal cancer was radiologically defined as tumors with extramural extension of <5 mm without mesorectal fascia involvement and lateral lymph node metastasis. Patients with "early" clinical T3 rectal cancer who received PCRT followed by TME or LE between January 2007 and December 2013 were retrospectively analyzed. Propensity scores were generated using patient and tumor characteristics, and a one-to-one case-matched analysis was conducted. Local recurrence-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) were compared between the TME and LE groups. RESULTS: Of the 406 enrolled patients, 351 received TME and 55 received LE. The median follow-up period was 45 months. Following propensity score matching, each group contained 55 patients. Among 103 patients evaluable for pathologic tumor response, 82 patients (79.6%) showed complete response or near-complete response. No significant differences were observed between the TME and LE groups in LRFS (3-year LRFS 98.1% vs 94.4%, P=.312), DFS (3-year DFS 92.1% vs 90.8%, P=.683), and OS (3-year OS 98.2% vs 100.0%, P=.895). CONCLUSIONS: In "early" clinical T3 rectal cancer, PCRT followed by LE showed comparable oncologic outcomes to TME. Because most of the matched cohort consisted of good responders to PCRT, the present results should be applied to a limited population.
[Mh] Termos MeSH primário: Pontuação de Propensão
Neoplasias Retais/patologia
Neoplasias Retais/cirurgia
Reto/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Antígeno Carcinoembrionário/sangue
Quimiorradioterapia
Intervalo Livre de Doença
Feminino
Seres Humanos
Masculino
Análise por Pareamento
Meia-Idade
Estadiamento de Neoplasias
Cuidados Pré-Operatórios
Dosagem Radioterapêutica
Neoplasias Retais/mortalidade
Neoplasias Retais/terapia
Reto/patologia
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Carcinoembryonic Antigen)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170821
[Lr] Data última revisão:
170821
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE


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[PMID]:28782114
[Au] Autor:Sutradhar R; Lokku A; Barbera L
[Ad] Endereço:Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
[Ti] Título:Cancer survivorship and opioid prescribing rates: A population-based matched cohort study among individuals with and without a history of cancer.
[So] Source:Cancer;123(21):4286-4293, 2017 Nov 01.
[Is] ISSN:1097-0142
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Little is known about opioid prescribing among individuals who have survived cancer. Our aim is to examine a predominantly socio-economically disadvantaged population for differences in opioid prescribing rates among cancer survivors compared with matched controls without a prior diagnosis of cancer. METHODS: This was a retrospective population-wide matched cohort study. Starting in 2010, individuals residing in Ontario, Canada, who were 18 to 64 years of age and at least 5 years past their cancer diagnosis were matched to controls without a prior cancer diagnosis based on sex and calendar year of birth. Follow-up was terminated at any indication of cancer recurrence, second malignancy, or new cancer diagnosis. To examine the association between survivorship and the rate of opioid prescriptions, an Andersen-Gill recurrent event regression model was implemented, adjusting for numerous individual-level characteristics and also accounting for the matched design. RESULTS: The rate of opioid prescribing was 1.22 times higher among survivors than among their corresponding matched controls (adjusted relative rate, 1.22; 95% CI, 1.11-1.34). Individuals from lower income quintiles who were younger, were from rural neighborhoods, and had more comorbidities had significantly higher prescribing rates. Sex was not associated with prescribing rates. This increased rate of opioid prescribing was also seen among survivors who were 10 or more years past their cancer diagnosis (compared with their controls). CONCLUSION: This study demonstrates substantially higher opioid prescribing rates among cancer survivors, even long after attaining survivorship. This raises concerns about the diagnosis and management of chronic pain problems among survivors stemming from their cancer diagnosis or treatment. Cancer 2017;123:4286-4293. © 2017 American Cancer Society.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Prescrições de Medicamentos/estatística & dados numéricos
Neoplasias
Sobreviventes/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Comorbidade
Feminino
Seres Humanos
Renda/estatística & dados numéricos
Masculino
Análise por Pareamento
Meia-Idade
Neoplasias/diagnóstico
Neoplasias/mortalidade
Ontário
Análise de Regressão
População Rural/estatística & dados numéricos
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170808
[St] Status:MEDLINE
[do] DOI:10.1002/cncr.30839


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[PMID]:28711556
[Au] Autor:Wivel AE; Lapane K; Kleoudis C; Singer BH; Horwitz RI
[Ti] Título:Medicine Based Evidence for Individualized Decision Making: Case Study of Systemic Lupus Erythematosus.
[So] Source:Am J Med;130(11):1290-1297.e6, 2017 Nov.
[Is] ISSN:1555-7162
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: To guide management decisions for an index patient, evidence is required from comparisons between approximate matches to the profile of the index case, where some matches contain responses to treatment and others act as controls. METHODS: We describe a method for constructing clinically relevant histories/profiles using data collected but unreported from 2 recent phase 3 randomized controlled trials assessing belimumab in subjects with clinically active and serologically positive systemic lupus erythematosus. Outcome was the Systemic lupus erythematosus Responder Index (SRI) measured at 52 weeks. RESULTS: Among 1175 subjects, we constructed an algorithm utilizing 11 trajectory variables including 4 biological, 2 clinical, and 5 social/behavioral. Across all biological and social/behavioral variables, the proportion of responders based on the SRI whose value indicated clinical worsening or no improvement ranged from 27.5% to 42.3%. Kappa values suggested poor agreement, indicating that each biological and patient-reported outcome provides different information than gleaned from the SRI. CONCLUSION: The richly detailed patient profiles needed to guide decision-making in clinical practice are sharply at odds with the limited information utilized in conventional randomized controlled trial analyses.
[Mh] Termos MeSH primário: Anticorpos Monoclonais Humanizados/uso terapêutico
Lúpus Eritematoso Sistêmico
Administração dos Cuidados ao Paciente/organização & administração
Modelagem Computacional Específica para o Paciente
[Mh] Termos MeSH secundário: Adulto
Algoritmos
Classificação/métodos
Tomada de Decisão Clínica/métodos
Medicina Baseada em Evidências/métodos
Feminino
Seres Humanos
Imunossupressores/uso terapêutico
Assistência de Longa Duração/organização & administração
Lúpus Eritematoso Sistêmico/diagnóstico
Lúpus Eritematoso Sistêmico/fisiopatologia
Lúpus Eritematoso Sistêmico/psicologia
Lúpus Eritematoso Sistêmico/terapia
Masculino
Análise por Pareamento
Anamnese/normas
Monitorização Fisiológica/métodos
Monitorização Fisiológica/normas
Monitorização Fisiológica/estatística & dados numéricos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Antibodies, Monoclonal, Humanized); 0 (Immunosuppressive Agents); 73B0K5S26A (belimumab)
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171101
[Lr] Data última revisão:
171101
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170717
[St] Status:MEDLINE


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[PMID]:28688646
[Au] Autor:Xu Y; Hua J; Li J; Shi L; Yuan J; Du J
[Ad] Endereço:Department of General Surgery, Huashan Hospital North, Fudan University, Shanghai, China.
[Ti] Título:Laparoscopic versus open gastrectomy for gastric cancer with serous invasion: long-term outcomes.
[So] Source:J Surg Res;215:190-195, 2017 Jul.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Laparoscopy-assisted gastrectomy (LAG) has already been introduced for advanced gastric cancer (AGC). However, little is known as to whether LAG is also applicable for AGC with serous invasion given the possibility that malignant cell dissemination and local recurrence incidence might increase. This study was designed to evaluate the technical feasibility and oncological adequacy of LAG in comparison with open gastrectomy (OG) for AGC with serous invasion. METHODS: A retrospective case-matched study was conducted to compare LAG and OG for AGC with serous invasion. For this study, 67 consecutive patients with AGC who underwent LAG between April 2007 and March 2011 were recruited and compared with 67 AGC patients who received OG during the same time period. We analyzed the patient demographics, operative results, pathologic characteristics, and long-term outcomes. RESULTS: No significant differences were observed in the numbers of harvested lymph nodes (24.0 ± 8.2 versus 25.6 ± 8.8, P = 0.083) or the average distance between the proximal and distal resection margins (4.8 ± 2.5 cm versus 4.6 ± 2.4 cm, P = 0.354; 6.6 ± 4.2 cm versus 7.6 ± 4.7 cm, P = 0.105) in the LAG and OG groups. The complication rate was similar between the LAG and OG groups (6.0% versus 4.5%, P = 0.500). The duration of postoperative analgesic use was significantly shorter in the LAG group than in the OG group (2.9 ± 0.6 d versus 3.9 ± 0.6 d, P < 0.001). The 5-y cumulative survival and recurrence-free survival rates of the two groups were similar (31.3% versus 29.9%, P = 0.949; 29.9% versus 23.9%, P = 0.716). CONCLUSIONS: The findings in this study suggest that LAG is a feasible and safe procedure for patients with seriously invasive AGC and predict acceptable long-term oncologic outcomes. LAG may be an appropriate choice to treat patients with seriously invasive AGC.
[Mh] Termos MeSH primário: Adenocarcinoma/cirurgia
Gastrectomia/métodos
Laparoscopia
Neoplasias Gástricas/cirurgia
[Mh] Termos MeSH secundário: Adenocarcinoma/mortalidade
Adenocarcinoma/patologia
Adulto
Idoso
Estudos de Viabilidade
Feminino
Seres Humanos
Masculino
Análise por Pareamento
Meia-Idade
Invasividade Neoplásica
Estudos Retrospectivos
Neoplasias Gástricas/mortalidade
Neoplasias Gástricas/patologia
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170710
[St] Status:MEDLINE


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[PMID]:28628713
[Au] Autor:Liu R; Liu Q; Zhao ZM; Tan XL; Gao YX; Zhao GD
[Ad] Endereço:Department of Hepatobiliary and Pancreatic Surgical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
[Ti] Título:Robotic versus laparoscopic distal pancreatectomy: A propensity score-matched study.
[So] Source:J Surg Oncol;116(4):461-469, 2017 Sep.
[Is] ISSN:1096-9098
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Robotic distal pancreatectomy (RDP) is considered a safe and feasible alternative to laparoscopic distal pancreatectomy (LDP). However, previous studies have some limitations including small sample size and selection bias. This study aimed to evaluate whether the robotic approach has advantages over laparoscopic surgery in distal pancreatectomy. METHODS: Demographics and perioperative outcomes among patients undergoing RDP (n = 102) and LDP (n = 102) between January 2011 and December 2015 were reviewed. A 1:1 propensity score matched analysis was performed between both groups. RESULTS: Both groups displayed no significant differences in perioperative outcomes including operative time, blood loss, transfusion rate, and rates of overall morbidities and pancreatic fistula. Robotic approach reduced the rate of conversion to laparotomy (2.9% vs 9.8%, P = 0.045), especially in patients with large tumors (0% vs 22.2%, P = 0.042). RDP improved spleen (SP) and splenic vessels preservation (SVP) rates in patients with moderate tumors (60.0% vs 35.5%, P = 0.047; 37.1% vs 12.9%, P = 0.025), especially in patients without malignancy (95.5% vs 52.4%, P = 0.001; 59.1% vs 19.0%, P = 0.007). RDP also reduced postoperative hospital stay (PHS) significantly (7.67% vs 8.58, P = 0.032). CONCLUSIONS: RDP is associated with less rate of conversion to laparotomy, shorter PHS, and improved SP and SVP rates in selected patients than LDP.
[Mh] Termos MeSH primário: Laparoscopia
Pancreatectomia/métodos
Procedimentos Cirúrgicos Robóticos
[Mh] Termos MeSH secundário: Perda Sanguínea Cirúrgica/estatística & dados numéricos
Transfusão de Sangue/estatística & dados numéricos
China/epidemiologia
Conversão para Cirurgia Aberta/estatística & dados numéricos
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Análise por Pareamento
Meia-Idade
Duração da Cirurgia
Tratamentos com Preservação do Órgão
Fístula Pancreática/epidemiologia
Neoplasias Pancreáticas/cirurgia
Pontuação de Propensão
Baço
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170620
[St] Status:MEDLINE
[do] DOI:10.1002/jso.24676


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[PMID]:28624032
[Au] Autor:McKendy KM; Lee LF; Boulva K; Deckelbaum DL; Mulder DS; Razek TS; Grushka JR
[Ad] Endereço:Division of General Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
[Ti] Título:Epidural analgesia for traumatic rib fractures is associated with worse outcomes: a matched analysis.
[So] Source:J Surg Res;214:117-123, 2017 Jun 15.
[Is] ISSN:1095-8673
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The optimal method of pain control for patients with traumatic rib fractures is unknown. The aim of this study was to determine the effect of epidural analgesia on respiratory complications and in-hospital mortality in patients with rib fractures. METHODS: Adult patients at a level I trauma center with ≥1 rib fracture from blunt trauma were included (2004-2013). Those with a blunt-penetrating mechanism, traumatic brain injury, or underwent a laparotomy or thoracotomy were excluded. Patients who were treated with epidural analgesia (EPI) were compared with those were not treated with epidural analgesia (NEPI) using coarsened exact matching. Primary outcomes were respiratory complications (pneumonia, deep vein thrombosis/pulmonary embolus, and respiratory failure) and 30-d in-hospital mortality. Secondary outcomes were total hospital and intensive care unit length of stay, and duration of ventilator support. RESULTS: About 1360 patients (EPI: 329 and NEPI: 1031) met inclusion criteria (mean age: 54.2 y; standard deviation [SD]: 19.7; 68% male). The mean number of rib fractures was 4.8 (SD: 3.3; 21% bilateral) with a high total burden of injury (mean Injury Severity Score: 19.9 [SD: 8.9]). The overall incidence of respiratory complications was 13% and mortality was 4%. After matching, 204 EPI patients were compared with 204 NEPI patients, with no differences in baseline characteristics. EPI patients experienced more respiratory complications (19% versus 10%, P = 0.009), but no differences in 30-d mortality (5% versus 2%, P = 0.159), duration of mechanical ventilation (EPI: 148 h [SD: 167] versus NEPI: 117 h [SD: 187], P = 0.434), or duration of intensive care unit length of stay (6.5 d [SD: 7.6] versus 5.8 d [SD: 9.1], P = 0.626). Hospital stay was higher in the EPI group (16.6 d [SD: 19.6] vs 12.7 d [SD: 15.2], P = 0.026). CONCLUSIONS: Epidural analgesia is associated with increased respiratory complications without providing mortality benefit after traumatic rib fractures. Alternate analgesic strategies should be investigated to treat these severely injured patients.
[Mh] Termos MeSH primário: Analgesia Epidural/efeitos adversos
Mortalidade Hospitalar
Doenças Respiratórias/etiologia
Fraturas das Costelas/terapia
Ferimentos não Penetrantes/terapia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Idoso de 80 Anos ou mais
Bases de Dados Factuais
Feminino
Seres Humanos
Incidência
Masculino
Análise por Pareamento
Meia-Idade
Doenças Respiratórias/epidemiologia
Fraturas das Costelas/complicações
Fraturas das Costelas/mortalidade
Resultado do Tratamento
Ferimentos não Penetrantes/complicações
Ferimentos não Penetrantes/mortalidade
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170619
[St] Status:MEDLINE



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