A randomized controlled study on acupuncture for peri-operative pain after open radical prostatectomy.

OBJECTIVES: To evaluate the advantages of adding acupuncture to standard postoperative pain management for open radical prostatectomy (RP). MATERIALS AND METHODS: A randomized controlled trial (1:1:1) comparing routine postoperative analgesic care (control [CON]) vs the addition of press tack needle acupuncture (ACU) or press tack placebo acupressure (SHAM) for pain management after open RP was performed. A total of 126 patients were enrolled between February 2020 and April 2021. After open RP, the CON group received standard postoperative analgesia, the ACU group received long-term acupuncture with press tacks at specific points (P-6, Shenmen and SP-6) along with standard analgesia, and the SHAM group received placebo press tacks at the same acupuncture points alongside standard analgesia. The primary endpoint was postoperative pain measured on a numeric rating scale, the NRS-11, calculated as the area under the curve. The cumulative use of routine postoperative analgesics, time to first defaecation, and quality of life were analysed using the Kruskal-Wallis rank sum test, Fisher's exact test, and Pearson's chi-squared test. RESULTS: The ACU group reported significantly less postoperative pain compared to the SHAM (P = 0.007) and CON groups (P = 0.02). There were no significant difference in median (interquartile range) cumulative pain medication usage, time to first defaecation (CON: 37 [33, 44] h; SHAM: 37 [33, 42] h; ACU: 37 [33, 41] h; P > 0.9), or health status at discharge (EuroQol five-dimension, five-level general health assessment questionnaire: CON: 70 [65-83]; SHAM: 70 [60-80]; ACU: 70 [50-80]). CONCLUSION: Incorporating acupuncture into postoperative pain management can improve patient postoperative outcomes.

Influence of body mass index on operability, morbidity and disease outcome following radical cystectomy.

INTRODUCTION: Obesity may influence postoperative outcome after tumor surgery. We evaluated the impact of patients' body mass index (BMI) on peri- and postoperative morbidity and outcome following radical cystectomy for bladder cancer. PATIENTS AND METHODS: 390 consecutive patients who underwent radical cystectomy due to bladder cancer from January 1986 to December 2004 were reviewed. According to WHO criteria, patients were divided into normal weight (NW, 45.6%), overweight (OW, 44.4%) and obese (10.0%) subgroups. The BMI of patients was associated to the time of surgery, amount of intraoperative blood units, TNM stage, postoperative complication rate as well as overall survival. RESULTS: The time of cystectomy increased with the degree of patients' obesity (NW, 330 min; OW, 355 min; p = 0.007). Between NW and OW patients no significant differences were noted in respect to intraoperative blood transfusion rate (NW, 3.0; OW, 2.0; p = 0.47), postoperative TNM stage (pTis-pT2b: 42.6 vs. 48.6%; pT3a-4: 38.2 vs. 27.2%; pN+: 20.2 vs. 24.2%) and postoperative complications, except for postoperative bleeding, which was more common in OW patients (p = 0.02). Mean overall survival times showed no significant differences between NW and OW patients receiving ileal conduits (5-year survival rate: 34.0 vs. 41.1%; p = 0.140) or ileal neobladders (5-year survival rate: 65.1 vs. 70.8%; p = 0.127). CONCLUSIONS: Increased BMI poses a greater challenge for surgical interventions such as radical cystectomy in bladder cancer patients. However, in our series, intra- and postoperative morbidity was not significantly elevated in OW patients. Overall survival was not reduced in OW compared to NW patients. Therefore, elevated BMI is not an exclusion criterion for radical cystectomy in bladder cancer patients.

Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention.

The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation.