RESUMO
BACKGROUND: We sought to determine the impact of social determinants of health (SDoH) on outcomes of patients undergoing resection for hepatocellular carcinoma (HCC). PATIENTS AND METHODS: Patients with HCC in the National Cancer Database who underwent resection from 2009 to 2018 were identified. SDoH associated with length of stay (LOS), 30-day readmission, and 30-day mortality were analyzed using regression analyses adjusted for confounding variables. RESULTS: Among 9235 patients, the median age (range) was 65.0 (18-90) years, 72.1% were male, and 57.9% were White. A total of 3% were uninsured, 11.1% had Medicaid, 21% resided in regions with a median household income within the lowest quartile of the US population, and 27.0% resided in regions within the lowest quartile of education level. The odds for having longer LOS were lower among patients with the highest regional education level compared with those with the lowest level [odds ratio (OR) 0.86, 95% confidence interval (CI) 0.77-0.97]. The risk of readmission was lower among patients with Medicare (OR 0.52; 95% CI 0.33-0.81), Medicaid (OR 0.52; 95% CI 0.31-0.87), or private insurance (OR 0.56; 95% CI 0.35-0.88) compared with uninsured patients. Thirty-day overall mortality was less likely among patients with Medicare (OR 0.45; 95% CI 0.27-0.75), Medicaid (OR 0.53; 95% CI 0.30-0.93), or private insurance (OR 0.40; 95% CI 0.24-0.66), and among patients with high regional income (OR 0.58; 95% CI 0.44-0.77). CONCLUSIONS: Adjusted regression analyses identified SDoH that were associated with HCC outcomes. Increased awareness of how SDoH relate to outcomes may inform strategies that attempt to account for these associations and improve patient outcomes.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Masculino , Idoso , Estados Unidos/epidemiologia , Feminino , Medicare , Carcinoma Hepatocelular/cirurgia , Determinantes Sociais da Saúde , Neoplasias Hepáticas/cirurgia , MedicaidRESUMO
BACKGROUND: The impact that distance traveled to receive treatment has on treatments and outcomes among patients with soft tissue sarcoma (STS) of the extremity has yet to be thoroughly investigated. METHODS: Information on patients treated for STS of the extremity between 2006 and 2015 was obtained from the National Cancer Database. Patients were stratified into two groups based on median distance traveled to receive treatment. Chi-square tests assessed associations between categorical variables and distance to treatment. Kaplan-Meier survival estimates and Cox regression were used to estimate survival. RESULTS: The sample included 21,763 patients. The mean age was 59.3 y, 54.6% were men, and 83.2% were white. The median distance traveled to the treating facility was 15.6 miles. Compared with patients who traveled <15 miles, those who traveled ≥15 miles were more likely to have undifferentiated rather than well-differentiated tumors (odds ratio [OR], 1.23; 95% confidence interval [95% CI], 1.10-1.37), and stage II rather than stage I disease (OR, 1.14; 95% CI, 1.04-1.24). They were also more likely to undergo limb-sparing resection (OR, 1.58; 95% CI, 1.39-1.79) or amputation (OR, 1.72; 95% CI, 1.44-2.07) rather than no surgery and less likely to have positive margins (OR, 0.86; 95% CI, 0.79-0.93). There was no difference in the risk of death between patients who traveled ≥15 miles and those who did not (hazard ratio, 1.00; 95% CI, 0.94-1.07). CONCLUSIONS: Although clinical characteristics and treatments may differ based on distance traveled, survival appears equivalent. Further research into reasons why greater distance traveled is associated with more advanced disease, but comparable survival is warranted.
Assuntos
Amputação Cirúrgica/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Tratamentos com Preservação do Órgão/estatística & dados numéricos , Sarcoma/cirurgia , Viagem/estatística & dados numéricos , Adulto , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Extremidades/patologia , Extremidades/cirurgia , Feminino , Geografia , Humanos , Estimativa de Kaplan-Meier , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/mortalidade , Sarcoma/patologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: We sought to investigate associations between race, clinical characteristics, and outcomes among patients with malignant phyllodes of the breast. METHODS: Malignant phyllodes cases were identified using Surveillance Epidemiology and End Results database. We used chi-square tests to compare characteristics between racial groups and multinomial logistic regression to calculate relative risk ratios (RRR) and 95% confidence intervals (CI) comparing the likelihood of having particular characteristics by race. Survival analyses included Cox regression and Kaplan-Meier functions. RESULTS: Among 1202 patients included, mean age was 51.7 y and 55.2% were white. Compared to whites, blacks were younger (mean age 45.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.91; 95% CI: 1.20-3.05) and tumors > 100 mm (RRR = 2.52; 95% CI: 1.56-4.05) than tumors ≤ 50 mm in size. Compared to whites, Hispanics were younger (mean age 46.7 versus 55.1 y; P < 0.001), and more likely to have tumors 51-100 mm (RRR = 1.46; 95% CI: 1.01-2.11) than tumors ≤ 50 mm in size. Asians were more likely to have tumors 51-100 mm (RRR = 1.52; 95% CI: 1.01-2.30) and tumors > 100 mm (RRR = 1.61; 95% CI: 1.03-2.52) than tumors ≤ 50 mm in size, and more likely to have tumors that extended beyond the breast tissue (RRR = 1.87; 95% CI: 1.05-3.31), compared to whites. Survival was similar for blacks (HR = 1.48; 95% CI: 0.80-2.76), Hispanics (HR = 1.02; 95% CI: 0.54-1.93), and Asians (HR = 1.13; 95% CI: 0.63-2.01) compared to whites. CONCLUSIONS: Further research into factors contributing to extensive disease at presentation among minorities is warranted.
Assuntos
Neoplasias da Mama/epidemiologia , Mama/patologia , Disparidades nos Níveis de Saúde , Tumor Filoide/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Povo Asiático/estatística & dados numéricos , Mama/cirurgia , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Feminino , Hispânico ou Latino/estatística & dados numéricos , Humanos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Tumor Filoide/patologia , Tumor Filoide/terapia , Radioterapia Adjuvante/estatística & dados numéricos , Fatores de Risco , Programa de SEER/estatística & dados numéricos , Análise de Sobrevida , Resultado do Tratamento , Carga Tumoral , Estados Unidos/epidemiologia , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Sarcomas are malignant tumors of connective tissue that can vary widely in etiology. Parameters such as grade, extent of resection, and tumor integrity have been shown to affect prognosis. Our principal aim was to examine associations between the laterality of retroperitoneal sarcomas and tumor characteristics, treatment, and patient outcomes. MATERIALS AND METHODS: We performed a retrospective study of patients treated at our tertiary referral center with a diagnosis of primary retroperitoneal sarcoma who underwent tumor resection. Categorical variables were compared using the chi-square test, whereas continuous variables were compared using one-way analysis of variance. Cox regression was used to estimate the risk of death. RESULTS: Data from 106 patients were analyzed. A greater proportion of bilateral or midline tumors were leiomyosarcomas (P = 0.02), whereas right-sided tumors were more likely to be liposarcoma (P = 0.02). There was no significant relationship between laterality and tumor grade or stage. Two-thirds of patients had at least one contiguous organ resected (n = 68, 65.4%). Patients with nephrectomy during sarcoma resection were more likely to have right-sided disease (P = 0.02). Splenectomy and pancreatectomy were associated with left-sided disease (P < 0.01; P < 0.01), and pancreaticoduodenectomies with bilateral or midline disease (P < 0.001). Adjusting for age, sex, race, grade, stage, histology, and treatment, there was no increased risk of death or recurrence based on laterality. CONCLUSIONS: Although laterality did not seem to have a measurable relationship with patient outcomes or survival, there was a significant association between laterality, tumor histology, and resection of contiguous organs. These preliminary findings warrant further investigation.
Assuntos
Leiomiossarcoma/mortalidade , Lipossarcoma/mortalidade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Retroperitoneais/mortalidade , Espaço Retroperitoneal/patologia , Idoso , Feminino , Humanos , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Lipossarcoma/patologia , Lipossarcoma/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia/prevenção & controle , Nefrectomia/estatística & dados numéricos , Pancreatectomia/estatística & dados numéricos , Pancreaticoduodenectomia/estatística & dados numéricos , Prognóstico , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Esplenectomia/estatística & dados numéricos , Resultado do TratamentoRESUMO
BACKGROUND: The association between regional breast cancer diagnostic rates, treatments, and outcomes is unclear. We sought to investigate the management and survival of women with invasive ductal carcinoma (IDC) from geographic regions with variable rates of diagnosis. METHODS: Data on women diagnosed with IDC years 2009-2010 were obtained from the Surveillance, Epidemiology, and End Results database. Patients were divided into quartiles based on the IDC diagnostic rate within their county of residence. Chi-square and one-way analysis of variance (ANOVA) analyses tested the association between patient and clinical characteristics and the diagnostic rate quartiles. Cox regression analyses compared survival between the quartiles. RESULTS: Among the 83,375 patients included, the mean age was 60.8 y and 70.9% were white. Patients residing in counties with the highest diagnostic rates were more frequently white, employed, educated, and wealthier and more often received adjuvant radiation following both partial mastectomy for localized disease and complete mastectomy for advanced disease compared to patients in counties with the lowest diagnostic rates. The highest diagnostic rate quartile had 10% decreased odds of death compared to the lower quartile (hazard ratio: 0.897; 95% confidence interval: 0.832-0.966). However, after adjustment for socioeconomic variables, survival was comparable (hazard ratio: 0.916; 95% confidence interval: 0.835-1.003). CONCLUSIONS: Regional variation in IDC diagnostic rates is associated with differences in socioeconomic status, grade, stage, and treatment. Patients from regions with the highest rates of diagnosis may have improved access to evidence-based care and resultant superior survival. Enhancing access to care may improve outcomes of patients residing in regions where breast cancer is diagnosed less frequently.
Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Programa de SEER/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/epidemiologia , Carcinoma Ductal de Mama/terapia , Feminino , Humanos , Incidência , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/estatística & dados numéricos , Classe Social , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Granular cell tumors (GCTs) are rare lesions occurring almost anywhere in the body. Multiple case reports have been published. However, there are very few large-scale studies regarding GCT. The aim of this study was to define characteristics, treatment patterns and outcomes of patients with GCT. METHODS: An institutional review board-approved retrospective chart review was performed. Descriptive statistics, chi-square analyses, and Kaplan-Meier survival estimates were produced. RESULTS: Fifty patients were treated for GCT at our institution between 1992 and 2015. The median age was 47 y; 62% of patients were female and 64% were whites. Median tumor size was 0.8 cm. Four percent of patients had malignant tumors, 10.0% had atypical tumors, and 86.0% had benign tumors. The most frequent location of tumors was the gastrointestinal tract (n = 30; 60%), followed by skin/subcutaneous tissues (n = 19; 38%), then respiratory tract (n = 1; 2%). Most patients underwent surgical excision or endoscopic removal of their tumors without prior biopsy. Three patients (6%) had multifocal tumors; they were more likely to experience recurrence than patients with unifocal tumors (33.3% versus 10.6%, respectively; P = 0.05). Six patients (12.0%) experienced recurrence, with a median time to recurrence of 13.5 mo. Overall cancer-specific 5-y survival was 98.0%. Overall recurrence-free 5-y survival was 86.4%. Patients with atypical tumors had a lower recurrence-free 5-y survival rate than those with benign tumors (75.0% versus 89.7%, respectively; P = 0.04). CONCLUSIONS: Patients with GCT fair well, particularly when tumors are benign. Patients with multifocal tumors are more likely to experience recurrence and should be closely monitored.
Assuntos
Institutos de Câncer/estatística & dados numéricos , Neoplasias Gastrointestinais/cirurgia , Tumor de Células Granulares/cirurgia , Recidiva Local de Neoplasia/epidemiologia , Neoplasias do Sistema Respiratório/cirurgia , Neoplasias Cutâneas/cirurgia , Adulto , Idoso , Biópsia , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Tumor de Células Granulares/mortalidade , Tumor de Células Granulares/patologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias do Sistema Respiratório/mortalidade , Neoplasias do Sistema Respiratório/patologia , Estudos Retrospectivos , Neoplasias Cutâneas/mortalidade , Neoplasias Cutâneas/patologia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Malignant granular cell tumor GCT (mGCT) has not been well described. We sought to investigate associations between tumor characteristics, treatments and survival. METHODS: Patients diagnosed with mGCT years 1995-2014 were identified using the Surveillance, Epidemiology and End Results database. Descriptive statistics regarding tumor and treatment characteristics were calculated. Chi-square tests determined associations between tumor location and features. Survival analyses included Kaplan-Meier functions and Cox proportional hazard ratios (HR). RESULTS: Of 113 patients included, median age was 54 years and 77.0% were female. Frequent tumor sites included soft tissues (36.3%), ovary/testis (16.8%), and skin (11.5%). Median tumor size was 4.0 cm. Metastases to regional lymph nodes (12.5%) and distant sites (11.4%) occurred. Treatments included surgery (85.0%), radiotherapy (12.4%) and chemotherapy (8.9%). Overall five and 10-year cause-specific survival was 74.3% and 65.2%, respectively. Survival was worse for patients with tumors >5 cm compared to those with tumors ≤5 cm (HR = 34.03; 95% confidence interval [CI]: 2.57-450.17), and patients with metastasis (HR = 15.25; 95% CI: 1.19-195.72) compared with those without metastasis. Patients who underwent surgery had superior survival than those who did not (HR = 0.13; 95% CI: 0.05-0.34). CONCLUSIONS: Particular tumor features and treatments are associated with superior survival. This information may be used to more accurately estimate prognosis.
Assuntos
Tumor de Células Granulares/mortalidade , Tumor de Células Granulares/patologia , Feminino , Tumor de Células Granulares/terapia , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Programa de SEER , Taxa de Sobrevida , Neoplasias Testiculares/mortalidade , Neoplasias Testiculares/patologia , Neoplasias Testiculares/terapia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Lobular carcinoma of the male breast is rare. We sought to investigate the clinical characteristics, treatment, and outcomes of men and women with lobular breast cancer, using a population-based database. METHODS: We reviewed the Surveillance, Epidemiology, and End Results database 1988-2008 and identified patients with a lobular breast cancer diagnosis (invasive lobular carcinoma [ILC] and lobular carcinoma in situ [LCIS]) using the "International Classification of Diseases for Oncology, Third Edition" codes. Bivariate analyses compared the male and female patients on demographics, clinical characteristics, and treatment modalities. Multivariate logistic regression analysis determined the risk-adjusted likelihood of receiving treatment. Survival analysis was done and hazard ratios were obtained using Cox proportional models. RESULTS: Overall, 133,339 patients were identified, including 133,168 women (99.9%) and 171 men (0.1%). Most had ILC (82.08%). The median age was 66 ± 20 y for the men and 61 ± 21 y for the women. The men with ILC were more likely to have poorly differentiated tumors (26.45% versus 15.61%; P < 0.001) and stage IV disease (9.03% versus 4.18%; P = 0.005) than were the women. The cancer-specific 5-year survival rates for ILC were 82.9% for the men and 91.9% for the women. Adjusted survival was better for patients with ILC receiving surgery plus radiotherapy than patients receiving neither (hazard ratio 0.52, 95% confidence interval 0.49-0.56). Women with ILC had a 55% increased odds of receiving surgery plus radiotherapy compared with men (odds ratio 1.55, 95% confidence interval 1.08-2.22). CONCLUSIONS: ILC presents at a higher grade and stage in men. The difference in disease characteristics and survival rates suggests that the treatment of men with lobular breast cancer should be adjusted to improve their outcomes.
Assuntos
Neoplasias da Mama Masculina/mortalidade , Neoplasias da Mama Masculina/patologia , Carcinoma Lobular/mortalidade , Carcinoma Lobular/patologia , Programa de SEER/estatística & dados numéricos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama Masculina/terapia , Carcinoma Lobular/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Modelos de Riscos Proporcionais , Fatores de Risco , Distribuição por Sexo , Adulto JovemRESUMO
BACKGROUND: We sought to determine if racial disparities in treatment and survival persist among patients with breast cancer in the Midsouth. METHODS: Patients with early-stage breast cancer were identified in the tumor registry of a large healthcare system in the Midsouth. Regression analyses were performed to determine how race was associated with receipt of treatment and mortality. RESULTS: Among 4605 patients, 38.8% were Black. Black patients were less likely to undergo surgery (OR = 0.71; 95%CI 0.53-0.97) and receive hormone therapy (OR = 0.81; 95%CI 0.69-0.95) than White patients, but more likely to receive radiation (OR = 1.20; 95%CI 1.08-1.40) and chemotherapy (OR = 1.36; 95%CI 1.16-1.61). Among Black patients, the risk of mortality was lower among those who underwent partial (OR = 0.25; 95%CI 0.12-0.51) or total (OR = 0.35; 95%CI 0.16-0.76) mastectomy and among those who received hormone therapy (OR = 0.62; 95%CI 0.40-0.97). CONCLUSION: There remains room for improvement in providing treatments that optimize survival among this patient population.
Assuntos
Neoplasias da Mama , Feminino , Humanos , Negro ou Afro-Americano , Neoplasias da Mama/mortalidade , Neoplasias da Mama/cirurgia , Disparidades em Assistência à Saúde , Hormônios , Mastectomia , BrancosRESUMO
Attrition is high among surgical trainees, and six of ten trainees consider leaving their programs, with two ultimately leaving before completion of training. Given known historically and systemically rooted biases, Black surgical trainees are at high risk of attrition during residency training. With only 4.5% of all surgical trainees identifying as Black, underrepresentation among their peers can lend to misclassification of failure to assimilate as clinical incompetence. Furthermore, the disproportionate impact of ongoing socioeconomic crisis (e.g., COVID-19 pandemic, police brutality etc.) on Black trainees and their families confers additional challenges that may exacerbate attrition rates. Thus, attrition is a significant threat to medical workforce diversity and health equity. There is urgent need for surgical programs to develop proactive approaches to address attrition and the threat to the surgical workforce. In this Society of Black Academic Surgeons (SBAS) white paper, we provide a framework that promotes an open and inclusive environment conducive to the retention of Black surgical trainees, and continued progress towards attainment of health equity for racial and ethnic minorities in the United States.
Assuntos
COVID-19 , Internato e Residência , Cirurgiões , Humanos , Estados Unidos , Pandemias , COVID-19/epidemiologia , Cirurgiões/educaçãoRESUMO
BACKGROUND: Race has been shown to impact receipt of and outcomes following hepatobiliary surgery. We sought to determine if racial disparities in the management of hepatocellular carcinoma persist. METHODS: Information on patients with hepatocellular carcinoma diagnosed between 2012 and 2016 was obtained from the Surveillance, Epidemiology, and End Results database. The sample was stratified by race/ethnicity, and associations between tumor characteristics, treatment, and survival were assessed. RESULTS: Of 33,672 patients, the mean age was 65 years, and 77% were male. By race, 17,150 (51%) were white, 4755 (14%) black, 6850 (20%) Hispanic, and 4917 (15%) Asian. When assessing the likelihood of treatment versus no treatment for tumors less than 5 cm, no difference was observed between whites and blacks in any year, but Hispanics were less likely than whites to receive treatment in most years. Asians were more likely to receive treatment every year. When assessing the likelihood of transplant versus surgical resection, blacks were less likely than whites to undergo transplant in all years except 2016. Hispanics were equally likely, while Asians were less likely to undergo transplant in all years. For years 2012 to 2016 collectively, Asians had better 5-year survival rates than other races after undergoing ablation and resection. No difference in the risk of death was observed among blacks, whites, or Hispanics after undergoing ablation, resection, or transplant. CONCLUSION: Racial disparities for blacks and Hispanics have improved. Although Asians were less likely to undergo transplant, they had better survival after undergoing resection or ablation.
Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Idoso , Carcinoma Hepatocelular/cirurgia , Etnicidade , Hispânico ou Latino , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Taxa de Sobrevida , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: As the obesity epidemic worsens, the prevalence of fatty liver disease has increased. However, minimal data exist on the impact of combined fatty liver and metabolic syndrome on hepatectomy outcomes. Therefore, the aim of this analysis is to measure the outcomes of patients who do and do not have a fatty liver undergoing hepatectomy in the presence and absence of the metabolic syndrome. METHODS: Patients with fatty and normal livers undergoing major hepatectomy (≥3 segments) were identified in the 2014 to 2018 American College of Surgeon National Surgical Quality Improvement Program database. Patients undergoing partial hepatectomy and those with missing liver texture data were excluded. Propensity matching was used and adjusted for multiple variables. A subgroup analysis stratified by the metabolic syndrome (body mass index ≥30 kg/m2, hypertension and diabetes) was performed. Demographics and outcomes were compared by χ2 and Mann-Whitney tests. RESULTS: Of 2,927 hepatectomies, 30% of patients (N = 863) had a fatty liver. The median body mass index was 28.6, and the metabolic syndrome was present in 6.3% of patients (N = 184). After propensity matching, 863 patients with fatty and 863 with normal livers were compared. Multiple outcomes were significantly worse in patients with fatty livers (P <.05), including serious morbidity (32% vs 24%), postoperative invasive biliary procedures (15% vs 10%), organ space infections (11% vs 7.8%), and pulmonary complications. Patients with fatty livers and the metabolic syndrome had significantly increased postoperative cardiac arrests, pulmonary embolisms, and mortality (P < .05). CONCLUSION: Fatty liver disease is associated with significantly worse outcomes after major hepatectomy. The metabolic syndrome confers an increased risk of postoperative mortality.
Assuntos
Fígado Gorduroso/complicações , Hepatectomia/mortalidade , Síndrome Metabólica/complicações , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
It has been previously suggested that lung tissue remains viable without blood supply from the pulmonary artery (PA). However, our experience demonstrates otherwise. We present 2 cases of accidental left lower lobe PA occlusion during upper lobectomy causing ischaemic changes to the remaining lung tissue. Both patients became septic secondary to necrosis of infarcted lung and required completion pneumonectomy. Development of collateral circulation to bypass the occluded PA may occur but is often insufficient to support the affected lung tissue. Unless the patient is medically unfit, resection of the ischaemic lung should be undertaken.
Assuntos
Infarto/diagnóstico , Lesão Pulmonar/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/irrigação sanguínea , Pneumonectomia/efeitos adversos , Artéria Pulmonar/diagnóstico por imagem , Estenose de Artéria Pulmonar/diagnóstico , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Angiografia por Tomografia Computadorizada , Humanos , Infarto/etiologia , Infarto/cirurgia , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Lesão Pulmonar/diagnóstico , Neoplasias Pulmonares/diagnóstico , Masculino , Complicações Pós-Operatórias , Reoperação , Estenose de Artéria Pulmonar/complicações , Ferimentos por Arma de Fogo/diagnóstico , Ferimentos por Arma de Fogo/cirurgia , Adulto JovemRESUMO
PURPOSE: Accurate estimation of esophageal hiatus surface area (HSA) prior to surgical repair of hiatal hernia is difficult. The ability to do so may assist with following progression of hiatal hernias, choosing the optimal surgical approach and post-surgical evaluation. We developed a method for measurement of HSA using multi-planar reconstruction (MPR) of multi-detector computed tomography (MDCT) scans and sought to validate our method using intra-operative HSA measurements. METHODS: Patients with thoracic or abdominal CT scans who were scheduled to undergo hiatal hernia repair were identified. A radiologist performed MPR of each MDCT scan to obtain the measured HSA (mHSA). Estimated HSA (eHSA) was obtained using intra-operative measurements of crura length and distance between crural edges. The association between eHSA and the corresponding mHSA was assessed using Pearson correlation. The intra-class correlation coefficient was calculated to assess both intra-observer and inter-observer agreement for the MDCT-MPR technique. RESULTS: Of 30 subjects included, 16 (53.3%) were female and the median age was 68.5 years. All patients underwent robotic-assisted laparoscopic hiatal hernia repair. The median HSA was 8.1 cm2 based on intra-operative measurements and 9.9 cm2 based on CT measurements. The correlation coefficient for eHSA and corresponding mHSA was 0.83 (p < 0.001). The intra-class correlation coefficient was 0.97 (p < 0.001) for intra-observer agreement and 0.97 (p < 0.001) for inter-observer agreement. CONCLUSION: We developed a MDCT-MPR technique that measures HSA in vivo. This technique is reproducible and can be used for pre-operative planning and post-operative follow-up of patients with symptomatic hiatal hernia.
Assuntos
Refluxo Gastroesofágico , Hérnia Hiatal , Laparoscopia , Idoso , Diafragma , Feminino , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/diagnóstico por imagem , Hérnia Hiatal/cirurgia , Humanos , Masculino , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to use current American Thyroid Association (ATA) management guidelines to identify groups who might be at risk of overtreatment with radioactive iodine (RAI) ablation after surgery for low-risk papillary thyroid cancer (PTC). METHODS: PTC patients were identified using the Surveillance, Epidemiology and End Results database. Characteristics of low-risk patients (defined as T1 without metastasis) were compared to those not low-risk. Predictors of receiving RAI for low-risk disease were determined using logistic regression. RESULTS: Of 32,229 cases, 17,286 (53.6%) were low-risk. Low-risk patients, compared to others, were older (mean age 51.3 versus 48.5 years), and more often female (81.6% versus 71.7%), white (69.7% versus 62.0%), and insured (87.6% versus 85.6%)(all p-valuesâ¯<â¯0.001). Nearly 25% of low-risk patients received RAI. Predictors of overtreatment with RAI included age <45 years (OR: 1.393; 95% CI: 1.250-1.552), age 45-64 years (OR: 1.275; 95% CI: 1.152-1.412), male sex (OR: 1.191; 95% CI: 1.086-1.305), Hispanic (OR: 1.236; 95% CI: 1.110-1.376) and Asian (OR: 1.306; 95% CI: 1.159-1.473) race, and extensive lymphadenectomy (OR: 1.243; 95% CI: 1.119-1.381). CONCLUSION: Low-risk PTC patients were more likely to receive post-surgical RAI when not indicated under ATA guidelines if they were younger, male, Hispanic or Asian, or underwent extensive lymph node surgery. Identification of groups at risk for overtreatment can help impact practice patterns and improve the effective utilization of healthcare resources.
Assuntos
Radioisótopos do Iodo/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Radioterapia Adjuvante/estatística & dados numéricos , Câncer Papilífero da Tireoide/radioterapia , Neoplasias da Glândula Tireoide/radioterapia , Idoso , Feminino , Seguimentos , Humanos , Radioisótopos do Iodo/uso terapêutico , Masculino , Pessoa de Meia-Idade , Prognóstico , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologiaRESUMO
BACKGROUND: We sought to identify treatment disparities existing prior to publication of the 2015 American Thyroid Association Management Guidelines in order to identify patients with papillary thyroid cancer (PTC) at risk for receiving inadequate treatment. METHODS: Patients diagnosed with PTC from 2011 to 2013 were identified using Surveillance, Epidemiology and End Results database. High-risk disease was defined as T4, N1, or M1. Chi-square tests compared characteristics of patients with and without high-risk disease and characteristics of high-risk patients who did and did not receive radioactive iodine ablation (RAI). Likelihoods of having high-risk disease, of receiving RAI, and of cause-specific death were calculated using regression analyses. RESULTS: Sample included 32,229 individuals; 7894 (24.5%) had high-risk disease. Mean age was 50.0 years, 24,815 (77.0%) were female, and 21,318 (66.2%) were white. Odds of high-risk disease were greater among males (OR:2.04; 95% CI:1.92-2.16), Hispanics (OR:1.67; 95% CI:1.56-1.79) and Asians (OR:1.49; 95% CI:1.37-1.62), and uninsured (OR:1.24; 95% CI:1.07-1.43), and lower among patients ages 45-64 (OR:0.57; 95% CI:0.53-0.60), and ≥65 years (OR:0.54; 95% CI:0.50-0.59), and Blacks (OR:0.46; 95% CI:0.40-0.53). Most (69.3%) high-risk patients received RAI. Odds of receiving RAI were lower among patients age ≥65 years (OR:0.67; 95% CI:0.58-0.77), uninsured (OR:0.52; 95% CI:0.41-0.67), or with Medicaid (OR:0.58; 95% CI:0.50-0.69). RAI use reduced the risk of cause-specific mortality (HR:0.29; 95% CI:0.18-0.47). CONCLUSION: Knowledge of these treatment disparities will allow recognition of groups at risk for high-risk disease and receiving inadequate treatment.
Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Radioisótopos do Iodo/uso terapêutico , Esvaziamento Cervical , Padrões de Prática Médica/estatística & dados numéricos , Câncer Papilífero da Tireoide/radioterapia , Neoplasias da Glândula Tireoide/radioterapia , Tireoidectomia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Fatores Etários , Idoso , Asiático/estatística & dados numéricos , Etnicidade/estatística & dados numéricos , Feminino , Disparidades em Assistência à Saúde/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Razão de Chances , Modelos de Riscos Proporcionais , Radioterapia Adjuvante/estatística & dados numéricos , Risco , Programa de SEER , Fatores Sexuais , Câncer Papilífero da Tireoide/mortalidade , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Estados Unidos , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: We sought to investigate how the interval between symptom onset and diagnosis of soft tissue sarcoma (STS) of the extremity was associated with survival. METHODS: Patients treated for extremity STS years 2006-2015 were stratified by symptom duration: at least two, six or twelve months between symptom onset and diagnosis. Chi-square tests compared patient and tumor-related characteristics based on symptom duration. Survival analysis included Cox regression and Kaplan-Meier estimates. RESULTS: Of 113 patients included, mean age was 56.7 years, 52.2% were male, and 75.2% were white. Median tumor size was 75â¯mm, 48.7% were grade 3, and 38.1% were stage I. With symptom duration of either at least 6 or 12 months, a greater proportion of patients who experienced the specified symptom duration had lower grade tumors (pâ¯<â¯0.01 and pâ¯=â¯0.01, respectively) and lower stage disease (pâ¯<â¯0.01 and pâ¯=â¯0.02, respectively) than those who did not. Among all patients, survival estimates were similar between those who experienced a symptom duration of 2 (pâ¯=â¯0.12), 6 (pâ¯=â¯0.18) or 12 (pâ¯=â¯0.61) months and those who did not. CONCLUSION: Patients with extremity STS who tolerated a longer symptom duration had less advanced disease. Reasons for prolonged symptom duration and methods to address these factors warrant further investigation.
Assuntos
Extremidades/patologia , Recidiva Local de Neoplasia/mortalidade , Sarcoma/mortalidade , Índice de Gravidade de Doença , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/terapia , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND: Breast spindle cell malignancies are rare. No standard treatment exists. METHODS: The Surveillance, Epidemiology, and End Results database was used to identify patients with breast spindle cell malignancies, 1992 to 2011. Descriptive statistical analysis and survival analysis were performed. RESULTS: A total of 286 patients were identified (98.6% female). Approximately, 15% had estrogen receptor-positive tumors and 12.5% had progesterone receptor-positive tumors. Nearly 38% underwent partial mastectomy, whereas 55.5% underwent mastectomy. The frequency of partial mastectomy has increased in more recent years. One-third received radiation. Lymph node metastases were infrequent (9.3%) and distant metastases were uncommon (6.1%). Ten-year survival rates for patients with early-stage (I and II) disease were 83.9% after partial mastectomy, 86.7% after partial mastectomy plus radiation, and 71.6% after complete mastectomy. Three-year survival rates for patients with late-stage (III and IV) disease were low with 40.0% after complete mastectomy and 0% after complete mastectomy plus radiation. CONCLUSIONS: This nationally representative analysis demonstrates that early-stage spindle cell carcinoma of the breast is adequately treated by partial mastectomy. Radiation may be considered for small, potentially early survival benefit. For late stage disease, complete mastectomy is appropriate; however, survival is poor, and radiation contributes no significant additional benefit.