ABSTRACT
BACKGROUND: In locally advanced breast cancer, axillary lymph node dissection remains a pivotal component of surgical therapy. Apart from this, it has been mostly replaced by sentinel node biopsy. Complications after axillary dissection include wound infection, neuropathy, lymphedema and-most frequently-seroma. In this retrospective multi-centre study, we compared the use of LigaSureTM with monopolar electrocautery regarding perioperative outcome. METHODS: A retrospective data analysis from female breast cancer patients who underwent axillary dissection at two breast centres in Austria that are using two different surgical techniques was performed for this study. We compared the rate of complications and re-operations, length of hospital stay, time to drain removal, total drain fluid, seroma formation after drain removal, number of seroma aspirations and total seroma fluid. RESULTS: Seventy one female patients with a median age of 63 (30-83) were included in this study. In 35 patients LigaSureTM and in 36 monopolar cautery was used for axillary dissection. There was no significant difference regarding intraoperative complications and rate of re-operations between the two groups (2.9 vs. 5.6%; p = 1 and 2.9 vs. 13.9%; p = 0.199). The time to drain removal and the length of hospital stay was similar in both groups. A significant difference in the occurence of postoperative wound infection could also not be shown. However, we found a significantly smaller total drain fluid in the LigaSureTM-group compared to the cautery-group (364.6 ml vs. 643.4 ml; p = 0.004). Seroma formation after drain removal was more frequent in the LigaSureTM-group (68.6 vs. 41.7%; p = 0.032) with a higher number of outpatient seroma aspirations (2.0 vs. 0.9; p = 0.005). CONCLUSION: LigaSureTM and monopolar cautery provide equivalent techniques in axillary lymph node dissection with comparable postoperative outcomes.
Subject(s)
Breast Neoplasms , Humans , Female , Breast Neoplasms/pathology , Retrospective Studies , Seroma/epidemiology , Seroma/etiology , Lymph Node Excision/methods , Drainage/methods , Axilla/surgery , Axilla/pathologyABSTRACT
BACKGROUND: Diagnosis and management of non-obstetric abdominal pathologies during pregnancy are clinically challenging for both obstetricians and general surgeons. Our aim was to evaluate the outcome of pregnant patients who had undergone non-obstetric abdominal surgery. METHODS: We retrospectively reviewed 76 pregnant patients who had required surgery for non-obstetric abdominal pathologies during pregnancy at our department from January 2005 to December 2015. Data were collected retrospectively from medical records as well as from our institutional perinatal database. We evaluated data for clinical presentation, perioperative management, preterm labor, and maternal and fetal outcomes. RESULTS: The patients' mean age was 29 (interquartile range IQR 25-33) years. Indications for surgery were acute appendicitis in 63%, adnexal pathology in 11%, cholecystolithiasis in 5% and other indications in 21%; surgery was performed in an elective setting in 18% and in an emergent/urgent setting in 82%. In five cases, complications, three of them oncological, called for further surgery. Ninety-seven percent of operations were conducted under general anesthesia. Median skin-to-skin time was 50 (37-80) minutes, median in-hospital stay was 4 (3.5-6) days, and 5 % required postoperative intensive care. Preterm labor occurred in 15%, miscarriage in 7% (none of them directly related to abdominal surgery). CONCLUSION: Abdominal surgery for non-obstetric pathology during pregnancy can be performed safely, if mandatory, without increases in maternal and fetal pathology, miscarriage, and preterm birth rates.
Subject(s)
Abdomen/surgery , Pregnancy Complications/surgery , Prenatal Care/statistics & numerical data , Abortion, Spontaneous/etiology , Acute Disease , Adnexal Diseases/surgery , Adult , Appendicitis/surgery , Cholecystolithiasis/surgery , Female , Humans , Pregnancy , Pregnancy Outcome , Premature Birth/etiology , Prenatal Care/methods , Retrospective Studies , Treatment OutcomeABSTRACT
INTRODUCTION: Low skeletal muscle mass is a known predictor of morbidity and mortality in patients undergoing major pancreatic surgeries. We sought to combine low skeletal muscle mass with established risk predictors to improve their prognostic capacity for postoperative outcome and morbidity. METHODS: As established parameters to predict preoperative mortality risk for patients, the ASA classification and the Charlson Comorbidity Index (CCI) were used. The Hounsfield Units Average Calculation (HUAC) was measured to define low skeletal muscle mass in 424 patients undergoing pancreatic resections for malignancies. Patients in the lowest sex-adjusted quartile for HUAC were defined as having low skeletal muscle mass (muscle wasting). Multivariable Cox regression analysis was utilized to identify preoperative risk factors associated with postoperative morbidity. RESULTS: Median patient age was 63 years (19-87), 47.9% patients were male, and half the cohort had multiple comorbidities (Charlson Comorbidity Index [CCI]>6, 63.2%), 30-day mortality was 5.8% (n = 25). Median HUAC was 19.78 HU (IQR: 15.94-23.54) with 145 patients (34.2%) having low skeletal muscle mass. Preoperative frailty defined by low skeletal muscle mass was associated with an increased risk for postoperative complications (OR 1.55, CI 95% 0.98-2.45, p = 0.014), and a higher 30-day mortality (HR 5.17, CI 95% 1.57-16.69, p = 0.004). With an AUC of 0.85 HUAC showed the highest predictability for 30-day mortality (CI 95% 0.78-0.91, p = 0.0001). Patients with CCI ≥6 and low skeletal muscle mass defined by the HUAC had a 9.78 higher risk of dying in the immediate postoperative phase (HR 9.78, CI 95% 2.98-12.2, p = 0.0001). CONCLUSION: Low skeletal muscle mass predicts postoperative mortality and complications best and it should be incorporated to conventional risk scores to identify high risk patients.
Subject(s)
Carcinoma/surgery , Frailty/epidemiology , Pancreatic Neoplasms/surgery , Pancreaticoduodenectomy , Postoperative Complications/epidemiology , Psoas Muscles/diagnostic imaging , Adult , Aged , Aged, 80 and over , Carcinoma/epidemiology , Comorbidity , Female , Frailty/diagnostic imaging , Humans , Male , Middle Aged , Mortality , Multivariate Analysis , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Organ Size , Pancreatic Neoplasms/epidemiology , Prognosis , Proportional Hazards Models , Psoas Muscles/pathology , Risk Assessment , Tomography, X-Ray Computed , Young AdultABSTRACT
INTRODUCTION: Laparoscopic appendectomy is widely used for the treatment of complicated appendicitis. Its use in patients with high operative risk is still on debate. The aim of the presented study was to investigate the benefits of laparoscopic appendectomy in patients with high peri- and postoperative risk factors. METHODS: We performed a retrospective analysis of all patients who underwent appendectomy in our center between 2006 and 2013. Patients were classified according to their preoperative risk (classification of the American Society of Anesthesia--ASA score). Only patients with ASA 3 and 4 were included and were divided into two groups--open appendectomy (OA group) and laparoscopic appendectomy (LA group). RESULTS: The operation time was slightly longer in the LA group (p = 0.05), but hospital stay was shorter (p = 0.05). Complications graded according to the Clavien Dindo classification were slightly more frequent in patients after LA, whereas severe complications occurred more frequently in patients after OA (p = 0.01). The postoperative WBC decreased steadily and significantly in patients after OA, whereas the decrease in patients after LA was delayed (p = 0.03). CRP slightly increased after OA and decreased thereafter, whereas it steadily decreased after LA (p = 0.05). CONCLUSION: Laparoscopic appendectomy can be recommended for patients with complicated appendicitis even with higher risk categories.
Subject(s)
Appendectomy/methods , Appendicitis/surgery , Laparoscopy , Adolescent , Adult , Aged , Aged, 80 and over , Appendectomy/adverse effects , Appendicitis/complications , C-Reactive Protein/analysis , Female , Humans , Inflammation/etiology , Laparoscopy/adverse effects , Length of Stay , Leukocyte Count , Male , Middle Aged , Operative Time , Retrospective Studies , Risk Factors , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: Despite improvements in liver surgery over the past decades, hemostasis during hepatic resections remains challenging. This multicenter randomized study compares the hemostatic effect of a collagen hemostat vs. a carrier-bound fibrin sealant after hepatic resection. METHODS: Patients scheduled for elective liver resection were randomized intraoperatively to receive either the collagen hemostat (COLL) or the carrier-bound fibrin sealant (CBFS) for secondary hemostasis. The primary endpoint was the proportion of patients with hemostasis after 3 min. Secondary parameters were the proportions of patients with hemostasis after 5 and 10 min, the total time to hemostasis, and the complication rates during a 3 months follow-up period. RESULTS: A total of 128 patients were included. In the COLL group, 53 out of 61 patients (86.9 %) achieved complete hemostasis within 3 min after application of the hemostat compared to 52 out of 65 patients (80.0 %) in the CBFS group. The 95 % confidence interval for this difference [-6.0 %, 19.8 %] does not include the lower noninferiority margin (-10 %). Thus, the COLL treatment can be regarded as noninferior to the comparator. The proportions of patients with hemostasis after 3, 5, and 10 min were not significantly different between the two study arms. Postoperative mortality and morbidity were similar in both treatment groups. CONCLUSION: The collagen hemostat is as effective as the carrier-bound fibrin sealant in obtaining secondary hemostasis during liver resection with a comparable complication rate.
Subject(s)
Blood Loss, Surgical/prevention & control , Collagen/administration & dosage , Hemostasis, Surgical , Hemostatics/administration & dosage , Hepatectomy/adverse effects , Liver Diseases/surgery , Aged , Female , Humans , Liver Diseases/pathology , Male , Middle Aged , Treatment OutcomeABSTRACT
Due to ameliorated surgery as well as better immunosuppression, the recipient age after liver transplantation has been extended over the past years. This study aimed to investigate the health related quality of life after liver transplantation in recipients beyond 60 years of age. The SF-36 was used to evaluate the recipients' health-related quality of life as standardized tool. It comprises 36 items that are attributed to 8 subscales attributed to 2 components: the physical component score and the mental component score. Differences in the health-related quality of life between the included aged recipients and age-matched general population as well as among female and male recipients. Aged recipients showed significantly lower scores in physical functioning (29 vs. 76, p = 0.001), role physical (42 vs. 73, p = 0.003), bodily pain (34 vs. 71, p = 0.003), general health (28 vs. 59, p = 0.001), vitality (25 vs. 61, p = 0.001), social functioning (36 vs. 87, p =0.001), role emotional (46 vs. 89, p = 0.001) as well as the physical component score (28 vs. 76, p = 0.001). Aged female recipients showed lower results as compared to males in social functioning, physical functioning, role physical, and social functioning (p = 0.03 respectively) but comparable results in the remaining. Quality of life seems to be an issue among aged recipients and should be assessed on a regular basis.
Subject(s)
Aging/psychology , Health Status , Liver Diseases/surgery , Liver Transplantation/psychology , Quality of Life , Age Factors , Aged , Female , Follow-Up Studies , Humans , Liver Diseases/psychology , Male , Middle Aged , Prognosis , Surveys and Questionnaires , Time FactorsSubject(s)
Choledochal Cyst/diagnosis , Choledochal Cyst/surgery , Puerperal Disorders/diagnosis , Puerperal Disorders/surgery , Anastomosis, Roux-en-Y/methods , Cholangiopancreatography, Magnetic Resonance , Cholecystectomy/methods , Comorbidity , Diagnosis, Differential , Female , Humans , Magnetic Resonance Angiography , Tomography, X-Ray Computed , Ultrasonography , Uterine Rupture/diagnosis , Uterine Rupture/surgery , Young AdultSubject(s)
Intestinal Obstruction/etiology , Pelvic Neoplasms/diagnosis , Rectal Diseases/etiology , Sigmoid Diseases/etiology , Splenosis/complications , Splenosis/diagnosis , Aged , Colonoscopy , Diagnosis, Differential , Female , Humans , Magnetic Resonance Angiography , Rectal Diseases/surgery , Sigmoid Diseases/surgery , Splenosis/surgery , Tomography, X-Ray ComputedSubject(s)
Bile Duct Neoplasms/diagnosis , Cholangiocarcinoma/diagnosis , Cholecystectomy, Laparoscopic/adverse effects , Cholestasis, Intrahepatic/diagnosis , Cholestasis, Intrahepatic/etiology , Iatrogenic Disease , Cholestasis, Intrahepatic/surgery , Constriction, Pathologic/diagnosis , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Diagnosis, Differential , Female , Humans , Middle Aged , Time FactorsABSTRACT
As hernias and abdominal wall defects have a variety of etiologies each with its own complications and comorbidities in various constellations, efficient treatment requires patient-oriented management. There is no recommended standard treatment and the very different clinical pictures demand an individualized interdisciplinary approach. Particularly in the case of complicated hernias, the planning of the operation should focus on the problems posed by the individual patient. Treatment mainly depends on the etiology of the hernia, immediate or long-term complications and the efficiency of individual repair techniques. Abdominal wall repair for recurrent herniation requires direct closure of the fascia generally using the sublay technique with a lightweight mesh. It is still unclear whether persistent inflammation, mesh dislocation, fistula formation or other long-term complications are due to certain materials or to the surgical technique. With mesh infections it has been shown to be advantageous to remove a polytetrafluoroethylene (PTFE) mesh, while the combination of systemic and local treatment appears to suffice for a polypropylene or polyester mesh. Heavier meshes in the sublay position or plastic reconstruction with autologous tissue are indicated as substitutes for the abdominal wall for giant hernias, repeated recurrences and large abdominal wall defects. A laparostoma is increasingly more often created to treat septic intra-abdominal processes but is very often responsible for a complicated hernia. If primary repair of the abdominal wall is not an option, resorbable material or split skin is used for coverage under the auspices of a planned hernia repair.
Subject(s)
Hernia, Ventral/surgery , Postoperative Complications/surgery , Surgical Wound Infection/surgery , Absorbable Implants , Algorithms , Fasciotomy , Humans , Polytetrafluoroethylene , Prosthesis-Related Infections/surgery , Rectus Abdominis/surgery , Recurrence , Reoperation/methods , Skin Transplantation/methods , Surgical Flaps , Surgical Mesh , Surgical Wound Dehiscence/surgery , Suture Techniques , Wound Healing/physiologyABSTRACT
In recent years a number of new therapeutics has been developed that were not general toxins and inhibitors of cell division like classical chemotherapeutics, but were designed to target a specific pathway. A prerequisite for this development was the comprehensive characterization of molecular alterations occurring in human hepatocellular carcinoma (HCC). However, while much knowledge of the molecular pathogenesis of human HCC has been gained, the model systems used to test the functional relevance of these alterations and applied for preclinical evaluation of drug candidates are still poorly characterized. In this paper, we reviewed the literature about several commonly used HCC cell lines and xenotransplantation models and present our own data on the molecular characterization of these. Results obtained demonstrate that it is important to have a sound knowledge of the specific molecular constitution of the experimental model and to carefully evaluate the functional status of the pathway of interest. For this reason, we make the gene expression profiles publicly available to help researchers making an informed decision about which model to use.
Subject(s)
Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Models, Biological , Transplantation, Heterologous , Animals , Carcinoma, Hepatocellular/genetics , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/genetics , Liver Neoplasms/surgery , Mice , Mice, NudeABSTRACT
In the context of the Austrian Genome Program, a tissue bank is being established (Genome Austria Tissue Bank, GATiB) which is based on a collection of diseased and corresponding normal tissues representing a great variety of diseases at their natural frequency of occurrence from a non-selected Central European population of more than 700,000 patients. Major emphasis is put on annotation of archival tissue with comprehensive clinical data, including follow-up data. A specific IT infrastructure supports sample annotation, tracking of sample usage as well as sample and data storage. Innovative data protection tools were developed which prevent sample donor re-identification, particularly if detailed medical and genetic data are combined. For quality control of old archival tissues, new techniques were established to check RNA quality and antigen stability. Since 2003, GATiB has changed from a population-based tissue bank to a disease-focused biobank comprising major cancers such as colon, breast, liver, as well as metabolic liver diseases and organs affected by the metabolic syndrome. Prospectively collected tissues are associated with blood samples and detailed data on the sample donor's disease, lifestyle and environmental exposure, following standard operating procedures. Major emphasis is also placed on ethical, legal and social issues (ELSI) related to biobanks. A specific research project and an international advisory board ensure the proper embedding of GATiB in society and facilitate international networking.
Subject(s)
Genome , Tissue Banks/organization & administration , Austria , Databases, Factual , Humans , International Cooperation , Metabolic Diseases/genetics , Metabolic Diseases/pathology , Neoplasms/genetics , Neoplasms/pathology , Quality Control , Tissue Banks/standards , Tissue Banks/trendsABSTRACT
BACKGROUND/AIMS: Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal. METHODOLOGY: Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team. RESULTS: The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%). CONCLUSIONS: The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.
Subject(s)
Abdominal Injuries/surgery , Multiple Trauma/surgery , Pancreas/injuries , Pancreatic Diseases/etiology , Pancreatic Ducts/injuries , Postoperative Complications/etiology , Practice Guidelines as Topic , Wounds, Nonpenetrating/surgery , Wounds, Penetrating/surgery , Abdominal Abscess/etiology , Abdominal Injuries/diagnosis , Humans , Multiple Trauma/diagnosis , Pancreas/surgery , Pancreatic Ducts/surgery , Pancreatic Fistula/etiology , Pancreatic Pseudocyst/etiology , Pancreatitis, Acute Necrotizing/etiology , Patient Care Team , Wounds, Nonpenetrating/diagnosis , Wounds, Penetrating/diagnosisABSTRACT
BACKGROUND: Pyogenic liver abscess (PLA) remains a serious disease with a mortality of 6-14%. METHODS: Clinical data of 76 patients with PLA were analyzed. Treatment options comprised antibiotics, percutaneous puncture/drainage, endoscopic papillotomy/stenting and/or surgery as indicated. RESULTS: Fifty-eight patients (76%) had single and 18 patients multiple PLA (right lobe: 65%; both lobes: 22%). The most frequent etiologies were: biliary (38%), hematogenous and posttraumatic (11%). Factors associated with the need for surgery included gallbladder empyema, biliary fistulas, malignancy, perforation, multicentricity, vascular complications and foreign bodies (e.g. infected ventriculo-peritoneal shunt, toothpick). CONCLUSIONS: Microbiological testing provides important information for treatment monitoring and modification. Complementary assessment of risk factors for a complicated course is crucial for timely identification of patients requiring additional treatment.
Subject(s)
Liver Abscess, Pyogenic/therapy , Anti-Bacterial Agents/therapeutic use , Biliary Fistula/complications , Biliary Fistula/pathology , Cell Culture Techniques , Drainage , Female , Humans , Liver Abscess, Pyogenic/diagnosis , Liver Abscess, Pyogenic/etiology , Liver Abscess, Pyogenic/surgery , Male , Microbial Sensitivity Tests , Retrospective Studies , Tomography, X-Ray ComputedABSTRACT
The purpose of this trial was to examine the efficacy of the addition of levamisole (LEV) or interferon alfa (IFN) to an adjuvant chemotherapy with 5-fluorouracil (5-FU) in patients with stage III colon cancer. According to a 2 x 2 factorial study design, 598 patients were randomly assigned to one of four adjuvant treatment arms. Patients in arm one received 5-FU weekly for 1 year, patients in arm two 5-FU plus LEV, in arm three 5-FU plus IFN and patients in arm four 5-FU, LEV and IFN. The relative risk of relapse and the relative risk of death were significantly higher for patients treated with LEV compared with those without LEV treatment (HR 1.452, 95% CI 1.135-1.856, P=0.0028; HR 1.506, 95% CI 1.150-1.973, P=0.0027, respectively). No significant impact on survival was observed for therapy with IFN in the univariate analysis. The addition of LEV to adjuvant 5-FU significantly worsened the prognosis of patients with stage III colon cancer. Interferon alfa had no significant influence on survival when combined with adjuvant 5-FU, but increased the toxicity of therapy substantially.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colonic Neoplasms/drug therapy , Colonic Neoplasms/surgery , Combined Modality Therapy , Disease-Free Survival , Drug Administration Schedule , Female , Fluorouracil/administration & dosage , Humans , Interferon-alpha/administration & dosage , Interferon-alpha/adverse effects , Leucovorin/administration & dosage , Levamisole/administration & dosage , Male , Middle Aged , Neoplasm Recurrence, Local , Prognosis , Survival AnalysisABSTRACT
BACKGROUND: Pancreatitis-associated protein (PAP) is known as a marker for pancreatitis and cystic fibrosis. The aim of our study was to evaluate PAP in patients with pancreatic cancer, to assess its correlation to the extent of the disease and to compare it to CA19-9. PATIENTS AND METHODS: This prospective study comprised 75 individuals. Thirty had pancreatic cancer, 30 were healthy controls and 15 had benign lesions of the pancreas. PAP was determined by enzyme-linked immunosorbent assay. Statistical analysis was by Wilcoxon test and Spearman correlation coefficients. RESULTS: As compared to healthy individuals and using a cut-off of 18 micrograms/l corresponding to a sensitivity of 90%, the specificity of PAP for pancreatic cancer was 82.8%. PAP elevation in cancer patients could not be explained by concomitant pancreatitis (p = 0.649). PAP did not show correlation to tumour size (p = 0.14), T-stages (p = 0.706) or tumour grading (p = 0.105), but was significantly correlated to the overall extent of the disease according to the UICC stages (p = 0.002). No correlation between PAP and CA19-9 was seen. Jaundice was not found to influence PAP values (p = 0.4). CONCLUSION: Elevation of PAP in patients with pancreatic cancer is not merely explainable by concomitant pancreatitis, but seems to be due to increased PAP production by the cancer cells and is also correlated to tumour load as expressed by the UICC stages.
Subject(s)
Acute-Phase Proteins/analysis , Antigens, Neoplasm , Biomarkers, Tumor/blood , Lectins, C-Type , Pancreatic Neoplasms/blood , CA-19-9 Antigen/blood , Humans , Pancreatic Diseases/blood , Pancreatic Neoplasms/physiopathology , Pancreatitis-Associated Proteins , Prospective StudiesSubject(s)
Immunosuppression Therapy/adverse effects , Killer Cells, Natural/immunology , Surgical Wound Infection/etiology , Thyroidectomy/adverse effects , Anti-Bacterial Agents/administration & dosage , Follow-Up Studies , Humans , Male , Middle Aged , Risk Assessment , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapy , Thyroidectomy/methods , Thyroiditis, Autoimmune/diagnosis , Thyroiditis, Autoimmune/surgery , Treatment Outcome , Wound Healing/physiologyABSTRACT
Because bronchogenic cysts may be found in or near any organ derived from the embryonic foregut, they sometimes pose considerable diagnostic difficulties. We describe the plain chest X-ray, computed tomographic, and angiographic findings in a patient with elevated CA 19-9 and upper quadrant abdominal pain due to a cystic tumor appearing as a hepatic mass. Surgery and histology showed a bronchogenic cyst located in the lower lobe of the right lung.