Adjuvant radiotherapy improves long-term survival after resection for gallbladder cancer A population-based cohort study.

BACKGROUND: Data supporting routine use of adjuvant radiotherapy (RT) compared to without RT (noRT) for gallbladder cancer (GBC) is unclear. This study aimed to determine whether RT improves long-term survival following resection for GBC. METHODS: Patients receiving resection for GBC followed by RT from 2004 to 2016 were identified from the National Cancer Database (NCDB). Patients with survival <6 months were excluded to account for immortal time bias. Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of RT on overall survival. RESULTS: Of 7514 (77%) noRT and 2261 (23%) RT, 2067 noRT and 2067 RT patients remained after PSM. After matching, RT was associated with improved survival (median: 26.2 vs 21.5 months, p < 0.001), which remained after multivariable adjustment (HR: 0.82, CI95%: 0.76-0.89, p < 0.001). On multivariable interaction analyses, this benefit persisted irrespective of nodal status: N0 (HR: 0.84, CI95%: 0.77-0.93), N1 (HR: 0.77, CI95%: 0.68-0.88), N2/N3 (HR: 0.56, CI95%: 0.35-0.91), margin status: R0 (HR: 0.85, CI95%: 0.78-0.93), R1 (HR: 0.78, CI95%: 0.68-0.88) and use of adjuvant chemotherapy (AC) (HR: 0.67, CI95%: 0.57-0.79). Benefit with RT were also seen in patients with T2 - T4 disease and in patients undergoing simple and extended cholecystectomy. CONCLUSION: RT following resection was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings may suggest addition of RT into multimodality therapy for GBC.

Adjuvant chemotherapy for perihilar cholangiocarcinoma: A population-based comparative cohort study.

BACKGROUND: Data supporting routine use of adjuvant chemotherapy (AC) compared to no AC (noAC) for perihilar cholangiocarcinoma (hCCA) is unclear. This study aimed to determine whether AC improves long-term survival following resection for hCCA. METHODS: Patients receiving resection for hCCA followed by AC or no AC from 2010 to 2016 were identified from the National Cancer Database (NCDB). Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of AC on overall survival. RESULTS: Of 924 (56%) noAC and 719 (44%) AC, 320 noAC and 320 AC patients remained after PSM. After matching, AC was associated with improved survival (median: 28.2 vs 19.9 months, p < 0.001), which remained after multivariable adjustment (HR: 0.61, CI95%: 0.50-0.75, p < 0.001). On multivariable interaction analyses, the benefit of AC over no AC persisted irrespective of nodal status: N0 (HR: 0.62, CI95%: 0.41-0.92, p = 0.019), N1 (HR: 0.52, CI95%: 0.36-0.75, p = 0.001), N2 (HR: 0.31, CI95%: 0.11-0.90, p = 0.032), Nx (HR: 0.22, CI95%: 0.09-0.55, p = 0.001) and margin status: R0 (HR: 0.74, CI95%: 0.57-0.97, p = 0.026), R1 (HR: 0.31, CI95%: 0.21-0.47, p < 0.001). Stratified analysis by nodal, margin and AC status demonstrated consistent results. CONCLUSION: AC following resection for hCCA was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings suggest incorporation of AC into multimodality therapy for hCCA in all cases, where appropriate.

Use of short-term steroids in the prophylaxis of atrial fibrillation after cardiac surgery.

OBJECTIVES: To assess the effectiveness of corticosteroids in the prophylaxis of postoperative atrial fibrillation (AF) in patients undergoing elective coronary artery bypass grafting or valvular heart surgery in terms of reducing its incidence and decreasing the length of hospital stay. METHODS: This prospective double blinded randomized study was conducted at Queen Alia Heart Institute (Amman, Jordan) from June 2014 to June 2015 on 340 patients who underwent their first on-pump elective coronary artery bypass grafting (CABG) alone or combined with valvular surgery. Inclusion criteria consisted of elective first time CABG or combined with valvular surgery, use of ß-adrenergic blockade, and normal sinus rhythm. Exclusion criteria included a history of heart block, previous episodes of AF or flutter, uncontrolled diabetes mellitus, history of peptic ulcer disease, systemic bacterial or mycotic infection, permanent pacemaker, and any documented or suspected supraventricular or ventricular arrhythmias. Patients were randomized into two equal groups (n = 170 each), then each group was subdivided into patients who underwent CABG alone (n = 120), and patients underwent valvular heart surgery with or without CABG (n = 50). In the treatment group, patients were given 1 g of methylprednisolone before cardiopulmonary bypass then 100 mg of hydrocortisone every 8 hours for the first 3 days postoperatively. The primary endpoint was the overall occurrence of postoperative AF. RESULTS: AF developed in 21.1% (36 patients) in the treatment group in contrast to 38.2% (65 patients) in the control group (p < 0.05). In the subdivided groups (CABG only), approximately 20% (24 patients) developed AF in the treatment group in contrast to 35% (42 patients) in the control group (p < 0.05). In the other group, (CABG + VALVE) 24% (12 patients) developed AF compared with 46% (23 patients) in the control group (p < 0.05). The length of hospital stay was 6.02 ± 11.23 days in the treatment group while it was 5.98 ± 1.86 days in the control group, which was found to be statistically nonsignificant. No statistical significant difference in the rate of postoperative complications including mediastinitis as well superficial wound infections was observed between the two groups. CONCLUSION: Prophylactic short-term use of steroids both intraoperatively and postoperatively proved to be safe and effective in reducing the incidence of postoperative AF in patients undergoing CABG alone or combined with valve surgery.