Hybrid robotic transversus abdominis release versus open: propensity-matched analysis of 30-day outcomes.

PURPOSE: To examine the hospital length of stay (LOS) and 30 day outcomes of hybrid robotic transversus abdominis release (hrTAR) compared with open transversus abdominis release (oTAR). METHODS: Patients receiving hrTAR were selected from the AHSQC database and propensity matched with a contemporary cohort of oTAR patients. RESULTS: The cohort included 95 hrTAR and 285 oTAR patients. There was a significantly shorter median LOS in the hrTAR cohort (3 vs. 5 days, p < 0.001). The rate of surgical site occurrences in the hrTAR cohort was also lower than for oTAR (5% vs. 15%, p = 0.015). Readmission rates were not different between hrTAR and oTAR (6% vs. 8%, p = 0.65). CONCLUSION: hrTAR demonstrates improved LOS compared to oTAR as well as fewer surgical site related occurrences. Further studies are needed to investigate the etiology behind the improved LOS and to confirm appropriate long-term outcomes from hybrid robotic TAR.

Hybrid robotic-assisted transversus abdominis release versus open transversus abdominis release: a comparison of short-term outcomes.

BACKGROUND: Although the open transversus abdominis release (oTAR) is an effective operation for large ventral hernias, it is historically associated with a relatively long length of stay. Robotic retromuscular transversus abdominis release (rTAR) allows minimally invasive repair of complex ventral hernias with shorter length of stay (LOS) compared to open repairs (TAR), but hybrid robotic TAR (hrTAR), partial open intervention via incision through the overlying hernia sac for fascial closure, may be required to accomplish effective repair of large defects. We compare LOS and short-term outcomes of a cohort of our hrTAR patients to our historical oTAR patients. METHODS: All hrTAR performed in our institution between November 2015 and July 2017 contained in a prospectively maintained robotic database and/or in the Americas Hernia Society Quality Collaborative (AHSQC) database were analyzed. Additionally, open TAR patients maintained in a prospective personal database and/or in the AHSQC from September 2013 to August 2016 were similarly analyzed and compared with hrTAR patients. RESULTS: 134 TAR patients and 49 hrTAR patients were analyzed. Age, gender, BMI, HTN, DM, and proportion of recurrent hernia were not significantly different. Hernia width (14.3 cm vs 14.0 cm, p = 0.80) and length (21.9 vs 20.0 cm, p = 0.10) were similar between groups. Mean operative times did not differ significantly between groups (274 min vs 304 min p = 0.06). Thirty day wound events including SSI and SSOPI were not significantly different between groups. LOS was significantly shorter in the hrTAR group (3 vs 7 days, p ≤ 0.001). CONCLUSION: Hybrid robotic transversus abdominis release (hrTAR) may be performed with significantly lower LOS, similar wound morbidity and complication profile compared to open TAR. This novel surgical technique provides a minimally invasive option for a challenging subset of large ventral hernias which cannot be treated effectively with a purely robotic approach and would traditionally require and open operation.

Efficacy and safety of lenalidomide treatment in multiple myeloma (MM) patients--Report of the Polish Myeloma Group.

UNLABELLED: The aim of the multi-centre retrospective study was to evaluate the efficacy and safety of lenalidomide (LEN) therapy in patients with resistant or relapsed multiple myeloma (MM) as well as in patients with stable disease (LEN used due to neurological complications). The primary endpoint of this study was an overall response rate (ORR). The secondary endpoints were as follows: time to progression (TTP), overall survival (OS) and the safety of drug use. Data were collected in 19 centres of the Polish Multiple Myeloma Study Group. The study group consisted of 306 subjects: 153 females and 153 males. In 115 patients (38.8%, group A), a resistant myeloma was diagnosed; in 135 (44.1%, group B) a relapse, and in 56 (18.3%, group C) a stable disease were stated. In 92.8% of patients, LEN+DEX combination was used; in remaining group, LEN monotherapy or a combination therapy LEN+bortezomib or LEN+bendamustine and other were used. In the entire study group, ORR was 75.5% (including 12.4% patients achieving complete remission [CR] or stringent CR [sCR]). Median time to progression (TTP) was 20 months. Median overall survival (OS) was 33.3 months. The regression model for "treatment response" was on the borderline of statistical significance (p=0.07), however the number of LEN treatment cycles ≥ 6 (R(2)=17.2%), baseline LDH level (R(2)=1.1%) and no ASCT use (R(2)=1.7%) where the factors most affecting treatment response achievement. The regression model for dependant variable--"overall survival"--was statistically significant (p=0.0000004). Factors with the most impact on OS were as follows: number of LEN cycles treatment ≥ 6 (R(2)=16.7%), treatment response achievement (R(2)=6.9%), ß-2-microglobulin (ß-2-M) level (R(2)=4.8%), renal function (R(2)=3.0%) and lack of 3/4 grade adverse events (R(2)=1.4%). SUMMARY: LEN is an effective and safe therapeutic option, even in intensively treated resistant and relapsed MM patients, as well as in patients with stable disease and previous treatment-induced neurological complications. In particular, the number of LEN treatment cycles ≥ 6 was the factor which affected treatment response achievement the most, together with an important impact on OS.

[Diagnosis of the increase of lymph nodes in the abdominal cavity]. / Diagnostyka powiekszenia wezlów chlonnych jamy brzusznej.

Isolated abdominal lymphadenopathy is not such a common but a real diagnostic problem. Widespread prevalence of ultrasonography in routine diagnostics has been contributed to its greater recognition. In the first part of the article examinations which lead to the diagnosis (such as: microbiological examination, ultrasonography, CT, MRI, lymphography, histopathological examination) are discussed basing on the literature. The potential etiology of abdominal lymphadenopathy is described in the second part of the article. The characteristic changes are discussed for mentioned disease entities.