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@#Objective To compare the short-term and long-term effects of minimally invasive esophagectomy (MIE) and traditional open esophagectomy (OE) in patients with stage T1b esophageal squamous cell carcinoma (ESCC). Methods We retrospectively analyzed the clinical pathology data of 162 patients undergoing thoracic surgery at Northern Jiangsu People's Hospital from 2015 to 2018 whose pathological diagnosis was stage pT1b ESCC. According to the surgical approach, they were divided into MIE group and OE group. There were 55 males and 21 females in the OE group, with an average age of 63.3±5.6 years, and 60 males and 26 females in the MIE group, with an average age of 64.7±6.1 years. The preoperative, intraoperative and postoperative data of the two groups were compared and followed up. Survival data were compared using Kaplan-Meier and log-rank tests between the two groups, and Cox proportional hazard regression models were used to analyze prognostic factors. Results Compared with the OE group, the intraoperative bleeding volume of the MIE group was less (119.8±70.0 mL vs. 210.5±136.2 mL, P<0.001), and the lymph nodes dissected during the operation were more (19.1±7.4 vs. 13.8±5.9, P<0.001), the rate of postoperative pulmonary infections was lower (9.3% vs. 21.1%, P=0.036), but the operation time was longer (240.0±52.4 min vs. 179.5±35.7 min, P<0.001). Twenty-one patients had lymph node metastasis, and the lymph node metastasis rate was 13.0%. At the end of the follow-up, 19 patients died, and the overall survival (OS) at 1 year, 3 years, and 5 years after operation were 97.5%, 88.8% and 82.9%, respectively; 31 patients had recurrence and metastasis, and the disease-free survival (DFS) rate at 1 year, 3 years, and 5 years after operation was 95.1%, 80.9% and 75.6%. There was no significant difference in OS and DFS between the two groups. Multivariate Cox regression analysis of OS found that lymph node metastasis, anastomotic fistula and chylothorax were independent risk factors for OS. Multivariate Cox regression analysis of DFS found that lymph node metastasis, anastomotic fistula, chylothorax, and vascular cancer thrombus were independent risk factors for OS. Conclusion MIE can achieve the same long-term effects as OE, with less intraoperative bleeding, more lymph nodes dissected, and lower incidence of postoperative pulmonary infections, but it takes longer operation time.
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@#Objective To investigate the prognostic survival status and influence factors for surgical treatment of esophageal squamous cell carcinoma (ESCC) in pathological stage T1b (pT1b). Methods The patients with ESCC in pT1b undergoing Ivor-Lewis or McKeown esophagectomy in Lanzhou University Second Hospital from 2012 to 2015 were collected, including 78 males (78.3%) and 17 females (21.7%) with an average age of 61.4±7.4 years. Results The most common postoperative complications were pneumonia (15.8%), anastomotic leakage (12.6%) and arrhythmia (8.4%). Ninety-three (97.9%) patients underwent R0 resection, with an average number of lymph node dissections of 14.4±5.6. The rate of lymph node metastasis was 22.1%, and the incidence of lymph vessel invasion was 13.7%. The median follow-up time was 60.4 months, during which 25 patients died and 27 patients relapsed. The overall survival rate at 3 years was 86.3%, and at 5 years was 72.7%. Multivariate Cox regression analysis showed that lymph node metastasis (P=0.012, HR=2.60, 95%CI 1.23-5.50) and lympovascular invasion (P=0.014, HR=2.73, 95%CI 1.22-6.09) were independent risk factors for overall survival of pT1b ESCC. Conclusion Esophagectomy via right chest approach combined with two-fields lymphadenectomy is safe and feasible for patients with pT1b ESCC. The progress of pT1b ESCC with lymph node metastasis or lymphovascular invasion is relatively poor.
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Objective To study the value of radiofrequency ablation of gallbladder beds in radical surgery for stage T1b gallbladder cancer.Methods A retrospective study was conducted on 21 patients with stage T1 b gallbladder cancer treated in the Department of Hepatobiliary Pancreas and Spleen Surgery,West Campus,Beijing Chaoyang Hospital,Capital Medical University,from April 1,2011 to March 31,2019.Patients who were diagnosed with frozen section during operation were included into the surgery group.Patients who were diagnosed postoperatively and underwent radical surgery for the gallbladder carcinoma were included in the secondary surgery group.The differences in surgical time,bleeding volume,survival rate,and survival time between the two groups after regular follow-up were compared,and the 5-year cumulative survival rates and overall survival time of the two groups were calculated.Results All patients underwent radical gallbladder cancer surgery.There were 14 males and 7 females,aged from 26 to 70 (49.0 ± 13.5)years.There were no perioperative deaths.There were 15 patients in the operation group,and 6 patients in the secondary surgery group.The bleeding volume of the surgery group was significantly less than the secondary surgery group [(101.3 ± 35.5) ml vs.(177.0 ± 44.6) ml,P ＜ 0.05].There were no significant differences in surgical time,survival rate,and survival time between the two groups (all P ＞ 0.05).The 5-year cumulative survival rate for the two groups of patients was 56.5％,and the overall survival time was (79.0 ± 9.3) months.Conclusions Radiofrequency ablation of the gallbladder bed was safe and effective in radical surgery of T1 b gallbladder cancer.For T1 b stage gallbladder cancer,which is difficult to diagnose during surgery,secondary radical surgery achieved the same results as primary radical surgery.
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PURPOSE: The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. MATERIALS AND METHODS: We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. RESULTS: The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. CONCLUSION: Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.
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Humans , Body Mass Index , Carcinoma, Renal Cell , Case-Control Studies , Comorbidity , Disease-Free Survival , Follow-Up Studies , Glomerular Filtration Rate , Korea , Nephrectomy , Prospective Studies , Renal Insufficiency, ChronicABSTRACT
Introducción: El Cáncer de Próstata (CaP) es uno de los principales problemas de salud en los países desarrollados. El CaP diagnosticado después de la cirugía prostática por patología benigna, se denomina incidental y oscila entre 4 por ciento y 15 por ciento. Corresponde al estadio T1a y T1b según clasificación TNM. Objetivos: Describir las características clínicas e histológicas y el manejo del Cáncer de próstata T1a y T1b diagnosticados en nuestro servicio. Material y Método: Análisis descriptivo retrospectivo de 2835 pacientes con adenoma prostático entre el año 2002 y 2012, cuyas biopsias post-cirugía fueron positivas para cáncer (63 pacientes). El análisis estadístico se realiza con test de Fisher, T-test y X2. Resultados: La edad promedio fue 72 años. PSA promedio fue 10,6 ng/dl, siendo el 50 por ciento de tamaño grado 3-4. En promedio el volumen prostático fue 79gr con un tamaño tumoral de 5,5gr y compromiso tumoral del 40 por ciento (T1a 7 por ciento y T1b 93 por ciento). 75 por ciento presento Gleason 5-7. El número de focos (+) fue mayoritariamente 1 o 2 (89 por ciento). Presentó márgenes (+) un 23 por ciento. El tratamiento posterior fue principalmente hormonoterapia (39 por ciento). Al comparar PSA, Gleason y tacto rectal entre sí y con las otras variables no se encontraron diferencias estadísticas significativas. Conclusiones: Los tumores T1a-T1b en nuestro servicio equivalen al 2,2 por ciento, menor a otras series publicadas. El no existir asociación estadística entre las variables lo atribuimos a un bajo n muestral. El cáncer incidental de próstata no es frecuente y la adecuada selección de los pacientes sometidos a biopsias, disminuye su incidencia.
Introduction: Prostate cancer (PCa) is a major health problem in developed countries. The PCa diagnosed after surgery for benign prostate, called incidental and ranges between 4 percent and 15 percent. Corresponds to stage T1a and T1b as TNM classification. Objectives: To describe the clinical and histological features and management of prostate cancer diagnosed in T1a and T1b our service. Methods: retrospective analysis of 2835 patients with prostatic adenoma between 2002 and 2012, whose post-surgery biopsies were positive for cancer (63 patients). Statistical analysis was performed with Fisher test, T-test and X2.Results: Mean age was 72 years. Average PSA was 10.6 ng / dl, with 50 percent grade 3-4. On average prostate volume was 79gr with a tumor size of 5.5 g and 40 percent tumor involvement (T1a 7 percent and T1b 93 percent). 75 percent showed Gleason 5-7. The number of foci (+) was mostly 1 or 2 (89 percent). Presented margins (+) 23 percent. The subsequent treatment was primarily hormonotherapy (39 percent). Comparing PSA, Gleason and DRE among themselves and with the other variables were not statistically different. Conclusions: T1a-T1b tumors in our service equal to 2.2 percent, lower than other published series. The absence of statistical association between the variables we attribute to a low n sample. Incidental prostate cancer is not a common and appropriate selection of patients undergoing biopsy, reduces its incidence.