Subject(s)
Neoplasms, Multiple Primary/surgery , Ovarian Neoplasms/secondary , Ovarian Neoplasms/surgery , Struma Ovarii/surgery , Thyroid Cancer, Papillary/surgery , Thyroid Neoplasms/surgery , Conservative Treatment , Female , Humans , Middle Aged , Neoplasms, Multiple Primary/pathology , Ovarian Neoplasms/pathology , Postmenopause , Salpingo-oophorectomy , Thyroid Cancer, Papillary/pathology , Thyroid Neoplasms/pathology , ThyroidectomyABSTRACT
OBJECTIVE: To assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC). METHODS: A multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1-2; or cervical involvement and grades 1-2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups. RESULTS: Both study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0-275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79-2.28) and OS (HR=0.72; 95% CI=0.42-1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups. CONCLUSION: Systematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.
Subject(s)
Endometrial Neoplasms/pathology , Endometrial Neoplasms/surgery , Lymph Node Excision , Uterine Neoplasms/pathology , Uterine Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Cost-Benefit Analysis , Endometrial Neoplasms/economics , Endometrial Neoplasms/epidemiology , Female , Humans , Lymph Node Excision/adverse effects , Lymph Node Excision/economics , Lymph Node Excision/statistics & numerical data , Lymphatic Metastasis , Matched-Pair Analysis , Middle Aged , Morbidity , Neoplasm Staging , Postoperative Complications/economics , Postoperative Complications/epidemiology , Retrospective Studies , Risk Factors , Severity of Illness Index , Survival Analysis , Treatment Outcome , Uterine Neoplasms/economics , Uterine Neoplasms/epidemiologyABSTRACT
Septal agenesis is a rare cerebral developmental anomaly characterized by partial or complete absence of the septum pellucidum (ASP). Septal agenesis may be associated with various congenital brain malformations, namely holoprosencephaly, septooptic dysplasia (SOD), schizencephaly or agenesis of the corpus callosum. Current imaging technologies do not enable differentiation in utero between isolated ASP and SOD. This is due to the fact that optic nerve hypoplasia and endocrine anomalies are never ruled out completely. We report a case of prenatal diagnosis of isolated ASP based on 2D and 3D ultrasound and fetal MRI. Postnatal MRI confirmed prenatal findings and the boy is currently doing well at 18 months of age.
