Clinical characteristics associated with pain in patients with peripheral vascular malformations.

OBJECTIVE: Vascular malformations (VM) can negatively impact the patient's quality of life (QoL). Pain is a common problem in these patients. The aim of this study was to investigate risk factors associated with pain and to assess how pain affects QoL. METHODS: This prospective cross-sectional study was conducted in a tertiary vascular anomaly expertise center. Between June and December 2020, all patients from our local database (334 adults and 189 children) with peripheral VMs were invited to complete the Outcome Measures for VAscular MAlformations questionnaire to evaluate the presence, frequency, and intensity of pain. Additionally, patients were asked to complete several Patient-Reported Outcome Measurement Information System scales to evaluate their QoL. Risk factors associated with pain were identified in bivariate analysis and multivariable logistic regression. QoL domains were compared between patients who experienced pain and patients who did not. RESULTS: A total of 164 patients completed the questionnaire about pain and 133 patients completed all QoL questionnaires. Approximately one-half of the patients (52%) reported pain in the past four weeks and 57% of these patients reported pain daily or several times a week. Female sex (P = .009), lesions located in the upper extremity (P < .001) or lower extremity (P < .001), and intramuscular/intraosseous lesions (P = .004) were independently associated with the presence of pain. The following QoL domains were diminished in patients who experienced pain in comparison with patients who did not: pain interference (P < .001), physical functioning (P < .001), and social participation (P < .001) in adults, and pain interference (P = .001), mobility (P = .001), and anxiety (P = .024) in children. CONCLUSIONS: Pain is a frequently reported complaint in patients with VMs and is present in approximately one-half of the patients. Patients with lesions located in the upper or lower extremity, intramuscular/intraosseous lesions, and female patients are more likely to experience pain. The presence of pain negatively impacted patients' QoL. Although VM are a benign condition and expectative management is frequently applied, our study shows that pain is a serious concern and needs to be actively assessed. Pain is a sign of various etiologies and should be examined to properly treat the pain.

Laparoscopic surgery for T4 colon cancer: a systematic review and meta-analysis.

BACKGROUND: In colon cancer, T4 stage is still assumed to be a relative contraindication for laparoscopic surgery considering the oncological safety. The aim of this systematic review with meta-analysis was to evaluate short- and long-term oncological outcomes after laparoscopic surgery for T4 colon cancer, and to compare these with open surgery. METHODS: Using systematic review of literature, studies reporting on radicality of resection, disease-free survival (DFS), and/or overall survival (OS) after laparoscopic surgery for T4 colon cancer were identified, with or without a control group of open surgery. Pooled proportions and risk ratios were calculated using an inverse variance method. RESULTS: Thirteen observational cohort studies published between 2012 and 2017 were included, together consisting of 1217 patients that received laparoscopic surgery and 1357 with an open procedure. The proportion of multivisceral resections was larger in the open group in five studies. Based on 11 studies, the pooled proportion of R0 resection was 0.96 (95% CI: 0.91-0.99) and 0.96 (95% CI: 0.90-0.98) after laparoscopic and open surgery, respectively. Analysing (mainly) T4a subgroups in 6 evaluable studies revealed pooled R0 resection rates of 0.94 in both groups. No significant differences were found between laparoscopic and open surgery for any survival measure: RR 1.07 (95% CI: 0.96-1.20) for 3-year DFS, RR 1.04 (95% CI: 0.95-1.15) for 5-year DFS, RR 1.07 (95% CI: 0.99-1.14) for 3-year OS, and RR 1.05 (95% CI: 0.98-1.12) for 5-year OS. CONCLUSION: Literature on laparoscopic surgery for T4 colon cancer is restricted to non-randomized comparisons with substantial allocation bias. Laparoscopic surgery for T4a tumours might be safe, whereas for T4b colon cancer requiring multivisceral resection it should be applied with caution.