Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 5 Articles
Background: The literature reports various treatment methodologies, such as trans-oral laser microsurgery, radiation\ntherapy, total/partial laryngectomies, and concurrent radiation chemotherapy for patients with early larynx cancer.\nHowever, at the forefront of early glottis treatment is trans-oral laser microsurgery and radiation therapy, likely due to\nbetter functional and survival outcomes. Here we conduct the largest Canadian head-to-head comparison of consecutive\npatients treated with either radiation therapy or trans-oral laser microsurgery. Additionally, we compare these two\ntreatments and their 5-year survival rates post treatment to add to the existing literature.\nMethods: Charts of patients who were diagnosed with early glottic cancer between 2006 and 2013 were reviewed.\nSeventy-five patients were identified, and split into 2 groups based on their primary treatment, trans-oral laser\nmicrosurgery and radiation therapy. Kaplanââ?¬â??Meier survival curves, life-tables, and the log-rank statistic were\nreported to determine if there was a difference between the two treatment groups and their disease-specific survival,\ndisease-free survival, and total laryngectomy-free survival. Additionally, each different survival analysis was stratified by\npotential confounding variables, to help conclude which treatment is more efficacious in this population.\nResults: The 5-year disease-specific survival rate is 93.3 % ÃÆ? = 0.063 and 90.8 % ÃÆ? = 0.056 for patients treated with\ntrans-oral laser microsurgery and radiation therapy, respectively (Ãâ?¡2 < 0.001, p = 0.983). The disease free survival\nrate is 60.0 % (ÃÆ? =0.121) for patients treated with trans-oral laser microsurgery, and 67.2 % (ÃÆ? = 0.074) for those\nwho received RT (Ãâ?¡2 = 0.19, p = 0.663). Additionally, the total laryngectomy-free survival rate is 84.1 % (ÃÆ? = 0.1) and\n79.1 % (ÃÆ? = 0.072) for patientsââ?¬â?¢ early glottic cancer treated by trans-oral laser microsurgery and radiation therapy,\nrespectively (Ãâ?¡2 = 0.235, p = 0.628). Chi-square analysis of age-group versus treatment group (Ãâ?¡2 = 6.455, p = 0.04)\nand T-stage versus treatment group (Ãâ?¡2 = 11.3, p = 0.001) revealed a statistically significant relationship, suggesting\nsurvival analysis should be stratified by these variables. However, after stratification, there was no statistically significant\ndifference between the trans-oral laser microsurgery and radiation therapy groups in any of the survival analyses.\nConclusion: No difference was demonstrated in the 5-year disease-specific survival, disease-free survival, and total\nlaryngectomy-free survival, between the RT and TLM treatment groups. Additionally, both groups showed similar\n5-year survival after stratifying by confounding variables....
Background: Patient selection for surgical treatment of subaxial cervical spine fractures (S-CS-fx) may be\nchallenging and is dependent on fracture morphology, the integrity of the discoligamentous complex, neurological\nstatus, comorbidity, risks of surgery and the expected long-term outcomes. The purpose of this study is to evaluate\ncomplications and long-term outcomes in a consecutive series of 303 patients with S-CS-fx treated with open\nsurgical fixation.\nMethods: Medical charts were retrospectively reviewed. The surviving patients participated in a prospective long-term\nfollow-up, including clinical history, physical examination and updated cervical CT. Patients with ankylosing spondylitis\nwere excluded from this study.\nResults: The median patient age was 48 years (range 14.7ââ?¬â??93.9), and 74 % were males. Preoperatively, 43 % had spinal\ncord injury (SCI), and 27 % exhibited isolated radiculopathy. The median time from injury to surgery was 2 days (range\n0ââ?¬â??136). The risks of SCI deterioration and new-onset radiculopathy after surgery were 2.0 % and 1.3 %, respectively.\nSurgical mortality (death within 30 days after surgery) was 2.3 %. The reoperation rate was 7.3 %. At the long-term\nfollow-up conducted a median of 2.6 years after trauma (range 0.5ââ?¬â??9.1), 256 (99.2 %) of the patients who had survived\nand were living in Norway participated. Of the patients with American Injury Severity Scale (AIS) Aââ?¬â??D at presentation,\n51 % had improved one or more AIS grades. At the time of follow-up, 89 % of the patients with preoperative\nradiculopathy were without symptoms. Furthermore, 11 % of the patients reported severe neck stiffness, 5 % reported\nsevere neck pain (Visual Analog Scale (VAS) ââ?°Â¥7), 6 % reported hoarseness, and 9 % reported dysphagia at the follow-up.\nThe stable fusion rate, as evaluated using cervical-CT, was 98 %.\nConclusions: In this large consecutive series of patients with S-CS-fx treated with open surgical fixation, the surgical\nmortality was 2.3 %, the risk of neurological deterioration was 3.3 % and the reoperation rate (any cause) was 7.3 %. The\nneurological long-term results were good, with 51 % improvement in AIS grade and resolution of radiculopathy in\n89 % of the patients. Stable fusion was excellent and was achieved in 98 % of the follow-up group....
The successful outcome of any minimally invasive procedure is highly dependent on the imaging\nchain, as the medical team has to rely on indirect visualization of the surgical field during the entire\nprocedure. During the last decade, the quality of the images obtainable pre- and intraoperatively\nhas evolved significantly. In addition to the introduction of intra-operative image acquisition\ntechniques such as ultrasound, X-ray, CT or MR, optical imaging technology as well as the corresponding\nprocessing units have undergone a rapid development. The article will review the activity\nrelated to minimally invasive procedures at the Operating Rooms of the Future (FOR) at St.\nOlavs Hospital, University Hospital of Trondheim, Norway. The imaging related demands of several\nsurgical fields are introduced and the evolution of the imaging and visualization techniques at\nFOR will be presented. Subsequently, ongoing research projects in a dedicated visualization laboratory\nwill be discussed and the advantages of updating the imaging equipment continuously in\norder to keep up with the latest developments in the field will be presented. It will be shown that\nthe quality of the image acquisition and display can be significantly improved when compared to\ntoday�s standard. In addition to increasing the surgeon�s confidence, better imaging will lead to\nincreased patient safety as well as more efficient interventions....
Background: When a soft tissue sarcoma (STS) is located at the distal part of an extremity and involves the tendon,\na wide excision usually causes severe functional disability. We therefore developed a minimally invasive surgical\ntechnique using intraoperative electron-beam radiotherapy (IOERT) to reduce the incidence of post-operative\nfunctional disability in patients with peri-/intra-tendinous STS. We assessed the clinical outcomes of the novel\nminimally invasive surgery.\nMethods: The study population included five patients who received treatment for distal extremity STSs. After\nelevating the tumor mass, including the tendon and nerve from the tumor bed with a wide margin, a lead board\nwas inserted beneath the tumor mass to shield the normal tissue. IOERT (25ââ?¬â??50 Gy) was then applied, and the\ntumor excised with care taken to maintain the continuity of the tendon.\nResults: In a desmoid patient, local recurrence was observed outside the irradiated field. No cases of neuropathy or\nbone necrosis were observed. The mean limb function score was excellent in all patients. None of the high-grade\nsarcoma patients had local recurrence or distant metastasis.\nConclusions: Although the current study is only a pilot study with a small number of patients, it shows that this\nminimally invasive procedure has the potential to become a standard treatment option for selected patients....
Background: The aim of this study was to evaluate the clinical efficiency of transduodenal ampullectomy (TDA)\ncompared to conventional pancreatoduodenectomy (PD) in patients with early ampullary cancers.\nMethods: We carried out a retrospective study by reviewing the medical records of 43 patients with early\nampullary cancer who underwent either TDA or PD from January 2001 to December 2014. TDA and PD were\nperformed on 22 patients and 21 patients, respectively. Clinical data, perioperative clinical outcomes and prognosis\nwere evaluated. The median follow-up was 75 (range, 38ââ?¬â??143) months.\nResults: The sensitivity of intraoperative frozen resection was 100 % (4/4) and 94.9 % (37/39) in patients with pTis\nand pT1 tumors compared to final histologic diagnoses. The 5-year survival rate of patients with early ampullary\ncancer was 77.3 % in TDA group and 75.9 % in PD group (P = 0.927). Patients with lymph node metastasis\npresented a shorter 5-year survival rate (P = 0.014). TDA was associated with lower surgical morbidity (P = 0.033),\nestimated blood loss (P = 0.002), medical cost (P = 0.028) compared to PD. No pancreatic fistula and surgical\nmortality occurred in TDA group.\nConclusions: TDA could produce satisfactory clinical efficiency in patients fulfilled the following criteria\nsimultaneously: pTis or pT1 stage, tumor size ââ?°Â¤ 2 cm, without lymph node metastasis. To achieve favorable\noutcomes, intraoperative frozen section examinations should be reliable and resection margins should be negative....
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