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Broughman JR, Vuong W, Mian OY. Current Landscape and Future Directions on Bladder Sparing Approaches to Muscle-Invasive Bladder Cancer. Curr Treat Options Oncol 2020; 22:3. [PMID: 33230599 DOI: 10.1007/s11864-020-00800-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/24/2022]
Abstract
OPINION STATEMENT Although radical cystectomy is considered the gold standard approach for patients with muscle-invasive bladder cancer, tri-modal therapy (TMT) is a well-tolerated and efficacious alternative to radical cystectomy that is underutilized in inoperable patients and rarely offered to cystectomy candidates in the USA. Retrospective data suggest similar outcomes between radical cystectomy and TMT after adjusting for patient selection and other confounding factors. Nearly 70-80% of patients can keep their native bladder with favorable post-treatment quality of life metrics. Current trials are investigating novel combination strategies including immune checkpoint inhibition along with chemoradiation or radiation. Emerging techniques for improved patient selection and risk stratification include incorporating MP-MRI, and novel biomarkers such as inflammatory, stromal, and DNA damage response gene signatures may guide patient selection and expand the landscape of bladder preservation options available to patients in the future.
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Affiliation(s)
- James R Broughman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, CA-50, Cleveland, OH, 44195, USA
| | - Winston Vuong
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, CA-50, Cleveland, OH, 44195, USA
| | - Omar Y Mian
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, 9500 Euclid Avenue, CA-50, Cleveland, OH, 44195, USA.
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Ouzaid I, Bernhard JC, Bigot P, Nouhaud FX, Long JA, Boissier R, Gimel P, Bodin T, Hetet JF, Méjean A, Albiges L, Bensalah K. Trends in the practice of renal surgery for cancer in France after the introduction of robotic-assisted surgery: data from the National Health Care System Registry. J Robot Surg 2020; 14:799-801. [PMID: 32350709 DOI: 10.1007/s11701-020-01076-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 04/02/2020] [Indexed: 01/20/2023]
Affiliation(s)
- Idir Ouzaid
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France.
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France.
- Department of Urology, Bichat Claude Bernard Hospital, 46, rue Henri Huchard, 75018, Paris, France.
| | - Jean-Christophe Bernhard
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Pierre Bigot
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - François-Xavier Nouhaud
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Jean-Alexandre Long
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Romain Boissier
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Pierre Gimel
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Thomas Bodin
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Jean-François Hetet
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Arnaud Méjean
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Laurence Albiges
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
| | - Karim Bensalah
- Association Française d'Urologie, Comité de cancérologie, 17 rue Viète, 75017, Paris, France
- CHU de Bordeaux-Direction générale, 12 Rue Dubernat, 33400, Talence, France
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Jain AL, Sidana A, Maruf M, Sugano D, Calio B, Wood BJ, Pinto PA. Analyzing the current practice patterns and views among urologists regarding focal therapy for prostate cancer. Urol Oncol 2019; 37:182.e1-182.e8. [PMID: 30522903 PMCID: PMC8258689 DOI: 10.1016/j.urolonc.2018.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/11/2018] [Accepted: 11/19/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND OBJECTIVE Focal therapy (FT) for localized prostate cancer (CaP) has been shown to have encouraging short-term oncological outcomes, excellent preservation of functional outcomes and is increasing in popularity in urologic community. We aim to evaluate the preferences and practice trends among urologists regarding this treatment strategy. METHODS A 20 item online questionnaire was designed to collect information on urologists' views and use of FT. The survey was sent to the members of the Endourological Society and the American Urological Association. Multivariate logistic regression analysis was done to determine predictors for utilization of FT. RESULTS A total of 425 responses were received [American Urological Association: 319, Endourological Society: 106]. Mean age of respondents was 53(SD: 11.3) years. Although half of the respondents (50.8%) believed FT to be moderate to extremely beneficial in the treatment of CaP, only 24.2% (103) of the respondents currently utilize FT in their practice. Respondents who were fellowship trained in urologic oncology were more likely to consider FT to be at least moderately beneficial (P < 0.001). Surgeon's experience (greater than 15 years in urology practice) (P = 0.025) and seeing more than 10 patients with new CaP diagnosis per month (P = 0.002) were independent predictors of FT utilization for localized CaP. While the most common setting for utilization of FT was in patients with unilateral intermediate-risk (72.8%) CaP, a small percentage of respondents also used FT for patients with unilateral high-risk CaP and bilateral intermediate risk (21.4% and 10.7%, respectively). Most common reasons for not using FT were the lack of belief in 'index lesion theory' (63.2%), lack of experience (41.3%), lack of belief in FT's efficacy (41.1%), lack of infrastructure (35.8%), difficult salvage treatment in cases of recurrence (22.7%) and high cost (21.8%). About 57.6% would use FT more often in an office or outpatient setting if they had access to reliable and cost-effective options. CONCLUSIONS Only a quarter of our respondents utilize FT in their practice with surgeon's experience being the important independent predictor for using FT. Majority of respondents though consider FT to be beneficial in CaP management, would use it more often if provided more reliable and cost-effective options. Over time, experience and accessibility to reliable methods to perform FT may lead to further utilization of this novel treatment strategy.
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Affiliation(s)
- Amit L Jain
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD.
| | - Abhinav Sidana
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Mahir Maruf
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Dordaneh Sugano
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Brian Calio
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Bradford J Wood
- Center for Interventional Oncology, National Cancer Institute & Clinical Center, National Institutes of Health, Bethesda, MD
| | - Peter A Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD
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Lianos GD, Christodoulou DK, Katsanos KH, Katsios C, Glantzounis GK. Minimally Invasive Surgical Approaches for Pancreatic Adenocarcinoma: Recent Trends. J Gastrointest Cancer 2017; 48:129-134. [PMID: 28326457 DOI: 10.1007/s12029-017-9934-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pancreatic resection for cancer represents a real challenge for every surgeon. Recent improvements in laparoscopic experience, minimally invasive surgical techniques and instruments make now the minimally invasive approach a real "triumph." There is no doubt that minimally invasive surgery has replaced with great success conventional surgery in many fields, including surgical oncology. METHODS AND RESULTS However, its progress in pancreatic resection for adenocarcinoma has been dramatically slow. Recent evidence supports the notion that minimally invasive distal pancreatectomy is safe and feasible and that is becoming the procedure of choice mainly for benign or low-grade malignant lesions in the distal pancreas. On the other side, minimally invasive pancreatoduodenectomy has not yet been widely accepted and there is enormous skepticism when applied for pancreatic head adenocarcinoma. In this review, we summarize the current evidence on the potential applications of minimally invasive surgical approaches for this aggressive, heterogeneous, and enigmatic type of cancer. CONCLUSIONS Moreover, the potential future applications of these approaches are discussed with the hope to improve the quality of life as well as the survival rates of pancreatic cancer patients.
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Affiliation(s)
- Georgios D Lianos
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece.
| | - Dimitrios K Christodoulou
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Konstantinos H Katsanos
- Department of Gastroenterology, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Christos Katsios
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
| | - Georgios K Glantzounis
- Department of Surgery, School of Medicine, University of Ioannina, University Hospital of Ioannina, 451 10, Ioannina, Greece
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Abstract
Objectives: To examine the trends of kidney cancer over the last 2 decades in a subset of a Saudi Arabian population. Methods: We conducted a retrospective study in a tertiary care center including all adult patients with primary kidney cancer who presented and were managed between 1990 and 2010. The time period was split into 4 quartiles, and variables tested and compared using chi-square, T-test, and Kaplan-Meier curves for survival. Results: The total was 215 patients with a mean age of 57.8 years. There was an increase in the number of kidney cancer cases over the last 2 decades. There was no significant difference in the mode of presentation or stage distribution between quartiles. A significant change was observed in the management towards minimally invasive and nephron-sparing surgeries (p<0.001). There was no change in recurrence-free and disease-specific survival over the last 20 years. Conclusions: There have been an increasing number of kidney cancer patients over the last 2 decades with no observed migration towards more incidental and low stage tumors as compared with developed countries.
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Affiliation(s)
- Sultan S Alkhateeb
- Division of Urology, Department of Surgery, King Abdulaziz Medical City, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Affiliation(s)
- Laura S Dominici
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Monica Morrow
- Department of Surgery, Weill Cornell Medical College, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Jennifer Bellon
- Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Tari A King
- Surgical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA.
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Banegas MP, Harlan LC, Mann B, Yabroff KR. Toward greater adoption of minimally invasive and nephron-sparing surgical techniques for renal cell cancer in the United States. Urol Oncol 2016; 34:433.e9-433.e17. [PMID: 27321355 PMCID: PMC5035195 DOI: 10.1016/j.urolonc.2016.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/22/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine national, population-based utilization trends of nephron-sparing and minimally invasive techniques for the surgical management of patients with adult renal cell cancer (RCC) in the United States. METHODS Linked data from the National Cancer Institute׳s Patterns of Care studies and the Area Health Resource File were used to evaluate trends of nephron-sparing and minimally invasive techniques in a sample of 1,110 patients newly diagnosed with American Joint Committee on Cancer stages I-II RCC, in 2004 and 2009, who underwent surgery. Descriptive statistics were used to assess patterns of surgery between 2004 and 2009. Multivariable logistic regression analyses were used to evaluate the associations between demographic, clinical, hospital, and area-level health care characteristics with surgery utilization, stratified by the subset of patients who were potentially eligible for partial nephrectomy (PN) vs. radical nephrectomy (RN) and laparoscopic RN (LRN) vs. open RN, respectively. RESULTS Between 2004 and 2009, PN use among stage I patients with tumors≤7cm increased from 29% to 41%, respectively (P = 0.22). Among patients with stage I tumors≤4cm, use of PN significantly increased from 43% in 2004 to 55% in 2009 (P≤0.05). Among patients with stage I tumors>4 to 7cm, laparoscopic partial nephrectomy increased from 8% to 15%, whereas LRN increased from 38% to 69%, between 2004 and 2009 (P = 0.07). Significant increases in LRN use were observed for both stage I (from 43% in 2004 to 58% in 2009; P≤0.05) and stage II patients (from 16% in 2004 to 47% in 2009; P≤0.01). Patients diagnosed at an older age, with larger tumors, non-clear cell RCC and who did not receive treatment in a hospital with residency training were significantly less likely to receive PN vs. RN; whereas, those diagnosed in 2009 with stage I disease were significantly more likely to receive LRN vs. open RN. CONCLUSIONS This study highlights a significant shift toward increased use of nephron-sparing and minimally invasive surgical techniques to treat patients with RCC in the United States. Our findings are among the first population-based reports in which most eligible patients with RCC received PN over RN. In light of the long-standing evidence on the improved patient outcomes, future investigation is warranted to identify the barriers to increased adoption of these nephron-sparing and minimally invasive approaches.
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Affiliation(s)
- Matthew P Banegas
- Kaiser Permanente Northwest, The Center for Health Research, Portland, OR.
| | - Linda C Harlan
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Bhupinder Mann
- Clinical Investigations Branch, Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD
| | - K Robin Yabroff
- Healthcare Assessment Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
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Kubota A, Sekiguchi M, Ikata S, Takeuchi S, Tsuchiya K. [The latest treatment of the forefoot and ankle of the patients with rheumatoid arthritis]. Nihon Rinsho 2016; 74:986-992. [PMID: 27311190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Operative therapy for the foot and ankle disorders of rheumatoid arthritis (RA) have been changing with advances in drug therapy. The surgical techniques, joint-preserving procedure for the RA foot and total ankle arthroplasty for the RA ankle, are the surgical techniques which allow patients with RA not only to relief their pain but also obtain higher lower limb function. Recently, more and more patients with RA have been receiving joint-preserving procedure for the foot or total ankle arthroplasty for the ankle. Therefore, in this article, we would like to describe surgical therapy for the lower limb of patients with RA.
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Guerra F, Pesi B, Amore Bonapasta S, Di Marino M, Perna F, Annecchiarico M, Coratti A. Challenges in robotic distal pancreatectomy: systematic review of current practice. MINERVA CHIR 2015; 70:241-7. [PMID: 25916194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023]
Abstract
Over the last decade, robotics has gained popularity and is increasingly employed to accomplish several abdominal surgical procedures. Nevertheless, pancreatectomies are regarded as demanding procedures for which the application of minimally-invasive surgery is still limited and its effectiveness has not been conclusively established. We aimed to investigate the current role of robot-assisted surgery to perform distal pancreatectomy. A systematic review of the English-language literature was conducted for articles dealing with robotic-assisted distal pancreatectomies. All relevant papers were evaluated on surgical and oncological outcomes. A total of 10 articles reporting on robotic distal pancreatectomies were finally considered in the analysis, including 259 patients. Mean operative time was 271 minutes (range 181-398); mean blood loss was 210 mL (range 104-361), in 11.6% of cases conversion to laparotomy occurred, spleen preservation was accomplished in 51.4% of procedures, mean time of postoperative hospital stay was 7 days. Overall, postoperative mortality and morbidity were 0% and 23.4% respectively, the mean number of lymph nodes harvested was 12.7. In all included series, no case of R1 resection was reported. Despite its relatively recent introduction in clinical practice, robotic-assisted surgery has been widely employed to perform distal pancreatectomy worldwide and it should be considered a safe and effective procedure. Both surgical and pathologic data support its application in the management of pancreatic lesions of the body and tail.
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Affiliation(s)
- F Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy -
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Kalogeridi MA, Kyrgias G, Zygogianni A, Kouvaris J, Theodorou K, Kelekis N, Kouloulias V. Challenges and choices in prostate cancer irradiation: from the three dimensional conformal radiotherapy to the era of intensity modulated, image-guided and adaptive radiation treatment. Urol J 2014; 11:1925-1931. [PMID: 25433469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 10/21/2014] [Indexed: 06/04/2023]
Abstract
In the last decades the status of radiotherapy was tremendously increased in terms of conformity to the target as well as image-guided techniques in conjunction with intensity-modulated radiotherapy (IMRT). The technological improvement had a significant clinical outcome for better response and lower toxicity to the surrounding normal tissues. Nowadays the incidence of rectal toxicity has been significantly decreased, especially with image guided radiation therapy (IGRT), whereas the dose escalation to the prostate has driven the clinical practice to the fact that radical radiotherapy for low or intermediate risk prostate cancer is definitely equivalent to surgery. The treatment volume can be reduced by reducing the size of the necessary margins to count for inaccuracies in target position and patient setup. This can be achieved either by improving the daily localization of the target before treatment or by adapting the treatment in response to feedback. This is the goal of image-guided and adaptive radiotherapy, respectively. These techniques improve the accuracy of dose delivery with a significant impact on clinical outcome and toxicity.
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Affiliation(s)
- Maria Aggeliki Kalogeridi
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly, Greece
| | - George Kyrgias
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly, Greece
| | - Anna Zygogianni
- First Department of Radiology, Radiotherapy Unit, Medical School, Kapodistrian University of Athens, Greece
| | - John Kouvaris
- First Department of Radiology, Radiotherapy Unit, Medical School, Kapodistrian University of Athens, Greece
| | - Kyriaki Theodorou
- Department of Radiotherapy, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Thessaly, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, Radiotherapy Unit, Medical School, Kapodistrian University of Athens, Greece
| | - Vassilios Kouloulias
- Second Department of Radiology, Radiotherapy Unit, Medical School, Kapodistrian University of Athens, Greece.
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Novikova EG, Shevchuk AS. [Organ-sparing therapy for patients with borderline ovarian tumors]. Vopr Onkol 2014; 60:267-273. [PMID: 25033676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Contemporary possibilities of organ-sparing therapy for borderline ovarian tumors are considered. World data was analyzed on recurrence rates and fertility rates after different methods of conservative surgery. The experience with ultra-conservative surgery in patients with bilateral borderline ovarian tumors at the Onco-Gynecological clinic of the P.A. Herzen Moscow Research Oncology Institute is presented.
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[Jubilee of Iu. S. Sidorenko, member of the Russian National Academy of Sciences]. Vopr Onkol 2014; 60:655-7. [PMID: 25823057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
BACKGROUND Traditionally, thyroid surgery has been an inpatient procedure due to the risk of several well-documented complications. Recent research suggests that for selected patients, outpatient thyroid surgery is safe and feasible, with the additional potential benefit of cost savings. In recognition of these observations, we hypothesized that there would be an increase in U.S. outpatient thyroidectomies with a concurrent decline in inpatient thyroidectomies over time. METHODS Comparative cross-sectional analyses of the National Survey of Ambulatory Surgery (NSAS) and Nationwide Inpatient Sample (NIS) databases from 1996 and 2006 were performed. All cases of thyroid surgery were extracted, as well as data on age, sex, and insurance status. Diagnoses and surgical cases were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnostic and treatment codes. Hospital charges were acquired from the NIS 1996 and 2006 and NSAS 2006 releases, using imputed data where necessary. After survey weights were applied, patient characteristics, diagnoses, and procedures were compared for inpatient versus outpatient procedures. RESULTS The total number of thyroidectomies increased 39%, from 66,864 to 92,931 cases per year during the study timeframe. Outpatient procedures increased by 61%, while inpatient procedures increased by 30%. The proportion of privately insured inpatients declined slightly from 63.8% to 60.1%, while those covered by Medicare increased from 22.8% to 25.8%. In contrast, the proportion of privately insured outpatients declined sharply from 76.8% to 39.9%, while those covered by Medicare rose from 17.2% to 45.7%. These trends coincided with a small increase in the mean inpatient age from 50.2 to 52.3 years and a larger increase in the mean outpatient age from 50.7 to 58.1 years. Inflation-adjusted per-capita charges for inpatient thyroidectomies more than doubled from $9,934 in 1996 to $22,537 in 2006, while aggregate national inpatient charges tripled from $464 million to $1.37 billion. By comparison, per-capita charges for outpatient thyroidectomy totaled $7,222 in 2006. CONCLUSIONS From 1996 to 2006, there has been a concurrent modest increase in inpatient and pronounced increase in outpatient thyroidectomies in the United States, with a consequential demographic shift and economic impact.
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Affiliation(s)
- Gordon H Sun
- Robert Wood Johnson Foundation Clinical Scholars, University of Michigan, Ann Arbor, Michigan 48109-2800, USA
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Naziri Q, Pivec R, Harwin SF, Costa CR, Johnson AJ, Bonutti PM, Mont MA. New technologies in knee arthroplasty. Surg Technol Int 2012; 22:272-284. [PMID: 22915499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Advances in surgical technique and implant design have increased the treatment options available to joint reconstruction surgeons. New technologies for component alignment such as custom cutting blocks and disposable cutting blocks hold the potential for more anatomic component positioning and less instrument turnover which may decrease infection rates. Improved component alignment may also be obtained with the use of computer-assisted surgery. Utilization of bone-sparing designs such as patellofemoral, unicompartmental, and bicompartmental knee arthroplasty allow for the surgeon to customize treatment based on patient symptoms by addressing each compartment individually. Gender-specific designs may be useful in the setting of populations which deviate from standard dimensions that are available in traditional unisex designs. New higher-conforming bearing designs such as rotating platform bearings allow for more natural knee kinematics, while also limiting polyethylene wear by decreasing contact stress. Newer interfaces for cementless fixation utilizing porous coated surfaces allows for biologic component fixation which has the potential to increase interface durability and implant survivorship. These new materials, designs, and techniques are challenging the traditional "gold standard" cemented total knee arthroplasty and have the potential for developing a more durable and naturally feeling prosthetic knee. Further study is required to identify which patients are most appropriate for each new technology.
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