Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Abstract Background High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004–2013. Results Patients age ≥ 80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p < 0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82–1.08, P = 0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84–1.13, P = 0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51–0.86, P = 0.002) was a significant independent prognostic factor, while extensive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22–2.91, P = 0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97–1.00, P = 0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18–27% in other programs, P < 0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6–6.6% in other programs, P < 0.001; 90-day mortality: 6.2% in AR vs. 13.6–16.4% in other programs, P < 0.001) compared to other facilities. Conclusions Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs. with early stage resectable PGC.

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Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

10.21203/rs.2.11440/v2 ◽

2019 ◽

Author(s):

Xuefei Wang ◽

Junjie Zhao ◽

Mark Fairweather ◽

Tingsong Yang ◽

Yihong Sun ◽

...

Keyword(s):

Gastric Carcinoma ◽

Elderly Patients ◽

Early Stage ◽

Medical Center ◽

Optimal Treatment ◽

National Cancer Database ◽

Invasive Approach ◽

Perioperative Morbidity ◽

Less Invasive Approach ◽

Proximal Gastric Carcinoma

Abstract Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.

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Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

10.21203/rs.2.11440/v3 ◽

2019 ◽

Author(s):

Xuefei Wang ◽

Junjie Zhao ◽

Mark Fairweather ◽

Tingsong Yang ◽

Yihong Sun ◽

...

Keyword(s):

Gastric Carcinoma ◽

Elderly Patients ◽

Early Stage ◽

Medical Center ◽

Optimal Treatment ◽

National Cancer Database ◽

Invasive Approach ◽

Perioperative Morbidity ◽

Less Invasive Approach ◽

Proximal Gastric Carcinoma

Abstract Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.

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The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm10071518 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1518

Author(s):

Tou Pin Chang ◽

Aik Yong Chok ◽

Dominic Tan ◽

Ailin Rogers ◽

Shahnawaz Rasheed ◽

...

Keyword(s):

Pelvic Exenteration ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Invasive Approach ◽

Perioperative Morbidity ◽

Rectal Cancers ◽

Beyond Tme ◽

Assisted Technologies

Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered.

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Outcomes and Patterns of Care in Elderly Patients with Glioblastoma Multiforme: A Population-Based Study of the National Cancer Database

World Neurosurgery ◽

10.1016/j.wneu.2021.01.028 ◽

2021 ◽

Author(s):

Ravi S. Nunna ◽

Syed I. Khalid ◽

Saavan Patel ◽

Abhishek Sethi ◽

Mandana Behbahani ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Elderly Patients ◽

Population Based ◽

Patterns Of Care ◽

National Cancer Database ◽

Population Based Study

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Is Proximal Gastrectomy Superior to Total Gastrectomy for Proximal Gastric Carcinoma?

Digestive Surgery ◽

10.1159/000172050 ◽

1992 ◽

Vol 9 (1) ◽

pp. 13-18

Author(s):

Shunichi Tsujitani ◽

Yoshihiro Kakeji ◽

Akihiro Watanabe ◽

Yoshihiko Maehara ◽

Motonosuke Furusawa ◽

...

Keyword(s):

Gastric Carcinoma ◽

Total Gastrectomy ◽

Proximal Gastrectomy ◽

Proximal Gastric Carcinoma

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Triple valve surgery through a less invasive approach: early and mid-term results

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivw430 ◽

2017 ◽

pp. ivw430

Author(s):

Petar Risteski ◽

Nadejda Monsefi ◽

Aleksandra Miskovic ◽

Tanja Josic ◽

Sherife Bala ◽

...

Keyword(s):

Valve Surgery ◽

Invasive Approach ◽

Less Invasive ◽

Less Invasive Approach ◽

Triple Valve ◽

Mid Term Results

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Endoscopy-Assisted Achilles Tendon Reconstruction With a Central Turndown Flap and Semitendinosus Augmentation

Foot & Ankle International ◽

10.1177/1071100716666365 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1333-1342 ◽

Cited By ~ 4

Author(s):

Prashant N. Gedam ◽

Faizaan M. Rushnaiwala

Keyword(s):

Minimally Invasive ◽

Achilles Tendon ◽

Achilles Tendon Rupture ◽

Wound Complication ◽

Reconstruction Technique ◽

Level Of Evidence ◽

Invasive Approach ◽

Perioperative Morbidity ◽

The Mean

Background: The objective of this study was to report the results of a new minimally invasive Achilles reconstruction technique and to assess the perioperative morbidity, medium- to long-term outcomes, and functional results. Methods: Our series was comprised 14 patients (11 men and 3 women), with a mean age of 45.6 years at surgery. Each patient had a chronic Achilles tendon rupture. The mean interval from rupture to surgery was 5.5 months (range, 2-10). The mean total follow-up was 30.1 months (range, 12-78). All patients were operated with a central turndown flap augmented with free semitendinosus tendon graft and percutaneous sutures in a minimally invasive approach assisted by endoscopy. The patients underwent retrospective assessment by clinical examination, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, and the Achilles Tendon Total Rupture Score (ATRS). Paired t tests were used to assess the preoperative and postoperative AOFAS scores, ATRS scores, and ankle range of motion. Results: The length of the defect ranged from 3 to 8 cm (mean, 5.1), while the length of the turndown flap ranged from 8 to 13 cm (mean, 10.1). The mean AOFAS score improved from 64.5 points preoperatively to 96.9 points at last follow-up. The mean ATRS score improved from 49.4 preoperatively to 91.4 points at last follow-up. None of the patients developed a wound complication. No patient had a rerupture or sural nerve damage. Conclusion: All patients in our study had a favorable outcome with no complications. We believe that with this triple-repair technique, one can achieve a strong and robust repair such as in open surgery while at the same time reducing the incidence of complications. Level of Evidence: Level III, retrospective comparative study.

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