Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the e...Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.展开更多
BACKGROUND The impact of the coronavirus on hospitalizations for gastrointestinal(GI)disease,particularly at a population level is understudied.AIM To investigate trends in hospitalizations,inpatient endoscopy resourc...BACKGROUND The impact of the coronavirus on hospitalizations for gastrointestinal(GI)disease,particularly at a population level is understudied.AIM To investigate trends in hospitalizations,inpatient endoscopy resource utilization,and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.METHODS Using the California State Inpatient Database for 2018-2020,we explored year-toyear and 2020 month-to-month trends in hospitalizations,length of stay,and inpatient mortality(all-cause&viral pneumonia-specific)for common inpatient GI diagnoses including acute pancreatitis,diverticulitis,cholelithiasis,noninfectious gastroenteritis,upper and lower GI bleeding(LGIB),Clostridium difficile,viral gastroenteritis,inflammatory bowel disease,and acute cholangitis.RESULTS Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding(NVUGIB),LGIB,and ulcerative colitis(UC)(ptrend<0.0001).Allcause inpatient mortality was higher in 2020 vs 2019,for acute pancreatitis(P=0.029),diverticulitis(P=0.04),NVUGIB(P=0.003),and Crohn’s disease(P=0.004).In 2020,hospitalization rates were lowest in April,November,and December.There was no significant corresponding increase in inpatient mortality except in UC(ptrend=0.048).Viral pneumonia and viral pneumonia complicated by respiratory failure increased(P<0.001)among GI hospitalizations.Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB(P<0.001).CONCLUSION Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic,particularly in April,November and December 2020.Allcause mortality was significantly higher among acute pancreatitis,diverticulitis,NVUGIB,and Crohn’s disease hospitalizations.Emergency endoscopy rates were mostly comparable between 2020 and 2019.展开更多
Background:Laparoscopic distal pancreatectomy(LDP)has become the preferred approach for surgical management of left sided pancreas pathology.Our institution previously published its experience with distal pancreatecto...Background:Laparoscopic distal pancreatectomy(LDP)has become the preferred approach for surgical management of left sided pancreas pathology.Our institution previously published its experience with distal pancreatectomies using a clockwise technique with good outcomes.We now reexamine our outcomes across a longer time interval.Methods:From August 2008 to November 2020,364 patients underwent LDP by hepatobiliary surgeons(HA and JS).All procedures were performed using the same clockwise approach,which includes the stepwise slow compression technique.Retrospective descriptive analysis of patient demographic,clinical,operative,and pathologic data was conducted.Results:Of the 364 patients who underwent LDP using this technique,clinically significant postoperative pancreatic fistula(POPF)was noted in 26(7.1%)patients,while major morbidity and mortality were reported in 9.9%and 0.3%,respectively.Hand-assisted method was required for 18(4.9%)patients and unplanned conversion in 20(5.5%)patients.In a subset analysis of patients with pancreatic adenocarcinoma(n¼90),POPF was noted in 13(14.4%),with minor complications occurring in 34.4%and major morbidity in 14.4%.Conclusion:LDP with a clockwise approach for dissection,combined with the stepwise slow compression technique results in excellent outcomes,with even lower POPF rates than originally reported.Subset analysis of patients with pancreatic adenocarcinoma shows acceptable perioperative outcomes with this technique.展开更多
Oligometastatic soft tissue sarcoma represents an intermediate state between localized and disseminated disease.Combination A combination of surgery,radiotherapy and systemic treatment significantly improves prognosis...Oligometastatic soft tissue sarcoma represents an intermediate state between localized and disseminated disease.Combination A combination of surgery,radiotherapy and systemic treatment significantly improves prognosis,with a 5-year overall survival as high as 50%.Due to the high prevalence of lung metastases,most of the surgical evidence is centered around lung metastasectomy.The decision to perform surgical metastasectomy remains dependent on optimal patient selection.Adequate post-surgical lung function,absence of extrapulmonary metastases,control of the primary tumor,and feasibility of achieving negative margins are major criteria for patients to undergo successful surgery.Adequate margins,longer disease-free interval,unilateral,limited number(≤2),metachronous and small(<2 cm)pulmonary metastasis are some factors associated with improved survival.Radiotherapy,especially SBRT,is an effective treatment for disease control,and its use as(neo)-adjuvant therapy has shown promising results.However,studies comparing radiotherapy against surgery are missing and the efficacy of radiotherapy independent of surgery is not yet clear.Interventional radiology techniques such as percutaneous thermal ablation(PTA)or arterial embolization have also been described as potential treatment alternatives in candidates deemed not fit for surgery.Systemic treatment has traditionally consisted of an anthracycline(doxorubicin)-based regimen with the addition of ifosfamide in certain cases.Recent advances in systemic treatment include the use of targeted therapy and immunotherapy in(oligo)-metastatic STS.However,except for certain histologies,most STS subtypes are chemoresistant,and the response to systemic treatment is poor.展开更多
Radiotherapy(RT)is an integral component of the multidisciplinary care for intrahepatic cholangiocarcinoma(iCCA).Over the past decades,RT techniques have been developed with the aim of enhancing tumor control and mini...Radiotherapy(RT)is an integral component of the multidisciplinary care for intrahepatic cholangiocarcinoma(iCCA).Over the past decades,RT techniques have been developed with the aim of enhancing tumor control and minimizing toxicity.The most recent technological advancements include proton beam therapy(PBT)and magnetic resonance-guided radiotherapy(MRgRT).PBT is notable for its unique physical characteristics that allow for greater sparing of surrounding normal organs,especially the liver,from low to moderate doses of radiation.MRgRT provides advantages in other aspects,including superior tumor visualization before treatment,on-board treatment plan adaptation,and tumor tracking during treatment.These features allow for precise dose delivery and safe dose escalation,especially for patients with tumors close to luminal GI structures.In this review article,the rationale,clinical outcomes,clinical applications,challenges,and future directions of PBT and MRgRT are discussed.Additionally,the potential combination of novel therapeutics with RT in iCCA is explored.展开更多
文摘Introduction:Radical cystectomy with pelvic node dissection remains the standard of care for muscle-invasive bladder carcinoma(MIBC);however,there is a growing interest in bladder preservation alternatives among the elderly population.Guidelines indicate that partial cystectomy(PC)combined with pelvic node dissection(LND)can be considered as an alternative in carefully selected individuals.Using the National Cancer Database,we analyzed the overall survival(OS)between PC with and without LND among octogenarians.Methods:We identified octogenarians with localized muscle-invasive bladder carcinoma(cT2-3N0M0)and urothelial histology who underwent PC with or without LND between 2004 and 2018.Based on the number of lymph nodes removed(LNR),the LND group was further subdivided into<10 and>=10 lymph node groups.A propensity-matched Kaplan-Meier survival analysis was performed to compare OS between these groups.Results:Among 2573 patients who underwent PC,492 octogenarians met our selection criteria.208(42.2%)had LND,while 284(57.8%)had no LND.Within the LND group,53(25.5%)had<10 LNR,and 155(74.5%)had>=10 LNR.The median OS for the matched LND and non-LND groups was 36.9 and 33.4 months(p=0.96),respectively.Similarly,<10 LNR and>=10 LNR had 36.9 and 43.5 months(p=0.42),respectively.Multivariate Cox regression analysis revealed no difference in the risk of mortality.Conclusion:Among octogenarians who underwent PC,there was no significant difference in OS between those with or without LND,and between<10 or>=10 LNR groups.Therefore,the role and extent of LND after PC need further exploration in this subset of the population.
文摘BACKGROUND The impact of the coronavirus on hospitalizations for gastrointestinal(GI)disease,particularly at a population level is understudied.AIM To investigate trends in hospitalizations,inpatient endoscopy resource utilization,and outcomes during the first year of the coronavirus pandemic and subsequent lockdowns.METHODS Using the California State Inpatient Database for 2018-2020,we explored year-toyear and 2020 month-to-month trends in hospitalizations,length of stay,and inpatient mortality(all-cause&viral pneumonia-specific)for common inpatient GI diagnoses including acute pancreatitis,diverticulitis,cholelithiasis,noninfectious gastroenteritis,upper and lower GI bleeding(LGIB),Clostridium difficile,viral gastroenteritis,inflammatory bowel disease,and acute cholangitis.RESULTS Disease-specific hospitalizations decreased for all included conditions except nonvariceal upper GI bleeding(NVUGIB),LGIB,and ulcerative colitis(UC)(ptrend<0.0001).Allcause inpatient mortality was higher in 2020 vs 2019,for acute pancreatitis(P=0.029),diverticulitis(P=0.04),NVUGIB(P=0.003),and Crohn’s disease(P=0.004).In 2020,hospitalization rates were lowest in April,November,and December.There was no significant corresponding increase in inpatient mortality except in UC(ptrend=0.048).Viral pneumonia and viral pneumonia complicated by respiratory failure increased(P<0.001)among GI hospitalizations.Endoscopy utilization within 24 h of admission was unchanged for GI emergencies except NVUGIB(P<0.001).CONCLUSION Our findings suggest that hospitalization rates for common GI conditions significantly declined in California during the COVID pandemic,particularly in April,November and December 2020.Allcause mortality was significantly higher among acute pancreatitis,diverticulitis,NVUGIB,and Crohn’s disease hospitalizations.Emergency endoscopy rates were mostly comparable between 2020 and 2019.
文摘Background:Laparoscopic distal pancreatectomy(LDP)has become the preferred approach for surgical management of left sided pancreas pathology.Our institution previously published its experience with distal pancreatectomies using a clockwise technique with good outcomes.We now reexamine our outcomes across a longer time interval.Methods:From August 2008 to November 2020,364 patients underwent LDP by hepatobiliary surgeons(HA and JS).All procedures were performed using the same clockwise approach,which includes the stepwise slow compression technique.Retrospective descriptive analysis of patient demographic,clinical,operative,and pathologic data was conducted.Results:Of the 364 patients who underwent LDP using this technique,clinically significant postoperative pancreatic fistula(POPF)was noted in 26(7.1%)patients,while major morbidity and mortality were reported in 9.9%and 0.3%,respectively.Hand-assisted method was required for 18(4.9%)patients and unplanned conversion in 20(5.5%)patients.In a subset analysis of patients with pancreatic adenocarcinoma(n¼90),POPF was noted in 13(14.4%),with minor complications occurring in 34.4%and major morbidity in 14.4%.Conclusion:LDP with a clockwise approach for dissection,combined with the stepwise slow compression technique results in excellent outcomes,with even lower POPF rates than originally reported.Subset analysis of patients with pancreatic adenocarcinoma shows acceptable perioperative outcomes with this technique.
文摘Oligometastatic soft tissue sarcoma represents an intermediate state between localized and disseminated disease.Combination A combination of surgery,radiotherapy and systemic treatment significantly improves prognosis,with a 5-year overall survival as high as 50%.Due to the high prevalence of lung metastases,most of the surgical evidence is centered around lung metastasectomy.The decision to perform surgical metastasectomy remains dependent on optimal patient selection.Adequate post-surgical lung function,absence of extrapulmonary metastases,control of the primary tumor,and feasibility of achieving negative margins are major criteria for patients to undergo successful surgery.Adequate margins,longer disease-free interval,unilateral,limited number(≤2),metachronous and small(<2 cm)pulmonary metastasis are some factors associated with improved survival.Radiotherapy,especially SBRT,is an effective treatment for disease control,and its use as(neo)-adjuvant therapy has shown promising results.However,studies comparing radiotherapy against surgery are missing and the efficacy of radiotherapy independent of surgery is not yet clear.Interventional radiology techniques such as percutaneous thermal ablation(PTA)or arterial embolization have also been described as potential treatment alternatives in candidates deemed not fit for surgery.Systemic treatment has traditionally consisted of an anthracycline(doxorubicin)-based regimen with the addition of ifosfamide in certain cases.Recent advances in systemic treatment include the use of targeted therapy and immunotherapy in(oligo)-metastatic STS.However,except for certain histologies,most STS subtypes are chemoresistant,and the response to systemic treatment is poor.
文摘Radiotherapy(RT)is an integral component of the multidisciplinary care for intrahepatic cholangiocarcinoma(iCCA).Over the past decades,RT techniques have been developed with the aim of enhancing tumor control and minimizing toxicity.The most recent technological advancements include proton beam therapy(PBT)and magnetic resonance-guided radiotherapy(MRgRT).PBT is notable for its unique physical characteristics that allow for greater sparing of surrounding normal organs,especially the liver,from low to moderate doses of radiation.MRgRT provides advantages in other aspects,including superior tumor visualization before treatment,on-board treatment plan adaptation,and tumor tracking during treatment.These features allow for precise dose delivery and safe dose escalation,especially for patients with tumors close to luminal GI structures.In this review article,the rationale,clinical outcomes,clinical applications,challenges,and future directions of PBT and MRgRT are discussed.Additionally,the potential combination of novel therapeutics with RT in iCCA is explored.
