RESUMEN
INTRODUCTION: Clinical benefits of laparoscopic surgery are well established, but evidence for financial benefits is limited. This study aimed to compare the financial impact of the introduction of laparoscopic colorectal surgery. METHODS: This study included patients who underwent colorectal surgery between January 2010 and 2015. We collected a range of financial data and divided the patients into 2 groups. Primary outcome was total cost defined by surgical-related costs. RESULTS: A total of 1,246 patients were included, of which 440 surgeries were performed laparoscopically. The total median cost of laparoscopy was higher compared to open surgery (EUR 4,665 vs. EUR 4,268, p = 0.001). Laparoscopy was associated with higher equipment costs (EUR 857 vs. EUR 232, p < 0.001), longer operating time (3.2 vs. 2.5 hours, p < 0.001), and more readmissions (10.9 vs. 8.5%, p < 0.001). However, after adjusting for heterogeneity, no difference was found in total cost. Surgical-related costs were counterbalanced by lower costs associated with shorter median hospital stay (6 vs. 9 days, p < 0.001), less morbidity (37.3 vs. 55.1%, p < 0.001), and less mortality (1.8 vs. 5.6%, p = 0.013) for laparoscopy. CONCLUSION: During the introduction of laparoscopy for colorectal surgery, no significant differences were found in total cost between laparoscopic and open colorectal surgery. However, favorable postoperative outcomes were achieved with laparoscopic surgery.
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Colectomía , Neoplasias Colorrectales/cirugía , Laparoscopía , Proctectomía , Anciano , Anciano de 80 o más Años , Colectomía/economía , Colectomía/métodos , Neoplasias Colorrectales/economía , Cirugía Colorrectal/economía , Economía Hospitalaria , Femenino , Costos de la Atención en Salud , Costos de Hospital , Humanos , Laparoscopía/economía , Masculino , Persona de Mediana Edad , Proctectomía/economía , Proctectomía/métodos , Estudios RetrospectivosRESUMEN
AIM: Laparoscopic peritoneal lavage has increasingly been investigated as a promising alternative to sigmoidectomy for perforated diverticulitis with purulent peritonitis. Most studies only reported outcomes up to 12 months. Therefore, the objective of this study was to evaluate long-term outcomes of patients treated with laparoscopic lavage. METHODS: Between 2008 and 2010, 38 patients treated with laparoscopic lavage for perforated diverticulitis in 10 Dutch teaching hospitals were included. Long-term follow-up data on patient outcomes, e.g. diverticulitis recurrence, reoperations and readmissions, were collected retrospectively. The characteristics of patients with recurrent diverticulitis or complications requiring surgery or leading to death, categorized as 'overall complicated outcome', were compared with patients who developed no complications or complications not requiring surgery. RESULTS: The median follow-up was 46 months (interquartile range 7-77), during which 17 episodes of recurrent diverticulitis (seven complicated) in 12 patients (32%) occurred. Twelve patients (32%) required additional surgery with a total of 29 procedures. Fifteen patients (39%) had a total of 50 readmissions. Of initially successfully treated patients (n = 31), 12 (31%) had recurrent diverticulitis or other complications. At 90 days, 32 (84%) patients were alive without undergoing a sigmoidectomy. However, seven (22%) of these patients eventually had a sigmoidectomy after 90 days. Diverticulitis-related events occurred up to 6 years after the index procedure. CONCLUSION: Long-term diverticulitis recurrence, re-intervention and readmission rates after laparoscopic lavage were high. A complicated outcome was also seen in patients who had initially been treated successfully with laparoscopic lavage with relevant events occurring up to 6 years after initial surgery.
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Diverticulitis/terapia , Perforación Intestinal/terapia , Laparoscopía/métodos , Lavado Peritoneal/métodos , Peritonitis/terapia , Anciano , Diverticulitis/complicaciones , Femenino , Estudios de Seguimiento , Humanos , Perforación Intestinal/complicaciones , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Peritonitis/etiología , Recurrencia , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: It is unclear how mortality and causes of death vary between patients and surgical procedures and how occurrence of postoperative complications is associated with prognosis. This study describes long-term mortality rates and causes of death in a general surgical population. Furthermore, we explore the effect of postoperative complications on mortality. METHODS: A single-centre analysis of postoperative complications, with mortality as primary endpoint, was conducted in 4479 patients undergoing surgery. We applied univariate and multivariable regression models to analyse the effect of risk factors, including surgical risk and postoperative complications, on mortality. Causes of death were also explored. RESULTS: 75 patients (1.7 %) died within 30 days after surgery and 730 patients (16.3 %) died during a median follow-up of 6.3 years (IQR 5.8-6.8). Significant differences in long-term mortality were observed with worst outcome for patients undergoing high-risk vascular surgery (HR 1.5; 95 % CI 1.2-1.9). When looking at causes of death, high-risk surgery was associated with a twofold higher risk of cardiovascular death (HR 1.9; 95 % CI 1.2-3.1), whereas the intermediate-risk group had a higher risk of dying from cancer-related causes (HR 1.5; 95 % CI 1.1-2.0). Occurrence of complications-particularly of cardiovascular nature- was associated with worse survival (HR 1.9; 95 % CI 1.3-2.7). CONCLUSION: High-risk vascular surgery and occurrence of postoperative complications are important predictors of late mortality. Further focus on these groups of patients can contribute to reduced morbidity. Improvement in quality of care should be aimed at preventing postoperative complications and thus a better outcome in a general surgical population.
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Enfermedades Cardiovasculares/mortalidad , Causas de Muerte , Cirugía General/estadística & datos numéricos , Neoplasias/mortalidad , Complicaciones Posoperatorias/mortalidad , Procedimientos Quirúrgicos Vasculares/mortalidad , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Complicaciones Posoperatorias/epidemiología , Pronóstico , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Obesity is generally believed to be a risk factor for the development of postoperative complications. Although being obese is associated with medical hazards, recent literature shows no convincing data to support this assumption. Moreover a paradox between body mass index and survival is described. This study was designed to determine influence of body mass index on postoperative complications and long-term survival after surgery. METHODS: A single-centre prospective analysis of postoperative complications in 4293 patients undergoing general surgery was conducted, with a median follow-up time of 6.3 years. We analyzed the impact of bodyweight on postoperative morbidity and mortality, using univariate and multivariate regression models. RESULTS: The obese had more concomitant diseases, increased risk of wound infection, greater intraoperative blood loss and a longer operation time. Being underweight was associated with a higher risk of complications, although not significant in adjusted analysis. Multivariate regression analysis demonstrated that underweight patients had worse outcome (HR 2.1; 95 % CI 1.4-3.0), whereas being overweight (HR 0.6; 95 % CI 0.5-0.8) or obese (HR 0.7; 95 % CI 0.6-0.9) was associated with improved survival. CONCLUSION: Obesity alone is a significant risk factor for wound infection, more surgical blood loss and a longer operation time. Being obese is associated with improved long-term survival, validating the obesity paradox. We also found that complication and mortality rates are significantly worse for underweight patients. Our findings suggest that a tendency to regard obesity as a major risk factor in general surgery is not justified. It is the underweight patient who is most at risk of major postoperative complications, including long-term mortality.
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Obesidad/complicaciones , Sobrepeso/complicaciones , Complicaciones Posoperatorias/epidemiología , Delgadez/complicaciones , Adulto , Anciano , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Índice de Masa Corporal , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/mortalidad , Estudios Prospectivos , Análisis de Regresión , Factores de Riesgo , Procedimientos Quirúrgicos Operativos/métodos , SobrevidaRESUMEN
PURPOSE: Fistulotomy is considered to be the golden standard for the treatment of low perianal fistula but might have more influence on continence status than believed. This study was performed to evaluate the healing rate after a fistulotomy and to show results for continence status. METHODS: A retrospective database study was performed in one university medical center and its six affiliated hospitals. All patients treated with a fistulotomy for a low perianal fistula were identified. Healing and recurrence of the fistula were identified. Questionnaires on continence status and quality of life were mailed to all patients. RESULTS: In total, 537 patients were identified. The primary etiology of the fistulas was cryptoglandular (66.5%). Recurrence was seen in 88 patients (16.4%) resulting in a primary healing rate of 83.6%. After secondary treatment for the recurrence, another 40 patients healed. This resulted in a secondary healing rate of 90.3%. The Kaplan-Meier analysis showed that at 5 years, the healing rate was 0.81 (95% confidence interval (95% CI) 0.71-0.85). The mean Vaizey score was 4.67 (SD 4.80). Major incontinence, defined as a Vaizey score of >6, was seen in 95 (28.0%) patients. Only 26.3% of the patients had a perfect continence status (Vaizey score 0). Quality of life was not different from the general population. CONCLUSIONS: Fistulotomy seems to be associated with a healing rate of 0.81 (95% CI 0.71-0.85) after 5 years. However, major incontinence is still reported by 26.8% of patients and only 26.3% of patients had a perfect continence status.
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Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Fístula Rectal/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Incontinencia Fecal/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Calidad de Vida , Fístula Rectal/patología , Recurrencia , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
A rare complication of diverticulosis of the colon is giant colonic diverticulum, an entity first described by Bonvin in 1946. The experience of any surgeon with this problem is at the most still small and reported management in the literature has been varied. We present the case of a 84-year-old woman presenting with a painless abdominal mass and constipation. A 30 x 10 cm gas-filled cyst was discovered on abdominal X-ray and CT examination. Furthermore, we provide an overview of pathophysiology, diagnosis and therapeutic options.
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Diverticulosis del Colon/complicaciones , Divertículo del Colon/diagnóstico por imagen , Divertículo del Colon/etiología , Anciano de 80 o más Años , Estreñimiento/etiología , Resultado Fatal , Femenino , Insuficiencia Cardíaca , Humanos , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: This study seeks to evaluate assessment of geriatric frailty and nutritional status in predicting postoperative mortality in gastric cancer surgery. METHODS: Preoperatively, patients operated for gastric adenocarcinoma underwent assessment of Groningen Frailty Indicator (GFI) and Short Nutritional Assessment Questionnaire (SNAQ). We studied retrospectively whether these scores were associated with in-hospital mortality. RESULTS: From 2005 to September 2012 180 patients underwent surgery with an overall mortality of 8.3%. Patients with a GFI ≥ 3 (n = 30, 24%) had a mortality rate of 23.3% versus 5.2% in the lower GFI group (OR 4.0, 95%CI 1.1-14.1, P = 0.03). For patients who underwent surgery with curative intent (n = 125), this was 27.3% for patients with GFI ≥ 3 (n = 22, 18%) versus 5.7% with GFI < 3 (OR 4.6, 95% CI 1.0-20.9, P = 0.05). SNAQ ≥ 1 (n = 98, 61%) was associated with a mortality rate of 13.3% versus 3.2% in patients with SNAQ =0 (OR 5.1, 95% CI 1.1-23.8, P = 0.04). Given odds ratios are corrected in multivariate analyses for age, neoadjuvant chemotherapy, type of surgery, tumor stage and ASA classification. CONCLUSIONS: This study shows a significant relationship between gastric cancer surgical mortality and geriatric frailty as well as nutritional status using a simple questionnaire. This may have implications in preoperative decision making in selecting patients who optimally benefit from surgery.
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Adenocarcinoma/cirugía , Gastrectomía/mortalidad , Evaluación Geriátrica , Estado Nutricional , Complicaciones Posoperatorias/mortalidad , Neoplasias Gástricas/cirugía , Adenocarcinoma/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Mortalidad Hospitalaria , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Neoplasias Gástricas/tratamiento farmacológicoRESUMEN
An electronic health record (EHR) should provide 4 key functionalities: (a) documenting patient data; (b) facilitating computerised provider order entry; (c) displaying the results of diagnostic research; and (d) providing support for healthcare providers in the clinical decision-making process.- Computerised provider order entry into the EHR enables the electronic receipt and transfer of orders to ancillary departments, which can take the place of handwritten orders.- By classifying the computer provider order entries according to disorders, digital care pathways can be created. Such care pathways could result in faster and improved diagnostics.- Communicating by means of an electronic instruction document that is linked to a computerised provider order entry facilitates the provision of healthcare in a safer, more efficient and auditable manner.- The implementation of a full-scale EHR has been delayed as a result of economic, technical and legal barriers, as well as some resistance by physicians.
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Sistemas de Apoyo a Decisiones Clínicas/organización & administración , Eficiencia Organizacional , Registros Electrónicos de Salud , Calidad de la Atención de Salud , Costos y Análisis de Costo , Sistemas de Apoyo a Decisiones Clínicas/instrumentación , Registros Electrónicos de Salud/economía , Registros Electrónicos de Salud/organización & administración , Humanos , Países BajosRESUMEN
The 'Individueel functioneren medisch specialisten' (Individual Functioning of Medical Specialists, IFMS) programme is a formative evaluation tool.- The aim of the IFMS programme is to consolidate good practices and to ameliorate those less desirable. - It is an integral system that takes the complexity of the medical profession, the physician as an individual and the expectations and demands from the individual's surroundings into account. - The IFMS programme uses the physician's intrinsic motivation and individual responsibility as its starting points. - The programme's features include maintaining a portfolio and acquiring feedback from the surroundings which are then used as a foundation for a personal discussion with a trained communicator.- The outcome of this method results in a physician who is and remains conscious of the need to deliver high-quality care, taking his or her personal aspirations and demands of the work setting into account.
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Medicina Basada en la Evidencia , Grupo de Atención al Paciente , Especialización/normas , Humanos , Motivación , Autonomía Profesional , Responsabilidad SocialRESUMEN
BACKGROUND: The Morel-Lavallée lesion is a post-traumatic collection of fluid arising after a 'closed degloving injury' has caused the separation of the skin and subcutis from the underlying muscular fascia. It usually occurs in the trochanteric region or proximal thigh. CASE DESCRIPTION: A 36-year-old obese man was referred to the emergency department by his general practitioner for fever and pain in the right lower abdominal quadrant. Blood testing revealed elevated infection parameters. As appendicitis was suspected, a CT scan of the abdomen was performed. This revealed a Morel-Lavallée lesion, which he had sustained 9 months earlier when he had been hit by a car while riding his bicycle. A rapid recovery ensued after ultrasound-guided percutaneous drainage and treatment with antibiotics. CONCLUSION: A Morel-Lavallée lesion, which could manifest even months later, should be considered after any traumatic injury. Ultrasound, CT and MRI are useful tools for proper diagnosis. There is no consensus about treatment in either the acute or the chronic phase to date.
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Traumatismos Abdominales/diagnóstico , Drenaje , Traumatismos de los Tejidos Blandos/diagnóstico , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/etiología , Traumatismos Abdominales/terapia , Accidentes de Tránsito , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/etiología , Traumatismos de los Tejidos Blandos/terapia , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: Laparoscopic lavage has recently emerged as a promising alternative to sigmoid resection in the treatment of perforated diverticulitis. This study examined an early experience with this technique. METHODS: The files of all patients with complicated diverticulitis were searched in 34 teaching hospitals of the Netherlands. Patients with perforated diverticulitis treated with laparoscopic lavage between 1 January 2008 and 31 December 2010 were included. RESULTS: Treatment with laparoscopic lavage was performed in only 38 patients in ten hospitals. Lavage was successful in controlling sepsis in 31 of the 38 included patients, with 32 per cent morbidity (10 of 31 patients) and fast recovery. Overall, 17 of 38 patients developed complications, of whom two had a missed overt sigmoid perforation. Two patients died from multiple organ failure and one from aspiration pneumonia; one other patient died after palliative management of inoperable lung carcinoma. Three patients in whom lavage was successful underwent subsequent sigmoid resection for recurrent diverticulitis. Patients in whom lavage was unsuccessful tended to have more co-morbidities, a higher preoperative C-reactive protein concentration and a higher Mannheim Peritonitis Index. CONCLUSION: Laparoscopic lavage for perforated diverticulitis was feasible in the majority of patients, but identification of an overt sigmoid perforation and patient selection are of critical importance.
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Diverticulitis del Colon/terapia , Perforación Intestinal/terapia , Laparoscopía/métodos , Adulto , Anciano , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Tempo Operativo , Complicaciones Posoperatorias/etiología , Segunda Cirugía , Irrigación Terapéutica/métodos , Resultado del TratamientoRESUMEN
PURPOSE: Incisional hernia is a frequent complication of abdominal surgery (incidence 2-20%). Diagnosis by physical examination is sometimes difficult, especially in small incisional hernias or in obese patients. The additional diagnostic value of standardized ultrasonography was evaluated in this prospective study. METHODS: A total of 456 patients participating in a randomized trial comparing two suture materials for closure of the abdominal fascia underwent physical examination and ultrasonography at 6-month intervals. Wound complaints and treatment of incisional hernia were also noted. Statistical analysis was performed using the Chi-squared and Fisher's exact tests (SPSS). Interest variability analysis was performed. RESULTS: During a median follow-up of 31 months, 103 incisional hernias were found. A total of 82 incisional hernias were found by physical examination and an additional 21 with ultrasonography. Six of these additional hernias were symptomatic and only one of the additional hernias received operative treatment. The false-negative rates for physical examination and ultrasonography were 25.3 and 24.4%, respectively. Interest variability was low, with a Kappa of 0.697 (P < 0.001). CONCLUSIONS: There are no clear diagnostic criteria for incisional hernia available in the literature. Standardized combination of ultrasonography with physical examination during follow-up yields a significant number of, mostly asymptomatic, hernias, which would not be found using physical examination alone. This is especially relevant in research settings.
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Hernia Abdominal/diagnóstico por imagen , Examen Físico , Anciano , Enfermedades Asintomáticas/terapia , Distribución de Chi-Cuadrado , Reacciones Falso Negativas , Femenino , Hernia Abdominal/diagnóstico , Hernia Abdominal/cirugía , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Ultrasonografía , Maniobra de ValsalvaRESUMEN
BACKGROUND: Incisional hernia is a frequent complication of abdominal surgery, often requiring surgical intervention. This prospective randomized trial compared suture materials for closure of the fascia after abdominal surgery. METHODS: In 456 patients the abdominal fascia was closed with either non-absorbable (polypropylene; Prolene(®)) or absorbable (polydioxanone; PDS(®)) suture material. Follow-up was by clinical examination and ultrasonography at 6-month intervals. Outcome measures were incisional hernia, surgical-site infection and suture sinus. RESULTS: Some 223 patients were analysed after closure with Prolene(®) and 233 after PDS(®) . Median follow-up was 32 and 31 months respectively. There was no significant difference in the incidence of incisional hernia between the groups: 20·2 per cent (45 of 223) for Prolene(®) and 24·9 per cent (58 of 233) with PDS(®) (P = 0·229). Kaplan-Meier analysis showed a cumulative rate after 4 years of 23·7 and 30·2 per cent for Prolene(®) and PDS(®) respectively (P = 0·222). Secondary outcome measures showed no significant differences. CONCLUSION: The incidence of incisional hernia in both groups was higher than expected from previous literature. There were no significant differences between the two suture methods. REGISTRATION NUMBER: ISRCTN65599814 (http://www.clinical-trials.com).
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Pared Abdominal/cirugía , Hernia Ventral/prevención & control , Polidioxanona/uso terapéutico , Polipropilenos/uso terapéutico , Complicaciones Posoperatorias/prevención & control , Suturas , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/etiología , Resultado del Tratamiento , Cicatrización de HeridasRESUMEN
OBJECTIVE: This study was performed to determine the probability of finding additional pathology, requiring treatment or follow-up, in patients referred with symptoms suggestive of haemorrhoids. Secondly, to determine, at what age a flexible sigmoidoscopy should be performed in these patients. METHOD: All patients referred for the treatment of haemorrhoids over a period of 5 years were prospectively included in a database. Data included patient characteristics, clinical information, histopathological analysis and the sigmoidoscopy results. RESULTS: Haemorrhoids were present in 961 (95.6%) of 1005 patients. Of these patients, 692 (72.0%) patients were free from any additional pathology, 161 (16%) patients had diverticulosis, in 15 (1.5%) patients the sigmoidoscopy showed signs of colitis, 116 (11.5%) patients had polyps and a malignancy was present in eight (0.8%) patients. In the age group between 30-40 and 40-50, the presence of additional pathology increased significantly (P < 0.05). No malignancies were found under the age of 40. CONCLUSIONS: The vast majority of patients referred for the treatment and analysis of haemorrhoids were free from any additional pathology. But, over the age of 40, the incidence of additional pathology increased significantly. Therefore, we suggest that a flexible sigmoidoscopy should be performed in all patients over the age of 40, with clinical signs of haemorrhoids.
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Enfermedades del Colon/complicaciones , Enfermedades del Colon/diagnóstico , Hemorroides/complicaciones , Sigmoidoscopía , Adulto , Factores de Edad , Anciano , Enfermedades del Colon/epidemiología , Femenino , Hemorroides/cirugía , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Estudios RetrospectivosRESUMEN
A case of femoral neck fracture is reported after electrical shock injury with 300 V direct current in a 41-year old male. He had two small full thickness burns on his left heel, probably the exit wounds. A fracture after electrical shock due to musculoskeletal contractions is a very rare condition. Surgeons caring for patients with electrical injury should be aware of the possibility of skeletal injuries. Without vigilance for these injuries, delay in diagnosis may occur.
RESUMEN
INTRODUCTION: International guidelines recommend a staging chest X-ray (SCXR) in patients with colorectal cancer to exclude pulmonary metastases. The SCXR is controversial, because evidence to support its use is insufficient. The aim of this study was to determine the value of the SCXR in patients with colorectal cancer. PATIENTS AND METHODS: Between January 1992 and August 2006, data from all patients with colorectal cancer, who presented to the surgical clinic of the Maasland Hospital, were prospectively collected and analysed. The main outcome was the rate of pulmonary metastases on SCXR. The secondary outcome was the influence of SCXR on patient management. RESULTS: Out of 1410 patients, 1057 had a chest X-ray before their operation. Median follow-up time was 4 years and 6 months (25th percentile 1 year and 7 months, 75th percentile 6 years and 11 months). Eight patients were excluded because follow-up data were incomplete. In 24 patients the chest X-ray was suggestive of malignancy; 9 of these patients actually had pulmonary metastases. Patient management was changed in 5 of them. Four patients were identified to have primary lung cancer. These data indicate a 0.86% detection rate of pulmonary metastases (confidence interval, 0.3-1.4%). DISCUSSION: Our results show that SCXR has a low detection rate of pulmonary metastases and a small influence on patient management. In accordance with previous studies our data do not support the routine use of the SCXR in patients with colorectal cancer.
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Neoplasias Colorrectales/patología , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Radiografía Torácica , Adulto , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Humanos , Neoplasias Pulmonares/terapia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Estadísticas no ParamétricasRESUMEN
Sentinel lymph node biopsy (SLNB) has been validated in the treatment of breast carcinoma and is considered to stage the axilla adequately in this disease. However, long-term follow-up data are scarce. We evaluated the results of SLNB with respect to loco-regional failures in the axilla in SN-negative patients with invasive breast carcinoma and analysed their causal factors. Between 1997 and May 2004, 656 patients without clinically palpable lymph nodes were included in our study. Data with regard to demographics, diagnostics, therapy and follow up were gathered prospectively from all patients. Patients treated after May 2004 were excluded from this study to permit at least one year of follow-up. Out of the 656 patients, 344 patients with a negative sentinel lymph node biopsy did not undergo axillary dissection and were followed up clinically. Median follow up was 43 months. In 3 patients (0.9%) axillary recurrences developed. All three patients subsequently underwent a completion axillary dissection, chemotherapy and radiotherapy. The low rate of clinical axillary recurrence after an intermediate follow up period suggests that a negative SN biopsy accurately reflects the nodal stage in patients with breast cancer.
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Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Ganglios Linfáticos/patología , Recurrencia Local de Neoplasia/epidemiología , Biopsia del Ganglio Linfático Centinela/estadística & datos numéricos , Anciano , Axila , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Prospectivos , Factores de TiempoRESUMEN
Sentinel lymph node biopsy (SLNB) has been validated in the treatment of breast carcinoma and is considered to stage the axilla adequately in this disease. However, long-term follow-up data are scarce. We evaluated the results of SLNB with respect to loco-regional failures in the axilla in SN-negative patients with invasive breast carcinoma and analysed their causal factors. Between 1997 and May 2004, 656 patients without clinically palpable lymph nodes were included in our study. Data with regard to demographics, diagnostics, therapy and follow up were gathered prospectively from all patients. Patients treated after May 2004 were excluded from this study to permit at least one year of follow-up. Out of the 656 patients, 344 patients with a negative sentinel lymph node biopsy did not undergo axillary dissection and were followed up clinically. Median follow up was 43 months. In 3 patients (0.9%) axillary recurrences developed. All three patients subsequently underwent a completion axillary dissection, chemotherapy and radiotherapy. The low rate of clinical axillary recurrence after an intermediate follow up period suggests that a negative SN biopsy accurately reflects the nodal stage in patients with breast cancer.
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Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/patología , Carcinoma Lobular/patología , Metástasis Linfática/patología , Recurrencia Local de Neoplasia/patología , Biopsia del Ganglio Linfático Centinela , Adulto , Anciano , Axila , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/radioterapia , Carcinoma Ductal de Mama/cirugía , Carcinoma Lobular/tratamiento farmacológico , Carcinoma Lobular/radioterapia , Carcinoma Lobular/cirugía , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Países Bajos , Guías de Práctica Clínica como Asunto , Estudios Prospectivos , Radioterapia Adyuvante , ReoperaciónRESUMEN
The aim of this study was to evaluate our postoperative pain protocol after ambulatory herniorrhaphy and to determine how infiltration with local anaesthetics would add to our management of postoperative pain. Two groups of 60 patients, scheduled for herniorrhaphy, received wound infiltration with 20 ml levobupivacaine 0.5% or saline 0.9%. Postoperatively, the patients regulated their own analgesic consumption and registered VAS scores, use of analgesics and side-effects in a diary for 5 days. The median time to first analgesic, the pain visual analogue scale scores, number of patients using no analgesic and the use of analgesic medication were significantly lower in the levobupivacaine group in the first 24 h, but not thereafter. Most patients used acetaminophen in the first 5 days after surgery and occasionally diclofenac. Only a minority used tramadol. Our multimodal pain protocol achieved reasonable results at rest, but a considerable number of patients experienced moderate to severe pain with movement.