RESUMEN

Introduction: Among super-microsurgical techniques, the anastomosis of vessels smaller than 0.5 mm is very difficult to perform due to the small diameter and thinness of the blood and lymphatic vessel walls. In this article, we report on the main points of super microsurgery, particularly on the anastomosis of veins and lymphatic vessels with diameters smaller than 0.5 mm. Methods and Results: Details of anastomosis of vessels smaller than 0.5 mm. (1) The outer wall of the first blood vessel near the abrupt end hook with the tip of the needle in the needle holder. The entire abrupt end of the first blood vessel was supported by forceps in the surgeon's left-hand. (2) The surgeon decided the entry point and angle of the needle while moving the tip. After the needle was fixed, a force was applied so that the needle could pass through to the vascular wall. (3) After the needle passed through, the tip was confirmed to be located in the lumen of the first blood vessel. (4) The tip of the needle was inserted into the lumen of the second blood vessel, and the bite was adjusted while touching the second blood vessel through the endometrium. (5) Once the tip was properly positioned, counter-traction was applied by holding the entire outer wall with a left-hand forceps. (6) The needle was held near the tip and pulled out along its curvature. The anastomosis time was 11.35 minutes on average (9 to 14 minutes). The patency rate for all 20 anastomosis procedures was also 100%. Conclusion: The important points of LVA for lymphatic vessels and veins smaller than 0.5 mm were reported. Once the surgeons are familiarized with this anastomosis procedure, they can typically perform one anastomosis in about 10 minutes.

RESUMEN

Trocar-site hernia is a rare and life-threatening complication of laparoscopic abdominal surgery; 5-mm trocar-site bowel herniation is rarer than ≥ 10-mm trocar-site herniation. We present a 41-year-old female patient on the postoperative 6th day with laparoscopic myomectomy admitted to our emergency department with severe vomiting and nausea. At the end of the evaluations, she was diagnosed with 5-mm trocar-site small bowel herniation. A herniated small bowel segment was rescued through the laparotomy. After full recovery, the patient was discharged on the 3rd day of hospitalization. Although there is no consensus on the closure of small fascia incisions (<10 mm) routinely, we suggest that all fascia incisions should be assessed in patients at risk to prevent trocar-site hernias. According to our investigation for trocar-site hernia in the literature, laparoscopic myomectomy may be considered a risk factor.

RESUMEN

Objective: To select chest CT image patterns for the diagnosis of pneumoconiosis and establish a method for determining the profusion of circular small shadows in chest CT. Methods: In April 2021, 66 cases of occupational pneumoconiosis patients with digital radiography (DR) chest radiographs and chest CT imaging data with circular small shadow as the main manifestations were selected as the study objects. 1.5 mm and 5 mm chest CT axial images, 1 mm and 5 mm chest CT coronal multi-plane recombination (MPR) images, and 5 mm chest CT coronal maximum intensity projection (MIP) images were used to observe the different characteristics of pneumoconiosis patients, and were compared and analyzed with DR chest radiographs to establish the experimental chest CT standards. The consistency of the profusion results between the experimental chest CT standards and GBZ 70-2015 Diagnosis of Occupational Pneumoconiosis was verified. Results: All the 66 objects were male, including 33 cases of stage Ⅰ pneumoconiosis, 17 cases of stage Ⅱ pneumoconiosis and 16 cases of stage Ⅲ pneumoconiosis. By observing five chest CT images of 66 objects, we found that chest CT images of different modes could clearly display and identify abnormal images such as small circular shadow, large shadow, small shadow aggregation, honeycomb glass shadow, flake glass shadow, uniform low-profusion glass shadow, mesh glass shadow, cable shadow, linear shadow, subpleural spinous shadow, subpleural nodules, various kinds of emphysema and lung texture distortion and fracture. Small shadow aggregation was usually accompanied by the appearance of large shadow. The vascular shadows in 5 mm CT images had good ductility, and small nodules were easy to distinguish. The coronal MIP image of 5 mm chest CT used edge enhancement technology, which was prone to small shadow fusion and fibrotic shadow fusion. The coronal MPR image of 5 mm chest CT was highly consistent with the DR chest radiographs in terms of the integrity of film reading. GBZ 70-2015 standard was used to compare the profusion of DR chest radiographs and 5 mm chest CT coronal MPR images of 66 objects, and the consistency test Kappa=0.64. GBZ 70-2015 standard and experimental chest CT standard were used to compare the profusion results of DR chest radiographs and 5 mm chest CT coronal MPR images of 66 objects, respectively, and the consistency test Kappa=0.80, with high consistency. Conclusion: 5 mm coronal MPR image is suitable for chest CT imaging in the diagnosis of pneumoconiosis. Following the selection path and method of GBZ 70-2015 profusion criterion, the established experimental chest CT standard in determining the profusion of small circular shadows in 5 mm coronal MPR images of chest CT with pneumoconiosis has a high consistency with GBZ 70-2015 standard.

Asunto(s)

RESUMEN

OBJECTIVE: The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods. METHODS: This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses. RESULTS: Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group. CONCLUSION: CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.

RESUMEN

Objectives: Implant prominence after ulnar fracture fixation may be mitigated by the use of lower profile plates. The biomechanical strength and stability of 2.7-mm and 3.5-mm locking compression plates for fixation were compared. Methods: Two fracture conditions, transverse (N = 10) and oblique (N = 10), were evaluated in an in vitro study. Half of the specimens for each condition were fixed with 2.7-mm plates and the other half with 3.5-mm plates, all fixed with conventional dynamic compression mechanisms. Specimens were loaded under ±2 Nm of cyclic axial torsion, then under 10 Nm of cyclic cantilever bending, and bending to failure. Interfragmentary motion and strain were analyzed to determine construct stability as a function of fracture pattern and plate size. Results: Interfragmentary motion was significantly larger in all constructs fixed with 2.7-mm plates, compared with 3.5-mm plates (P < 0.01). The 2.7-mm constructs with transverse fractures had the greatest motion, ranging between 5° and 10° under axial rotation and 5.0-6.0 mm under bending. Motions were the lowest for 3.5-mm constructs with oblique fractures, ranging between 3.2 and 4.2 mm under bending and 2°-3.5° for axial rotation. For oblique fractures, the bending moment at ultimate failure was 31.4 ± 3.6 Nm for the 2.7-mm constructs and 10.0 ± 1.9 Nm for 3.5-mm constructs (P < 0.01). Similarly, for transverse fractures, the bending moment was 17.9 ± 4.0 Nm for the 2.7-mm constructs and 9.7 ± 1.3 Nm for the 3.5-mm constructs (P < 0.01). Conclusions: Although 3.5-mm plates were more effective at reducing fracture motion, they were consistently associated with refracture at the distal-most screw hole under load to failure. By contrast, 2.7-mm plates plastically deformed despite excessive loads, potentially avoiding a subsequent fracture. Level of Evidence: Level V.

RESUMEN

OBJECTIVE: To propose an expression relating the number and volume of targets with the prescription dose in determining normal brain volume receiving 12 Gy dose (V12) for five to ten brain metastases treated in linear accelerator-based stereotactic radiosurgery (SRS) planning. To determine the volume of tumor that can be treated within the brain tolerance dose, for different SRS prescription doses. METHODS: Single-isocenter multiple-target (SIMT) SRS plans were devised for spherical targets that are modeled to simulate 47 tumor scenarios with varying tumor sizes and locations within the brain. Volumetric modulated arc therapy (VMAT) plans were devised using a 5-mm-leaf-width multi-leaf collimator (MLC) with high conformity and dose gradient in the Eclipse treatment planning system for the 21 Gy prescription dose with a 6FFF photon beam. The prescription dose was rescaled to 20 Gy, 18 Gy, 15 Gy and 12Gy to determine the brain V12 volume for a total of 235 SRS plans. RESULTS: Linear correlation was observed between the number, volume and prescription dose of the tumor. The expression relating these parameters was constructed to predict the normal brain V12 volume. The maximum tumor volume that can be treated using SIMT SRS with a 5-mm MLC for 5 to 10 number of targets and for a prescription dose of 21 Gy, 20 Gy, 18 Gy and 15 Gy is determined. CONCLUSION: Using the expression obtained, V12 volume can be calculated using the number of tumors and the total volume of tumors from the pre-planning MRI data. The prescription dose and the SRS fractionation size can be determined before radiotherapy treatment planning.

Asunto(s)

RESUMEN

Purpose: To compare residual stromal thickness (RST) in eyes undergoing small incision refractive lenticule extraction (SMILE) using a lenticular diameter of 6.5 mm versus those with a diameter of 5 mm. Methods: In this retrospective: comparative case series. , consecutive: patients who underwent SMILE between 2016 and 2021 with at least 6 months of follow-up were included. Preoperative best-corrected distance visual acuity (BCDVA), refractive error, contrast sensitivity, central corneal thickness, keratometry, higher order aberrations, and scotopic pupil size were recorded using a Placido disk topography with Sheimpflug tomography-based system. Patients underwent SMILE with a lenticular diameter of 6.5 mm until 2018 (n = 372 eyes). Thereafter, the lenticular diameter was reduced to 5 mm (n = 318). The RST, postoperative refraction, aberrations, subjective glare, and halos were compared across groups at 1 and 6 months. Results: The mean age of participants was 26.8 ± 5.8 years with a mean preoperative spherical equivalent of -4.48 D ± 2.16 D (range: -0.75 to -12.25 D) and mean scotopic pupil of 3.7 ± 0.75 mm. Eyes in the 5 mm group had 30.6 m (95% confidence interval [CI] = 28 to 33 m, P < 0.001) greater RST compared to the 6.5 mm group after adjusting for spherical equivalent and preoperative pachymetry. There were no differences in vision, contrast sensitivity, aberrations (wavefront error of 0.19 ± 0.2 vs. 0.25 ± 0.2, P = 0.19) or glare between the two groups. Conclusion: SMILE performed with a lenticular diameter of 5 mm leads to greater RST across the myopic range, but without inducing significant higher-order aberrations.

Asunto(s)

RESUMEN

BACKGROUND: Linked color imaging (LCI) improves detection of colorectal neoplastic lesions during colonoscopy. However, polyps <5 mm in diameter often do not require resection, and the benefits of LCI are unclear for detection of colorectal polyps ≥5 mm that are indicated for endoscopic resection in clinical practice. This randomized controlled trial compared rates of detection of adenoma polyps, stratified by size, for LCI and white light imaging (WLI). METHODS: We compared ADR (5 mm-) and PDR (5 mm-), which were defined as the proportion of patients with at least one adenoma or polyp with a diameter of 5 mm or larger in the LCI and WLI groups. Moreover, we estimated ADR and PDR for diameters between 5 and 10 mm (ADR (5-9 mm), PDR (5-9 mm) ) and for diameters larger than 10 mm (ADR (10 mm-), PDR (10 mm-) ). RESULTS: Data from 594 patients (LCI, n=305; WLI, n=289) were analyzed. ADR (5 mm-) and PDR (5 mm-) were significantly higher in the LCI group than in the WLI group (ADR (5 mm-): P=0.016, PDR (5 mm-): P=0.020). In the assessment of adenoma and polyp size, ADR (5-9 mm) and PDR (5-9 mm) were significantly higher in the LCI group than in the WLI group, although no significant differences were seen in ADR (10 mm-) and PDR (10 mm-) between these groups. CONCLUSIONS: Polyps ≥5 mm, which are indicated for endoscopic treatment, were more easily visualized with LCI mode than with WLI mode. The improvement in detection rate was obvious for polyps <10 mm, which are easier to miss.

Asunto(s)

RESUMEN

PURPOSE: To determine whether additional stem extension for stability is necessary, we performed mid-term follow-up of patients who had been managed with 5-mm metal block augmentation for a tibial defect, where tibial prosthesis was fixed using bone cement without stem extension. Also, we evaluated clinical and radiologic results including survival rate of patients without stem extension. METHODS: We retrospectively analyzed patients with tibial bone defect, had undergone primary total knee arthroplasty, and had been treated with 5-mm metal block augmentation without stem extension between March 2003 and September 2013. Among 74 patients (80 cases), 47 patients (52 cases) were followed up for at least 5 years. RESULTS: Mean flexion contracture improved from 8.8° (0-40°) preoperatively to 0.4° (-5° to 15°) at final follow-up (P < 0.01), but there was no significant change in the mean angle of great flexion: 124.6° (75-150°) preoperatively and 126.2° (90-145°) at final follow-up (P = 0.488). Mean range of motion improved from 115.8° (35-150°) preoperatively to 125.5° (90-145°) at final follow-up (P < 0.01). Mean knee score improved from 38.7 points (0-66 points) preoperatively to 93.2 points (79-100 points) at final follow-up (P < 0.01), and mean functional score also improved from 50.4 points (10-70 points) preoperatively to 81.8 points (15-100 points) at final follow-up (P < 0.01). The mean postoperative Western Ontario and McMaster University osteoarthritis score was 19.5 points (0-66.0 points). The mean femorotibial angle was corrected from 9.0° varus (23.0° varus-6.3° valgus) preoperatively to 5.5° valgus (2.2° varus-11.1° valgus) at final follow-up (P < 0.01). There was no change in the mean ß-angle, which was 90.7° (87.2-94.9°) immediately postoperative and 90.8° (87.2-94.9°) at final follow-up (P = 0.748) and in the mean δ-angle, which was 86.2° (81.3-90.0°) immediately postoperative and 87.2° (83.1-96.5°) at final follow-up (P = 0.272). Radiolucent lines (RLL) were observed in ten cases (26.3%), and the mean RLL scores at final follow-up were 0.34 points (0-3 points) in the anteroposterior view and 0.42 points (0-6 points) in the lateral view. Scores for the RLL were ≤ 4 points in 36 cases, 5-9 points in two cases. Revision surgery due to aseptic loosening (three cases) is rarely required, and the Kaplan-Meier survival rate at 10 postoperative years was 96.4% CONCLUSION: When performing 5-mm metal block augmentation for a proximal tibial defect, no additional tibial stem extension can be a good surgical option for the stability of tibial prosthetic construct and mid-term clinical and radiologic results. LEVEL OF EVIDENCE: IV.

Asunto(s)

RESUMEN

BACKGROUND: To assess the feasibility and safety of tubeless video-assisted thoracoscopic sympathectomy (VATS) with a single 5 mm port under nonintubated, intravenous anesthesia with spontaneous ventilation in selected patients with primary palmar hyperhidrosis (PPH). METHODS: Adults (aged between 18 and 60 years) with moderate or severe PPH symptoms were enrolled. Demographic information and clinical data were obtained from 172 consecutive patients undergoing thoracoscopic surgery for PPH from March 2014 to December 2020. The primary outcomes were the rate of complications, including death, and the intraoperative conversion rate to 3-port VATS. The secondary outcomes were the conversion rate to intubated anesthesia during the operation and the surgical duration and pain score of postoperative day 0. RESULTS: In total, 172 patients were included with 88 males and 84 females. The median age was was 25 years (IQR:21-30 years). No mortalities or major morbidities occurred in any patient. The overall median surgical duration was 53 min (IQR:37-72 min). The median length of postoperative hospital stay was one day (IQR:one-one day). The median pain score of POD0 was 2 (IQR:2-2). Intraoperative conversion to 3-port VATS followed by drainage tube insertion occurred in one (0.6%) patient due to extensive pleural adhesions. No patients required conversion to intubated anesthesia during surgery. No postoperative mechanical ventilation was noted in any patient. CONCLUSIONS: For selected patients with PPH, tubeless VATS with a single 5 mm port using spontaneous ventilation anesthesia can be considered a feasible and safe operation. The surgical wound is extremely small and the operation time is shorter than the conventional technique. Trial registration This study was in conformity with the Declaration of Helsinki, and was approved by the National Ethics Committee of the University of the Hong Kong-Shenzhen Hospital (Approval number: [2020]70). We registered the study in the Chinese Clinical Trial Registry (Registration number: ChiCTR2100049063) in 2021.Informed consent was collected from all the participants of this study. URL for this clinical trial registration is: https://www.chictr.org.cn/index.aspx .

Asunto(s)

RESUMEN

@#Objective    To assess the feasibility and safety of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis. Methods    From March 1, 2018 to February 1, 2021, 90 patients with primary palmar hyperhidrosis who underwent ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy at the Thoracic Surgery Department of the University of Hong Kong-Shenzhen Hospital. There were 47 males and 43 females, with a median age of 26.0 (22.0, 31.0) years. During the operation, T3 and/or T4 thoracic sympathetic nerve chain was transected using an ultra-micro 5 mm single-port incision near the areola or under the axilla. The surgical data of the patients were retrospectively reviewed and analyzed. Results     All patients successfully completed the operation without major bleeding during the operation and no conversion to thoracotomy. There was no death or serious complication during the perioperative period. The operation time was 43.0 (23.0, 60.0) min, and the intraoperative blood loss was 2.0 (1.0, 2.0) mL. In the perioperative period, only one patient needed a tiny chest tube indwelling. The symptoms of hyperhidrosis on the hands all disappeared after the operation. The pain score on the postoperative day was 2.0 (2.0, 2.0) points. The hospital stay after surgery was 1.0 (1.0, 1.0) d. In the first month after the operation, the symptoms of hyperhidrosis on the hands were significantly relieved compared with those before the operation. The surgical incisions healed well, the wounds were concealed, and there was no wound infection or poor healing. The patients' satisfaction with the surgical incisions was 100.0%. After the operation, 14 (15.6%) patients had mild compensatory hyperhidrosis, 5 (5.6%) patients had moderate compensatory hyperhidrosis, and no patient had severe compensatory hyperhidrosis. Overall satisfaction rate was 94.0%. Conclusion     The clinical application of ultra-micro 5 mm single-port endoscopic thoracic sympathicotomy in selected patients with primary palmar hyperhidrosis is safe and feasible. The surgical wound is extremely small and hidden, the operation time is short, the pain is very slight, and the clinical outcome is good. It can fully meet the patients' pursuit of beauty.

RESUMEN

Previous studies have demonstrated safety and efficacy using 6.0 and 6.5 mm optical zones in the WaveLight EX500 Excimer Laser System but have not evaluated if differing optical zone sizes influence refractive outcomes. This study examines visual outcomes between two study populations undergoing LASIK with either a 6.0 mm (1332 patients) or 6.5 mm (1332 patients) optical zone. Outcomes were further stratified by severity of myopia (low, moderate, and high) and astigmatism (low and high). Patients were matched by age and preoperative manifest sphere and cylinder. Postoperative measurements were then compared. The 6.5 mm group demonstrated better postoperative manifest refractive spherical equivalent (MRSE), manifest sphere, and absolute value of the difference in actual and target spherical equivalent refraction (|∆ SEQ|), within the total population, moderate myopia, and low astigmatism groups, but this did not lead to improved postoperative uncorrected distance visual acuity (UDVA) or best corrected distance visual acuity (CDVA). Though astigmatic correction and postoperative angle of error were similar between optical zone sizes, they were significantly worse with high myopia. Overall, this study demonstrates differences in visual outcomes between the 6.0 and 6.5 mm optical zone sizes that may warrant consideration; however, essentially, the results are comparable between them.

RESUMEN

Introduction: The use of staples to perform intestinal anastomosis in children has gained popularity in the past years. The aim of this study is to evaluate the outcomes of pediatric patients who underwent intestinal anastomosis with a 5-mm staple in a tertiary health care center. Material and Methods: From April 2017 to November 2019, the records of all pediatric patients who underwent intestinal anastomosis with a 5-mm staple were retrospectively revised. The reconstruction technique was functional end-to-end anastomosis. Results: A total of 12 intestinal anastomoses were evaluated. Mean age at surgery was 120 days. Small bowel anastomosis was the most frequently performed procedure (eight cases). Stapling difficulties were found in 3 patients. The anastomosis could not be performed with the 5-mm endostapler in one of these patients. The median follow-up was 26 months (interquartile range 20-40 months). Postoperative complications included one bowel obstruction that was surgically treated. Conclusions: Mechanical suturing with 5-mm staple is a safe alternative technique to perform intestinal anastomosis in neonates and infants. The use of this staple has proven to be safe and feasible in pediatric patients. It is necessary to select patients carefully according to their bowel characteristics.

Asunto(s)

RESUMEN

Here, we report our experience with a 5-mm trocar site hernia (TSH) near a stoma. This is the first report describing the relationship between TSH and extraperitoneal colostomy. A 72-year-old man underwent laparoscopic abdominoperineal resection with extraperitoneal sigmoid colostomy and partial hepatectomy for rectal cancer accompanied by synchronous liver metastasis (pT3N1aM1a Stage IVA Union for International Cancer Control [UICC] 8th edition). The surgical procedures were completely performed without morbidity. After 1 year, he presented to our hospital with sudden nausea. Computed tomography (CT) revealed small bowel obstruction due to a 5-mm TSH, 1 cm from the stoma. The patient underwent laparoscopic hernia repair. The incidence of a 5-mm TSH is low. However, an abdominal wall vulnerability caused by the extensive exfoliation of the retroperitoneum due to the construction of the colostomy was observed, and the extraperitoneal colostomy influenced the onset of the 5-mm TSH. When the port and hernia sites are located in close proximity to each other, even a 5-mm trocar site may increase the incidence of TSH.

RESUMEN

Laparoscopically assisted anorectoplasty (LAARP) for recto-bulbar urethral fistula (RBUF) is not now a standard operation due to urethra injury risk and incomplete removal of fistula. Our approach is a novel and secure technique of trans-perineal transection using a 5-mm stapler for RBUF. Before performing LAARP, the orifice of RBUF was confirmed under flexible cystoscope inspection. Before transection of RBUF, the center of the muscle complex was detected at perineal skin. The muscle complex and the pubo-rectal sling were then also confirmed with electrical nerve stimulator under laparoscopic approach. A 5-mm trocar was inserted to pass through the center of the muscle complex from perineal incision of the neo-anus. RBUF was stapled and transected using a 5-mm stapler inserted from the neo-anus. The operator successfully confirmed complete adequate closure of RBUF under flexible cystoscope inspection. A 5-mm stapler was effective and useful for the transection of RBUF.

Asunto(s)

RESUMEN

Laparoscopic choledochal cyst excision and hepaticojejunostomy for choledochal in children is performed only at particular institutions because of the technical difficulty. Although choledochal cyst excision and hepaticojejunostomy are feasible, the small working space of infants makes intraabdominal Roux-Y reconstruction technically challenging. A 2-month-old girl diagnosed with a choledochal cyst underwent complete laparoscopic choledochal cyst excision and hepaticojejunostomy, including intraabdominal Roux-Y reconstruction with a 5-mm stapler. After cyst excision, Roux-Y reconstruction was performed in the intraabdominal cavity. Jejunojejunostomy was performed in a side-to-side fashion using a 5-mm stapler, and the entry hole was closed laparoscopically by hand-sewing, along with the mesentery defect. All procedures were performed by laparoscopic surgery. The postoperative course was uneventful, and the patient showed a quick recovery. Using small-diameter instruments, completely laparoscopic procedures for choledochal cyst are feasible.

Asunto(s)

RESUMEN

When we are practicing, especially in rural India, we often face problems of instrument failure or lost instrument, etc... which may sometimes necessitate abandoning the procedure just because of the lack of a single instrument. We do mobile laparoscopic surgery, carrying all the laparoscopic instruments to far-off places, as far as 60-80 km. On one such occasion, my staff had lost a 5-mm trocar, which had gone unnoticed until I posted a case for laparoscopic cholecystectomy. There was not much time to buy a new one and also it was difficult to procure from the dealer because of the COVID-19 situation. Just because of the lack of one instrument we were facing a situation of postponing laparoscopy!

RESUMEN

Purpose Our study reports the clinical outcomes of patients treated with 5-mm isotropic margin, fiducial-guided stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC). We also sought to assess the effect of histological subtype on local control. Methods We retrospectively reviewed the charts of all patients treated with SBRT for NSCLC between 2007 and 2017 at our institution. All patients who had implanted fiducial markers, planning target volume (PTV) margins of 5 mm or less, early stage disease (T1-T2, N0), and at least one follow-up CT were included in this analysis. Estimates of local control were generated using the Kaplan-Meier method, and differences between survival curves were assessed using the log-rank test. Results A total of 152 patients met the inclusion criteria for this analysis, with a median follow-up of 27.9 months. Patients received 54 Gy in three fractions for peripheral tumors and 48-52.5 Gy in four to five fractions for central tumors. NSCLC histology was adenocarcinoma in 69 (45.4%) cases, squamous cell carcinoma in 65 (42.8%) cases, and other or non-subtyped in 18 (11.8%) cases. Across the entire cohort, the two-year estimate of local control was 95.1%. When histology was considered, the two-year estimate of local control among patients with adenocarcinoma was 95.6% as compared with 85.0% for patients with other subtypes (p=0.044). Conclusions Fiducial-guided, isotropic 5-mm PTV margin for thoracic SBRT did not compromise local control compared with historical standards. In this series, patients with adenocarcinoma experienced improved local control compared with squamous cell carcinoma.

RESUMEN

Objectives: To clarify the natural history of asymptomatic renal stones ≤5 mm in comparison with stones ≥5 mm. Calculi ≤5 mm are considered insignificant stones, but to what extent stone-related events can occur is unclear. Patients and Methods: In this retrospective study, 207 patients with asymptomatic renal stones confirmed by both CT and ultrasonography performed on the same day were enrolled. A follow-up ultrasound was performed every 6 months. The active indications for surgical intervention included stone relocations into the ureter and stone-related symptoms. The primary endpoint was the rate of surgical intervention. Results: A total of 207 patients (71 cases with stones ≤5 mm and 136 cases with stones >5 mm) were included in this study. At a median follow-up of 3.3 years, 14 patients (20%) from the ≤5-mm group and 52 (38%) from the >5-mm group underwent surgical treatment (p = 0.0067). Moreover, 11 patients (16%) from the ≤5-mm group and 27 (20%) from the >5-mm group received surgical intervention as they manifested active indications, showing no significant difference (p = 0.44). As regards stone events, there were no significant differences in spontaneous stone passage, pain, hematuria, and stone growth. Multivariate analysis revealed that age ≤50 years and a history of stone surgery were significant factors, but stone size was not. Conclusion: About 20% of asymptomatic renal stones ≤5 mm require surgical treatment within 5 years.

Asunto(s)