RESUMEN
BACKGROUND: Skin-sparing (SSM) and nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) have significantly increased. There is limited information on complications of IBR in patients with prior cosmetic breast surgery (CBS). We compare IBR outcomes in patients undergoing SSM and/or NSM with and without prior CBS. MATERIALS AND METHODS: Patients undergoing mastectomy from January 1, 2017 to December 31, 2019 were selected. Patient characteristics, surgical approach, and complications were compared between mastectomy and IBR cases for breasts with and without prior CBS. Binary logistic regression analysis was performed to identify predictors of complications and reconstruction loss. RESULTS: 956 mastectomies were performed in 697 patients, with IBR performed for 545 mastectomies in 356 patients. Median age was 51 (range 19-83), 45.8% of patients were age < 50, 62.6% of mastectomies were performed for breast cancer. 95 mastectomies (17.4%) were performed in breasts with prior CBS and 450 (82.6%) without. NSM was more frequently utilized for breasts with prior CBS (P < .001). Complications occurred in 80 mastectomies (14.7%); reconstruction loss in 30 (5.5%). On multivariable analysis, age ≥ 50 (OR 1.76, 95%CI 1.01-3.09, P = .047) and NSM (OR 2.11, 95%CI 1.17-3.79, P = .013) were associated with an increased risk of any complication. Prior CBS was not associated with an increased risk of complications (OR 1.11, 95%CI 0.58-2.14, P = .743) or reconstruction loss (OR 1.32, 95%CI 0.51-3.38, P = .567). CONCLUSION: In this analysis of mastectomy and IBR, prior CBS was not associated with an increased risk of complications or reconstruction loss. In patients with prior CBS undergoing mastectomy, IBR may be safely performed.
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Neoplasias de la Mama/cirugía , Mamoplastia/psicología , Mastectomía Subcutánea/psicología , Pezones/cirugía , Tratamientos Conservadores del Órgano/psicología , Adulto , Anciano de 80 o más Años , Neoplasias de la Mama/psicología , Femenino , Humanos , Mamoplastia/métodos , Mastectomía Subcutánea/métodos , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Satisfacción del Paciente , Estudios Retrospectivos , Adulto JovenRESUMEN
With delayed childbearing in women, preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma (EOC). Fertility-sparing surgery (FSS) can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life. In order to evaluate oncological safety, attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS, this multicenter retrospective study was conducted. Between January 2005 and December 2014, total of 87 young women with FIGO stage I EOC were included, with their clinicopathologic parameters in relation to disease-free survival (DFS) and overall survival (OS) assessed. Attitudes toward childbearing, ovarian function and fertility were studied in women undergoing FSS (n=36). As a result, in contrast to radical surgery, FSS did not affect prognosis by Kaplan-Meier curves (log-rank test; DFS: P=0.484; OS: P=0.125). However, two of the three recurrence cases and both death cases were in FSS group stage IC. All women undergoing FSS resumed regular menstrual periods after chemotherapy. Only 16 (44.44%) had tried to conceive, and 17 pregnancies occurred in 15 (93.75%) women. Among 20 women who did not attempt conception, the most common reason was not being married (70%), followed by already having children (15%). In summary, FSS is considered safe in young women with stage IA EOC. Regular menstruation and good obstetric outcomes can be achieved. This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.
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Carcinoma Epitelial de Ovario/cirugía , Preservación de la Fertilidad/métodos , Neoplasias Ováricas/cirugía , Ovariectomía/métodos , Adolescente , Adulto , Carcinoma Epitelial de Ovario/psicología , Femenino , Preservación de la Fertilidad/psicología , Humanos , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Neoplasias Ováricas/psicología , Ovariectomía/psicología , Embarazo , Índice de Embarazo , Pronóstico , Calidad de Vida/psicología , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
Lower extremity amputation as a treatment of diabetic foot ulcer is probably a major burden for the patient's family and friends, who typically act as caregivers and support the patient in coping with the physical disabilities and emotional distress. In the present prospective study, we investigated the effects of different lower extremity amputation levels for diabetic foot ulcer treatment on caregivers of patients with diabetes using the Zarit Burden Interview (ZBI-12) scale. Patients with diabetic foot ulcers who underwent unilateral major amputation (above-below knee) and minor amputation of foot (heel sparing) and their caregivers were requested to volunteer to participate in this study from June 2016 to December 2018. The ZBI-12 form was completed immediately preoperatively and 3 and 6 months after postoperatively. In the minor amputation group, the mean age of the 51 patients was 72.1 years. In the major amputation group, the mean age of the 88 patients was 73.7 years. Both groups of caregivers of patients with minor amputation and major amputations showed a significant improvement in ZBI-12 score when compared preoperatively and at 3- and 6-month follow-up visits. The mean ZBI-12 score was significantly higher in the major than in the minor amputation group in preoperative and all postoperative visits. The absence of the ankle joint in the below- or above-knee amputation renders it more difficult for the amputee to quickly learn the use of prosthesis, thereby increasing the burden of the patient and caregivers. We found that lower extremity amputation for the treatment of chronic diabetic foot ulcers has significantly favourable effect on the caregiver burden, and thereby heel sparing was considerably more effective for the caregiver burden.
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Amputación Quirúrgica/psicología , Amputación Quirúrgica/rehabilitación , Amputación Quirúrgica/estadística & datos numéricos , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Pie Diabético/cirugía , Familia/psicología , Tratamientos Conservadores del Órgano/psicología , Adaptación Psicológica , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Diabetes Mellitus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estrés Psicológico , TurquíaAsunto(s)
Neoplasias de la Mama/cirugía , Mastectomía/métodos , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Neoplasias de la Mama/patología , Neoplasias de la Mama/psicología , Femenino , Humanos , Mastectomía/psicología , Tratamientos Conservadores del Órgano/psicología , Satisfacción del PacienteRESUMEN
BACKGROUND: Nipple-sparing mastectomies (NSMs) with reconstruction are believed to be more difficult to perform than skin-sparing mastectomies (SSMs), but there is little quantitative data to support this claim. METHODS: This prospective study analyzed four surgeons performing mastectomies. Electromyography (EMG) electrodes placed on selected muscle groups on each surgeon were used to capture muscle exertion intraoperatively and a percentage of maximum voluntary exertion was calculated (%MVE). Data regarding surgeon demographics, exercise habits, musculoskeletal problems, and surgery-specific workload was collected using a questionnaire. RESULTS: A total of 61 mastectomies were analyzed; 40 were NSM and 21 were SSM/total mastectomies. NSM were considered to be more mentally demanding and physically demanding than SSM (p < 0.001). When the surgeons' EMG data was analyzed as a group, there was a statistically significant difference in %MVE for NSM versus SSM at high muscle activity in bilateral anterior deltoid muscle groups and at average muscle activity for the left anterior deltoid muscle only. At low muscle activity, there was a statistically significant increase in activation for SSM versus NSM in bilateral cervical erector spinae. Repeated measures ANOVA was performed, which showed statistically significant differences at high muscle activity between NSM and SSM in the left cervical erector spinae and bilateral anterior deltoid muscles. CONCLUSIONS: Our pilot study shows that intraoperative EMGs can assess muscle activity for mastectomy operations and show a difference between NSM and SSM. This is the first study to provide quantitative data on muscle strain with NSM.
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Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Ergonomía , Mastectomía/psicología , Tratamientos Conservadores del Órgano/psicología , Cirujanos/estadística & datos numéricos , Neoplasias de la Mama/patología , Femenino , Estudios de Seguimiento , Humanos , Mastectomía/métodos , Persona de Mediana Edad , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Proyectos Piloto , Pronóstico , Estudios ProspectivosRESUMEN
BACKGROUND: In choosing between implant-based and autologous breast reconstruction, surgeons and patients must weigh relative risks and benefits. However, differences in outcomes across procedure types may vary between unilateral versus bilateral reconstructions. Procedure-related differences in complications and patient-reported outcomes were evaluated for unilateral and bilateral reconstruction. METHODS: Complications and patient-reported outcomes (BREAST-Q and Patient-Reported Outcomes measurement Information System surveys) were assessed at 2 years for patients undergoing autologous or implant-based reconstructions. Stratified regression models compared outcomes between autologous and implant-based reconstructions, separately for unilateral and bilateral cohorts. RESULTS: Among 2125 patients, 917 underwent unilateral (600 implant and 317 autologous) and 1208 underwent bilateral (994 implant and 214 autologous) reconstructions. Complication rates were significantly higher in the autologous versus implant-based group for both unilateral (overall: OR, 2.50, p < 0.001; major: OR, 2.19, p = 0.001) and bilateral (overall: OR, 2.13, p < 0.001; major: OR, 1.69, p = 0.014) cohorts. In unilateral reconstruction, the autologous group demonstrated significantly better patient-reported outcomes versus implant-based group in satisfaction with breast (mean difference, 9.85; p < 0.001), psychosocial well-being (mean difference, 4.84; p = 0.006), and sexual well-being (mean difference, 11.42; p < 0.001). In bilateral reconstruction, the autologous group demonstrated significantly higher patient-reported outcomes only for satisfaction with breast (mean difference, 5.13; p = 0.001). CONCLUSIONS: Although autologous reconstruction is associated with significantly better patient-reported outcomes compared to implant-based techniques in unilateral reconstruction, procedure choice has far less impact in bilateral reconstruction. Autologous procedures have higher complications rates in both unilateral and bilateral settings. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
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Mamoplastia/métodos , Colgajos Quirúrgicos , Autoinjertos , Implantes de Mama/efectos adversos , Implantes de Mama/psicología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Toma de Decisiones Clínicas , Femenino , Humanos , Mamoplastia/efectos adversos , Mamoplastia/psicología , Mastectomía/efectos adversos , Mastectomía/métodos , Mastectomía/psicología , Persona de Mediana Edad , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Medición de Resultados Informados por el Paciente , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Resultado del Tratamiento , Estados UnidosRESUMEN
INTRODUCTION AND HYPOTHESIS: The aim of this study was to compare preferences of patients with pelvic organ prolapse (POP) regarding their uterus between German- and Russian-speaking areas. METHODS: Six urogynecologic tertiary referral centers participated in this prospective study: three centers from German-speaking countries and three from different regions of Russia. To assess the uterus-related preferences as well as the attitude toward hysterectomy versus uterus-sparing prolapse surgery, we developed a structured questionnaire that included 5-point Likert scales related to benefit of uterus (BOU) and benefit of not having uterus (BNU). Each scale consisted of 12 items (range of possible scores: 12-60). Finally, patients were asked if they preferred uterus removal or preservation when undergoing prolapse surgery. RESULTS: One hundred and seventy-eight German-speaking and 206 Russian-speaking patients were included in the study. There was no significant difference in patients' preference before undergoing POP surgery regarding uterus preservation versus hysterectomy between German- and Russian-speaking patients: 40% of German-speaking and 54% of Russian-speaking patients preferred to retain their uterus before undergoing POP surgery. Comparison of BOU mean scores showed a significant difference between groups: 20.6 ± 6.7 for German-speaking compared with 32.5 ± 9.1 for Russian-speaking patients (p < 0.01). The Russian-speaking group had significantly higher mean scores on domains sexuality, body image, and partnership of the BOU scale (2.6 ± 1.0 vs. 1.8 ± 0.9 for sexuality; 2.4 ± 1.1 vs. 1.5 ± 0.7 for body image, and 2.6 ± 0.9 vs. 1.6 ± 0.7 for partnership domains; p < 0.05). CONCLUSIONS: Although a large proportion of German- and Russian-speaking patients prefers uterus preservation when undergoing prolapse surgery, the uterus was more important for sexuality, partnership, and body image in Russian-speaking patients.
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Actitud Frente a la Salud/etnología , Histerectomía/psicología , Tratamientos Conservadores del Órgano/psicología , Prioridad del Paciente , Prolapso de Órgano Pélvico/psicología , Adulto , Imagen Corporal/psicología , Comparación Transcultural , Femenino , Alemania , Humanos , Lenguaje , Persona de Mediana Edad , Prolapso de Órgano Pélvico/cirugía , Estudios Prospectivos , Federación de Rusia , Conducta Sexual/psicología , Encuestas y Cuestionarios , Útero/cirugíaRESUMEN
Nipple- and areola-sparing mastectomy is a novel surgical approach that preserves the nipple-areolar complex. Patients with moderate and/or severe breast ptosis are usually not eligible for this surgical approach. In this study, we aimed to demonstrate the feasibility of nonconventional surgical approaches for nipple-sparing mastectomy. One hundred consecutive patients diagnosed with primary breast cancer (BC) were enrolled in this study. Clinical and pathological data such as body mass index, smoking status, breast ptosis, complications, and aesthetic satisfaction (Breast-Q test) were collected. According to different types of breast ptosis, surgical procedures were classified as (a) hemi-periareolar, (b) round block, (c) vertical pattern, and (d) wise pattern skin incisions. We performed statistical analysis to assess the correlation with complications, degree of ptosis, and breast-Q scores. Among the 117 surgical procedures performed in 100 patients with BC, no significant associations are verified considering clinical and pathological data, complications, pre- and postsurgery satisfactions, and other parameters. Different surgical approaches represent the evolution of "classic" nipple-sparing mastectomy, thus meeting the cosmetic and oncological results. These procedures are safe and also indicated in cases conventionally considered as not eligible for nipple-areola preservation.
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Neoplasias de la Mama/cirugía , Mastectomía/métodos , Pezones/cirugía , Tratamientos Conservadores del Órgano/métodos , Adulto , Anciano , Implantación de Mama/métodos , Implantes de Mama , Neoplasias de la Mama/psicología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/métodos , Mamoplastia/psicología , Mastectomía/psicología , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/psicología , Satisfacción del Paciente , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The effect on quality of life (QOL) of laryngectomy and organ preservation protocols is important in decision making. The aim of this cross-sectional study was to evaluate QOL outcomes of patients with advanced laryngeal tumors who were treated with laryngectomy or organ preservation protocols in Latin America. A total of 35 patients from three oncology units were enrolled. Patients with stage III/IV laryngeal cancer who were treated using organ preservation protocols or laryngectomy were assessed with the University of Washington QOL Questionnaire. The most important domains that affected QOL for both groups were speech and activity. In the laryngectomy group, the next most important domains were appearance, taste, pain, and recreation, whereas in the organ preservation group, they were saliva, recreation, mood, and swallowing. There were no statistically or clinically significant differences in the global score or the 7 days of QOL assessments before patients were interviewed. Global QOL assessments were similar when comparing laryngectomy and organ preservation protocols.
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Neoplasias Laríngeas/psicología , Laringectomía/psicología , Tratamientos Conservadores del Órgano/psicología , Calidad de Vida , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Neoplasias Laríngeas/terapia , Laringectomía/métodos , América Latina , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
BACKGROUND: Psychological stress of patients with penile cancer arises from the cancer diagnosis itself and the treatment consequences. In addition, there is cancer-specific distress. There is the chance of cure in localized stages and in those with limited regional lymph node metastases but this requires surgery and often adjuvant chemotherapy. This systematic review gives a summary of the existing literature to date. MATERIALS AND METHODS: A critical database search using Medline was made in Ovid from 1946 to 2017, in the Cochrane Central Register of Controlled Trials (CENTRAL) and in the Web of Science from 1900 to 2017. This was complemented by a search of the World Health Organization's International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov. The reference lists of the included studies were manually searched for additional references. RESULTS: Selected studies (nâ¯= 10) addressed the psychosocial effects of penile cancer treatment on quality of life and sexual function. Due to the heterogeneity of the study designs only a narrative description of the results was possible. Defects or mutilation due to penile cancer cause psychological distress in a significant number of patients. Organ-sparing interventions have a positive impact on quality of life and sexual function. CONCLUSION: The external genitals are a focus of sexual identity. Mutilating treatment causes significant distress but organ-sparing treatment and reconstruction positively influence quality of life.
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Neoplasias del Pene/psicología , Calidad de Vida/psicología , Rol del Enfermo , Adaptación Psicológica , Quimioterapia Adyuvante , Terapia Combinada , Progresión de la Enfermedad , Humanos , Metástasis Linfática/diagnóstico , Metástasis Linfática/patología , Masculino , Estadificación de Neoplasias/psicología , Tratamientos Conservadores del Órgano/psicología , Orgasmo , Neoplasias del Pene/diagnóstico , Neoplasias del Pene/patología , Neoplasias del Pene/terapia , Pene/patología , Pene/cirugía , Procedimientos de Cirugía Plástica/psicología , Resultado del TratamientoRESUMEN
BACKGROUND: Results from population-based studies and the Prostate Testing for Cancer and Treatment trial reported worse urinary continence (UC) and erectile function (EF) for radical prostatectomy (RP) patients compared with their radiation or active surveillance counterparts. OBJECTIVE: To investigate functional outcomes for patients undergoing RP in a high-volume center. DATA, SETTING, AND PARTICIPANTS: A total of 8573 consecutive RP patients (2008-2012) were analyzed. INTERVENTION: RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Standardized questionnaires assessing EF, UC, and quality of life (QoL), were completed at baseline and annually thereafter. UC was defined as use of 0 or 1 safety pad/d, whereas the regular use of 1 pad/d was considered incontinent. EF was defined as ≥3 points in the International Index of Erectile Function question two. QoL was assessed using the EORTC-QLQ-C30 Global Health/QoL item. Statistics relied on comparison of means and proportions. RESULTS AND LIMITATIONS: EF and UC rates significantly decreased after RP. Overall, 12-mo, 24-mo, and 36-mo EF rates were 45%, 51%, and 53%, but reached up to 65.7% in preoperatively potent patients with bilateral nerve sparing. At 36 mo, 13% reported problems in their partnership. However, at the same time point, 77% were satisfied with their sexual intercourse. UC rates were 89.1%, 91.3%, and 89.0% at 12-mo, 24-mo, and 36-mo postoperatively. Mean EORTC-QLQ-C30 scores ranged from 74 to 79 and remained constant compared to baseline. CONCLUSIONS: Although varying definitions hinder direct comparisons to other studies, functional outcomes seemed favorable for patients undergoing RP in a high-volume center and most patients reported excellent QoL. PATIENT SUMMARY: Results of functional outcomes (urinary continence and potency) after radical prostatectomy are better in a high-volume center compared with those obtained from population-based data, and most patients report excellent quality of life after radical prostatectomy.
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Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Calidad de Vida , Anciano , Coito/psicología , Disfunción Eréctil/etiología , Humanos , Relaciones Interpersonales , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Medición de Resultados Informados por el Paciente , Erección Peniana/psicología , Complicaciones Posoperatorias/etiología , Prostatectomía/psicología , Neoplasias de la Próstata/psicología , Parejas Sexuales/psicología , Centros de Atención Terciaria , Traumatismos del Sistema Nervioso/prevención & control , Resultado del Tratamiento , Incontinencia Urinaria/etiologíaRESUMEN
OBJECTIVE: This study aims to evaluate local control and intermediate-term cosmetic outcome in patients with cancer of the nose treated with intensity-modulated radiotherapy (IMRT). METHODS: From June 2008 to September 2015, 36 consecutive patients presenting with nasal cavity, ala of the nose, or nasal vestibule tumors were treated at the Department of Radiation Oncology, University Hospital Zurich either postoperatively (n = 14; 3/14 with nasal ablation) or with definitive IMRT (n = 22). Of these 36 patients, 8 presented with recurrent disease after surgery only and 1/36 with N1 disease. Concurrent systemic therapy was administered in 18/36 patients (50%). Nasal follow-up (FU) imaging documentation of 13 patients with preserved organ and >6 months FU offers a pre/post IMRT FU comparison. In addition, these patients' subjective evaluation of cosmesis was assessed. RESULTS: Mean/median FU was 41/33 months (range 5-92 months). Salvage ablation with curative intent was undergone by 3 patients with local relapse after definitive (n = 2) and postoperative (n = 1) IMRT. The 3year local control, ultimate local control, and overall survival rates were 90, 97, and 90 %, respectively. Subjective and objective cosmetic outcome after IMRT is very satisfying so far. CONCLUSION: IMRT for nasal tumors was found to be effective and well tolerated. Intermediate-term cosmetic results are good. Radical surgical procedures may be saved for curative salvage treatment.
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Neoplasias Nasales/psicología , Neoplasias Nasales/radioterapia , Tratamientos Conservadores del Órgano/métodos , Satisfacción del Paciente , Radioterapia Conformacional/métodos , Radioterapia Conformacional/psicología , Adulto , Anciano , Anciano de 80 o más Años , Técnicas Cosméticas/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Neoplasias Nasales/diagnóstico , Tratamientos Conservadores del Órgano/psicología , Terapia Recuperativa/métodos , Resultado del TratamientoAsunto(s)
Canal Anal/cirugía , Colectomía , Colitis , Enfermedad de Crohn , Tratamientos Conservadores del Órgano , Calidad de Vida , Toma de Decisiones Clínicas , Colectomía/efectos adversos , Colectomía/métodos , Colectomía/psicología , Colitis/patología , Colitis/psicología , Colitis/cirugía , Enfermedad de Crohn/patología , Enfermedad de Crohn/psicología , Enfermedad de Crohn/cirugía , Humanos , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Selección de Paciente , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Total abdominal colectomy with ileorectal anastomosis for Crohn's colitis is acceptable in the presence of a suitable rectum. Intentional IPAA has been proposed for diffuse Crohn's proctocolitis without enteric or anoperineal disease. OBJECTIVE: The aim of this study was to evaluate the long-term outcomes of sphincter-saving procedures for large-bowel Crohn's disease. DESIGN: Patients with preoperative Crohn's disease diagnosis undergoing intentional IPAA and ileorectal anastomosis were included. SETTINGS: The study was conducted at a tertiary care research center. PATIENTS: Ileorectal anastomosis was performed in 75 patients with Crohn's disease, whereas 32 patients underwent intentional IPAA. MAIN OUTCOME MEASURES: Long-term functional results and permanent stoma requirement of sphincter-saving operations were assessed. Quality of life and postoperative medication use were also compared with a control group of patients undergoing total proctocolectomy and end ileostomy. RESULTS: Patients undergoing ileorectal anastomosis were older and had longer disease duration, higher prevalence of perianal and penetrating disease, and history of small-bowel resection than those receiving IPAA. Indications for surgery, preoperative use of immunomodulators, and postoperative use of biologics were also significantly different. Although functional defecatory outcomes were comparable, reported quality of life 3 years after surgery was significantly better in patients who underwent IPAA than in patients with ileorectal anastomosis. Patients with IPAA were associated with significantly lower cumulative rates of surgical recurrence (HR = 0.28 (95% CI, 0.09-0.84); p = 0.017), indefinite stoma diversion (HR = 0.35 (95% CI, 0.13-0.99); p = 0.039), and proctectomy with end ileostomy (HR = 0.27 (95% CI, 0.07-0.96); p = 0.030) than those with ileorectal anastomosis. LIMITATIONS: The study was limited by its retrospective nature and small sample size. CONCLUSIONS: Contemporary patients selected to have intentional IPAA for Crohn's colitis have disease characteristics very different from those selected to have ileorectal anastomosis. Long-term follow-up confirms intentional IPAA as an acceptable option in selected patients with Crohn's colitis.
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Canal Anal/cirugía , Colectomía , Colitis , Enfermedad de Crohn , Ileostomía , Efectos Adversos a Largo Plazo , Tratamientos Conservadores del Órgano , Calidad de Vida , Adulto , Factores de Edad , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/psicología , Colectomía/efectos adversos , Colectomía/métodos , Colectomía/psicología , Colitis/epidemiología , Colitis/patología , Colitis/cirugía , Comorbilidad , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/patología , Enfermedad de Crohn/cirugía , Femenino , Humanos , Ileostomía/efectos adversos , Ileostomía/métodos , Ileostomía/psicología , Efectos Adversos a Largo Plazo/epidemiología , Efectos Adversos a Largo Plazo/etiología , Efectos Adversos a Largo Plazo/fisiopatología , Efectos Adversos a Largo Plazo/psicología , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Selección de Paciente , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Estados Unidos/epidemiologíaAsunto(s)
Procedimientos Quirúrgicos Ginecológicos/efectos adversos , Tratamientos Conservadores del Órgano , Prolapso de Órgano Pélvico/cirugía , Mallas Quirúrgicas/efectos adversos , Factores de Edad , Femenino , Humanos , Tratamientos Conservadores del Órgano/psicología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Riesgo , Prevención SecundariaRESUMEN
The objective of the present study was to increase the efficiency of the treatment of the patients presenting with laryngeal cancer by the enhancement of the functional reserve of the preserved portion of the larynx and the prevention of the narrowing of its lumen. Another objective was to develop an algorithm for the rehabilitation of the patients with laryngeal localization of the tumour following open functionally sparing operations that consists of the operative and postoperative stages. During the period from 2006 to 2014, a total of 71 patients underwent functionally sparing operations. 66 of them were operated for laryngeal cancer, 1 for thyroid cancer spreading over trachea and larynx, 3 for papillomatosis. Resection of the larynx in the vertical and horizontal planes was performed in 62 and 9 patients respectively. Vertical plane surgery included the following procedures: fronto-lateral resection of the larynx in 51 patients, extended fronto-lateral resection in 10, and combined resection in 1 patient. It is concluded that the systemic approach to the treatment of the patients with laryngeal cancer and the proposed algorithm for their rehabilitation made it possible to restore the laryngeal function in 68 of the 71 patients (95.8%).
Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias Laríngeas/cirugía , Laringectomía , Laringoestenosis , Laringe , Tratamientos Conservadores del Órgano , Complicaciones Posoperatorias/prevención & control , Algoritmos , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/fisiopatología , Femenino , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/fisiopatología , Laringectomía/efectos adversos , Laringectomía/métodos , Laringectomía/rehabilitación , Laringoestenosis/etiología , Laringoestenosis/prevención & control , Laringe/patología , Laringe/cirugía , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/psicología , Recuperación de la Función , Resultado del TratamientoRESUMEN
For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
Asunto(s)
Colectomía/psicología , Tratamientos Conservadores del Órgano/psicología , Estomía/psicología , Calidad de Vida , Neoplasias del Recto/psicología , Neoplasias del Recto/cirugía , Canal Anal , Colectomía/métodos , Humanos , Estomía/métodos , Prioridad del PacienteRESUMEN
This retrospective analysis focusses on the impact of therapy on perceived long-term post-cancer treatment function. A validated questionnaire including items and components for the assessment of communicative ability, quality of voice and swallowing was sent to 129 patients. All patients were treated between 1998 and 2007. A total of 76 patients (58.9%) with carcinoma of the larynx or hypopharynx replied to the questionnaire. Data was evaluated retrospectively. Therapy delivered was definitive radio(chemo)therapy (defchRT/RT) (21/76, 28%), laryngectomy + radio(chemo)therapy (LE + chRT/RT) (28/76, 37%), or larynx conservation surgery + radio(chemo)therapy (LCS + chRT/RT) (27/76, 36%). Radiotherapy was administered using 2D- or 3D-conformal planning. The most common concomitant chemotherapy delivered was cisplatin + 5FU. For statistical analyses of the components, averages were calculated and tested using the Kruskal-Wallis test and the U-test of Mann and Whitney. Differences were assessed by the Monte Carlo method or Fisher's exact test. The single item rates were compared with Fisher's exact test. Mean follow-up was 56.7 months (range, 8-130 months). After defchRT/RT, patients trended towards more substantial-strong hoarseness compared with LCS + chRT/RT (P = 0.2). After LE, patients were dissatisfied with their artificial larynx/electrolarynx and the tone of their voice (P = 0.3, P = 0.07) and communicative ability (P = 0.005, P = 0.008) compared with those treated with defchRT/RT and LCS + chRT/RT, respectively. Dysphagia and additional percutaneous endoscopic gastrostomy (PEG) feeding were more frequent after defchRT/RT in comparison with the other two groups (P < 0.05). Voice quality and communicative ability were slightly worse after defchRT/RT and LE + chRT/RT, but satisfying with all treatment modalities. Further development of the therapy approach is necessary to reduce long-term side effects, with measures of post-treatment function as important endpoints.
Asunto(s)
Quimioradioterapia/efectos adversos , Trastornos de Deglución/etiología , Ronquera/etiología , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/terapia , Laringectomía , Adulto , Anciano , Terapia Combinada/métodos , Deglución , Trastornos de Deglución/psicología , Femenino , Ronquera/psicología , Humanos , Neoplasias Hipofaríngeas/psicología , Neoplasias Laríngeas/psicología , Laringe/efectos de la radiación , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Satisfacción del Paciente , Traumatismos por Radiación/etiología , Traumatismos por Radiación/psicología , Estudios Retrospectivos , Resultado del Tratamiento , Calidad de la VozRESUMEN
Increasing emphasis is being placed on low mastectomy rates. Our objective was to investigate factors influencing rates of mastectomy and breast conserving surgery. A group of 171 patients (27%) who could have had breast conserving surgery (BCS) but chose mastectomy was identified as well as all patients who underwent BCS over a 6 year period. A questionnaire asking patient's attitudes to factors which could influence their choice of operation was compiled and sent to this study group. Results showed surgical advice to be the most important factor, with significantly more influence in BCS patients. No significant difference was found in distance to treatment between the groups. Shorter duration radiotherapy would have made 47% of mastectomy patients more likely to accept BCS. BCS rates are a poor measure of quality of patient care. More emphasis should be put on choices offered to patients rather than overall uptake of a specific choice.
Asunto(s)
Neoplasias de la Mama , Conducta de Elección , Consejo Dirigido , Mastectomía , Tratamientos Conservadores del Órgano , Radioterapia Adyuvante/psicología , Adulto , Actitud Frente a la Salud , Australia/epidemiología , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/psicología , Neoplasias de la Mama/cirugía , Consejo Dirigido/métodos , Consejo Dirigido/normas , Consejo Dirigido/estadística & datos numéricos , Determinación de la Elegibilidad , Femenino , Humanos , Mastectomía/métodos , Mastectomía/psicología , Mastectomía/estadística & datos numéricos , Persona de Mediana Edad , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/psicología , Tratamientos Conservadores del Órgano/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Selección de Paciente , Mejoramiento de la Calidad , Radioterapia Adyuvante/métodos , Encuestas y CuestionariosRESUMEN
OBJECTIVE: The purpose of this study was to describe patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse symptoms and to describe predictors of preference for uterine preservation. STUDY DESIGN: This multicenter, cross-sectional study evaluated patient preferences for uterine preservation vs hysterectomy in women with prolapse symptoms who were being examined for initial urogynecologic evaluation. Before meeting the physician, the women completed a questionnaire that asked them to indicate their prolapse treatment preference (uterine preservation vs hysterectomy) for scenarios in which the efficacy of treatment varied. Patient characteristics that were associated with preferences were determined, and predictors for uterine preservation preference were identified with multivariable logistic regression. RESULTS: Two hundred thirteen women participated. Assuming outcomes were equal between hysterectomy and uterine preservation, 36% of the women preferred uterine preservation; 20% of the women preferred hysterectomy, and 44% of the women had no strong preference. If uterine preservation was superior, 46% of the women preferred uterine preservation, and 11% of the women preferred hysterectomy. If hysterectomy was superior, 21% of the women still preferred uterine preservation, despite inferior efficacy. On multivariable logistic regression, women in the South had decreased odds of preferring uterine preservation compared with women in the Northeast (odds ratio [OR], 0.17; 95% CI, 0.05-0.66). Women with at least some college education (OR, 2.87; 95% CI, 1.08-7.62) and those who believed that the uterus is important for their sense of self (OR, 28.2; 95% CI, 5.00-158.7) had increased odds for preferring uterine preservation. CONCLUSION: A higher proportion of women with prolapse symptoms who were examined for urogynecologic evaluation preferred uterine preservation, compared with hysterectomy. Geographic region, education level, and belief that the uterus is important for a sense of self were predictors of preference for uterine preservation.