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Purpose: This study analyzes levels of social participation in patients with breast cancer on average 5 years following primary surgery as compared to women in the general population. In addition, the role of breast cancer-related complaints and medical data as possible influencing factors on levels of patients’ social participation is investigated. Methods: A total of n = 454 patients after primary surgery (t0) were recruited for a third follow-up study, and n = 372 completed this survey (t3), corresponding to a response rate of 82.2%. For measuring breast cancer-related complaints, participants completed a written questionnaire. Social participation was measured by a questionnaire on different leisure activities that was taken from the Socio-Economic Panel Study. Medical information was extracted from medical reports at t0. A principal component analysis was carried out to identify different dimensions of social participation. Chi2-tests and logistic regression analyses were applied to analyze social participation as compared to the general population and the role of possible medical and diagnosis-related influencing factors thereby. Results: Compared to the general population, patients show lower levels of social participation in the domains “socio-cultural participation” and “participation in institutions,” while no significant differences for “social participation in the private sphere” and “social participation via social media” were found. Psychological symptoms, pain, and a history of mastectomy were most strongly associated with restrictions in social participation. Conclusions: Our study suggests that social withdrawal may happen due to disease-related symptoms, preventing some breast cancer patients from participating fully in society. Cancer-related follow-ups should address this issue and support patients’ reintegration into society through appropriate therapeutic interventions. [ABSTRACT FROM AUTHOR]

Purpose: Data reported on comparing primary and revisional procedures in the elderly is still limited. The aim of this study was to compare the efficacy and safety between primary and revisional bariatric surgery in a cohort of older patients. Materials and Methods: All patients ≥ 60 years old were divided into two cohorts, primary surgery cohort (PSC) and revisional surgery cohort (RSC). Baseline and perioperative outcomes were analyzed. Results: Fifty-eight patients were included (34 PSC and 24 RSC) in the study. Forty-two (25 PSC and 17 RSC) 72.4% were female. The mean age was 64 (± 3.3 years) in the PSC and 65 (± 4.2 years) in the RSC, the median initial BMI was 46.7 and 47.4 kg/m2 (p < 0.848), respectively. The mean hospital stay was (3 PSC vs. 5 RSC, p < 0.022) days. Readmissions occurred in (1 PSC vs. 3 RSC, p = 0.158) patients within 30 days of discharge. Postoperative major complications included (1 PSC vs. 5 RSC, p < 0.0278) patients. Reoperations were reported in (0 PSC vs. 3 RSC, p < 0.034) patients. Patients who underwent surgery for weight management, the initial mean BMI was (46.7 PSC vs. 47.4 RSC kg/m2, p = 0.848). At 12-months post-procedure, the mean BMI was (34.3 PSC vs. 37.7 RSC kg/m2, p = 0.372) and (23.7 PSC vs. 19.1 RSC, p = 0.231) %TBWL. The mean overall follow-up was (12.4 PSC vs. 27.5 RSC, p < 0.004) months, and one unrelated death (cancer) was reported in the RSC. Conclusion: PSC and RSC are effective in the elderly, however postoperative complications occurred more often in the RSC group. [ABSTRACT FROM AUTHOR]

Purpose: Surgeons want to achieve native kinematics in primary total knee arthroplasty (TKA). Cruciate-substituting (CS) implants could restore the knee kinematics more efficiently than posterior-stabilised (PS) TKA. This study aimed to compare gait patterns in patients with CS or PS TKA at 6 months. The hypothesis was that CS implants would demonstrate comparable gait parameters to PS implants at 6 months. Methods: In this prospective case–control study, 38 primary TKA without coronal laxity were divided into 2 groups: 19 cruciate-substituting (CS) and 19 posterior-stabilised (PS) implants. The type of prosthesis was determined according to the surgical period. Exclusion criteria were TKA revision, associated procedures and inability to walk on a treadmill. Gait analysis was conducted on a treadmill 6 months postoperatively for each patient with a knee assessment device (KneeKG®). Gait characteristics included analysis in three spatial dimensions (flexion–extension, abduction–adduction, internal–external rotation, anterior–posterior translation). Clinical outcomes (Knee Society Score and Forgotten Joint Score) were compared between both groups at 6 months postoperatively. Results: At 6 months, the gait analysis did not demonstrate any significant difference between CS and PS implants. The range and the maximum anteroposterior translation were similar in both groups (9.2 ± 6.5 mm in CS group vs. 8.1 ± 3 mm in PS group (n.s.); and − 5.2 ± 5 mm in CS group vs. − 6.3 ± 5.9 mm in PS group (n.s.), respectively). The internal/external rotation, the flexion, and the varus angle were similar between CS and PS implants. The KSS Knee score was higher at 6 months in the CS group than in the PS group (92.1 ± 5.6 vs. 84.8 ± 8.9 (p < 0.01)). Conclusion: Cruciate-substituting and posterior-stabilised TKA had similar gait patterns at 6 months postoperatively, despite a non-equivalent posterior stabilisation system. CS prostheses were an interesting option for primary TKA for knee kinematics restoration without requiring a femoral box. Level of evidence: Prospective, case–control study; Level II. [ABSTRACT FROM AUTHOR]

Sutureless closure has been used for primary repair of total anomalous pulmonary venous connection (TAPVC) for over 20 years but its superiority over conventional technique is still uncertain. This systematic review was conducted to compare the effectiveness of sutureless closure and conventional surgery as the primary repair for TAPVC. Systematic search was performed in June 2021 on 12 databases. All studies comparing sutureless and conventional surgery for TAPVC were included. The primary endpoints were early mortality, overall mortality, postoperative pulmonary venous stenosis (PVS), and reoperation. Meta-analysis of two-arm studies was performed with several sensitivity and subgroup analyses. Six retrospective studies with 767 patients were included in meta-analyses. Sutureless closure significantly reduced the risk of early mortality, overall mortality, postoperative PVS, and reoperation by 53%, 45%, 77%, and 67% compared to conventional technique, respectively. No heterogeneity was found and presence of publication bias was non-significant. The results were consistent in all sensitivity analyses. Subgroup analyses revealed that sutureless closure was superior to conventional technique in patients with and without preoperative pulmonary venous obstruction, and neonates and non-neonates. Sutureless closure is better than conventional closure as the primary surgery for TAPVC patients. We advocate using sutureless closure for patients with TAPVC. Future large-scale observational studies or clinical trials are required to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: It remains unclear the effect of prior endoscopic resection (ER) on the secondary surgery (SS) for T1 colorectal cancer (CRC). This study aimed to compare the short- and long-term outcomes between primary surgery (PS) and ER followed by SS for T1 CRC. Methods: A systematic literature search was performed in PubMed and Ovid for studies comparing PS with ER followed by SS for T1 colorectal cancer. The last search was performed on 18 May 2021. The primary outcomes were surgical parameters and the secondary outcomes were survival indicators. The meta-analysis was performed with Review Manager Software (version 5.3). Results: A total of fifteen studies published between 2013 and 2021 with 4349 patients were included in this meta-analysis finally. No significant difference was observed between the two groups for operative time (P = 0.75, WMD = 3.16, 95%CI [−15.88, 22.19], I2 = 64%), blood loss (P = 0.86, WMD = 12.33, 95%CI [−122.99, 147.65], I2 = 95%), and postoperative complications (P = 0.59, OR = 0.93, 95%CI [0.71, 1.22], I2 = 0%). Besides, the two groups showed comparable survival outcomes, including overall recurrence rate (P = 0.15, OR = 0.78, 95%CI [0.56, 1.09], I2 = 23%) and 5-year overall survival (P = 0.76, OR = 0.86, 95%CI [0.33, 2.25], I2 = 0%). In the subgroup analysis for studies with propensity matching score or lesions located in the rectum, the results were not changed. Conclusion: ER followed by SS is feasible for T1 CRC with high-risk factors. The prior ER would not bring additional adverse effects to the SS. More advanced tools should be developed to improve the diagnostic accuracy for the high-risk factors before treatment for T1 CRC. [ABSTRACT FROM AUTHOR]

Objectives: Controversy exists regarding the justification of primary surgery in primary spontaneous pneumothorax, and surgery is not free from recurrence. We hypothesized that surgery is a risk factor for contralateral recurrence pneumothorax in adolescent. Methods: We performed a retrospective cohort study of 163 adolescent with pneumothorax who were treated conservatively with chest tube (n = 100) or chest tube followed by video-assisted thoracoscopic surgery (n = 63) from January 2009 through December 2017. Results: Ipsilateral recurrence was significantly more common following conservative treatment than surgical treatment (25.0 vs. 3.2%, P < 0.001), while contralateral recurrence was more common in the surgical group than in the conservative group (15.9 vs. 6.0%, P = 0.039). The rates of second episode pneumothorax did not significantly differ between the two treatment groups (P = 0.092). Univariate analysis identified that patients who were treated conservatively had greater risk of ipsilateral recurrence (P = 0.002), while those who proceeded to surgery had greater risk of contralateral recurrence (P = 0.046). No predictors for second episode pneumothorax were found. Conclusion: To avoid over treatment, we recommend that conservative treatment should be the superior option and CT scan should not be a routine examination in adolescent with their first episode of PSP. [ABSTRACT FROM AUTHOR]

Neoadjuvant chemotherapy in gastric cancer can treat micro metastatic disease and can increase the resectability rate. The trial was to compare early outcomes after primary surgery versus neoadjuvant chemotherapy followed by surgery in gastric adenocarcinoma. The primary aim of the study was to compare resectability and R0 resection rates in upfront surgery v/s chemotherapy followed by surgery arm. A secondary aim was to see if neoadjuvant chemotherapy is well tolerated or not by comparing postoperative morbidity and mortality. The study consisted of 60 consecutive patients of carcinoma stomach randomized into primary surgery and neoadjuvant chemotherapy followed by surgery arms. Morbidity, pathological status, and mortality data were collected and analyzed. Mean operating time in primary surgery arm was 290 ± 46.5 min, while in NACTarm, it was 316.7 ± 56.6 min, respectively. When postop complications were compared between the arms, it was not significant. Comparing the histopathological report of two groups, there was no significant difference between differentiated, T stage, mean lymph node harvest, R0 resection, PNI, and LVI. Neoadjuvant chemotherapy showed a trend towards improving in the R0 resection rate. There is no increase in postoperative morbidity and mortality with neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Over the past four decades, the treatment algorithms for rectal cancer have fundamentally changed, which resulted in a considerable improvement of oncological outcomes. In this context, the surgical concept of total mesorectal excision and the implementation of multimodal treatment strategies represent key milestones. These improvements were complemented by a standardized histopathological work-up of the surgical specimen and the introduction of high-resolution magnetic resonance imaging (MRI) diagnostics. In addition, novel surgical techniques have been introduced, such as laparoscopic and robotic rectal resection. Other technological innovations include intraoperative pelvic neuromonitoring and fluorescence imaging. This review highlights the current evidence for selected, sometimes controversially discussed principles of surgical treatment strategies in rectal cancer. [ABSTRACT FROM AUTHOR]

The surgical treatment of oral cavity cancers can be influenced by post-operative complications. Identification of risk factors based on clinical characteristics may assist in therapeutic planning and thereby helps in reducing complications. Here, an attempt is made to identify the factors associated with post-operative complications (complications developing within 1 month of surgery) in patients undergoing primary oral cancer surgery. Six hundred seventy-six consecutive patients who underwent primary surgery for oral cancer from December 2007 to May 2010 were prospectively evaluated. The risk factors that predict for post-operative complications were analyzed. There was one mortality and 15% (103 patients) had post-operative complications. The complications included metabolic complications, primary site problems, donor site problems, and systemic complications. Fifteen factors were found statistically significant for the development of post-operative complications by univariate analysis. On multivariate analysis, three of the 15 factors, i.e., presence of COPD, full thickness wide excision, and increased duration of surgery were found to be independently associated with the development of post-operative complications. Presence of COPD, full thickness wide excision, and increased duration of surgery were identified as independent risk factors for post-operative complications in primary oral cancer surgery. The development of complications invariably resulted in increased hospital stay. Hence, the prompt recognition of risk factors for complications based on pre-operative clinical characteristics plus the identification of the risks associated with the surgical procedure can help in determining the appropriate therapeutic planning to prevent complications and in achieving cost effectiveness. [ABSTRACT FROM AUTHOR]

This study is a retrospective analysis of clinico-pathological data to investigate survival rates of patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with different modalities in a single academic head and neck cancer center in different time intervals. Altogether, 287 patients with OPSCC were included in this comparison. Patients were analysed during two different treatment periods: Group 1 included patients treated mainly with primary surgery ± adjuvant radio(chemo)therapy between 2002 and 2007, while Group 2 included patients treated with organ/function-preservation protocols if indicated. Main outcome measures were overall survival (OS) and recurrence-free survival (RFS). Between 2002 and 2007, early-stage OPSCC showed a 5-year OS of 75% compared to that of 86% between 2008 and 2013. Locally advanced OPSCC showed a 5-year OS of 66% between 2002 and 2007 compared to that of 74% between 2008 and 2013. RFS in early-stage OPSCC was 48% between 2002 and 2007 in contrast to that of 77% between 2008 and 2013. With locally advanced OPSCC, RFS was 55% between 2002 and 2007 compared to that of 56% between 2008 and 2013. These differences were statistically not significant. The OS and RFS remained generally unchanged over the analysed time period. There was no significant difference in the outcomes with regards to HPV status and to their treatment modality. [ABSTRACT FROM AUTHOR]

Obstetric brachial plexus injuries (OBPP) are a relatively common stretch injury of the brachial plexus that occurs during delivery. Roughly 30 % of patients will not recover completely and will need a surgical repair. Two main treatment strategies have been used: primary surgery, consisting in exploring and reconstructing the affected portions of the brachial plexus within the first few months of the patient's life, and secondary procedures that include tendon or muscle transfers, osteotomies, and other orthopedic techniques. Secondary procedures can be done as the only surgical treatment of OBPP or after primary surgery, in order to minimize any residual deficits. Two things are crucial to achieving a good outcome: (1) the appropriate selection of patients, to separate those who will spontaneously recover from those who will recover only partially or not at all; and (2) a good surgical technique. The objective of the present review is to assess the published literature concerning certain controversial issues in OBPP, especially in terms of the true current state of primary and secondary procedures, their results, and the respective roles each plays in modern-day treatment of this complex pathology. Considerable published evidence compiled over decades of surgical experience favors primary nerve surgery as the initial therapeutic step in patients who do not recover spontaneously, followed by secondary surgeries for further functional improvement. As described in this review, the results of such treatment can greatly ameliorate function in affected limbs. For best results, multi-disciplinary teams should treat these patients. [ABSTRACT FROM AUTHOR]

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Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Study Design: Cohort study., Objectives: To report the two-year revision risk following primary adult spinal deformity (ASD) surgery, describe reasons for revisions, and assess risk factors for revision surgery., Summary of Background Data: Revision risk following primary ASD surgery has been reported to vary between 7% and 26%, but with loss to follow-up as a considerable challenge., Methods: Patients ≥18 years of age undergoing primary instrumented surgery for ASD in Denmark during 2006-2014 were identified by procedure and diagnosis codes in the Danish National Patient Registry (DNPR). Complete two-year follow-up on revision surgery for each patient was achieved. Medical records were reviewed to determine reasons for revisions. Overall comorbidity was summarized using the Charlson Comorbidity Index (CCI) based on DNPR data; low comorbidity (CCI 0); medium comorbidity (CCI 1-2); and high comorbidity (CCI ≥3). Risk factors for revision were assessed in a Cox regression model., Results: A total of 553 patients were identified. Of these, 19.9% were revised within the two-year follow-up and 7.2% of patients were revised more than once. Median time to revision was 308 days (interquartile range 105-508). The most common reason for revision was implant failure (38.2%) followed by infection (11.8%). Increased age (hazard ratio [HR] = 1.13, 95% confidence interval [CI] 1.01-1.26, per 10 years increment) and high comorbidity burden (HR = 2.10, 95% CI 1.16-3.79) were associated with increased revision risk. Risk of revision increased from 2006 to 2014; hence, year of primary surgery (with 2006 as reference) was associated with increased revision risk (HR = 1.09, 95% CI 1.01-1.18)., Conclusions: The revision risk within 2 years after primary ASD surgery was 19.9% nationwide in Denmark, and implant failure was the most common reason for revision. Increased comorbidity and age were separately associated with increased risk of revision., Level of Evidence: Level II., (Copyright © 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Study Design: Retrospective comparative study., Objectives: To compare correction rates and complications of revision versus primary patients undergoing vertebral column resection (VCR)., Summary of Background Data: Although an all-posterior VCR has obviated the need for a circumferential approach, it is technically demanding, especially in a revision setting., Methods: Between 2002 and 2009, 55 revision patients underwent a posterior-only VCR. Diagnoses included severe scoliosis (n = 3), kyphoscoliosis (KS) (n = 29), global kyphosis (GK) (n = 13), and angular kyphosis (AK) (n = 10). Radiographic findings and complications were compared with 38 primary patients who underwent a VCR during the same period. All patients had a minimum 2-year follow-up (range, 2-6 years)., Results: The mean number of VCR levels were 1.6 in revision versus 1.2 in primary cases (p = .005). In the severe scoliosis and KS groups, major coronal curve correction was 48% in revision versus 63% in primary cases (p = .001). In the KS, GK, and AK groups, the major sagittal curve correction was 52% in revision versus 57% in primary cases (p = .27). Preoperative (p = .015) and postoperative (p = .002) sagittal imbalance was significantly greater in the revision group. There were no spinal cord-related complications, but 7 revision (13%) and 3 primary (8%) patients temporarily lost neuromonitoring data or failed wakeup tests; however, none had a permanent neurological deficit. Six revision patients (11%) required further revision surgery due to implant failure (3), progressive sagittal or coronal imbalance (2), and delayed deep wound infection (1) versus only 1 primary patient (3%) due to increased coronal imbalance. Preoperative and postoperative Scoliosis Research Society scores were not significantly different between groups., Conclusions: Vertebral column resections in revision patients may be more technically demanding than in primary patients but can be performed safely in conjunction with intraoperative spinal cord monitoring. Revision and primary patients undergoing a VCR showed improved clinical outcomes., (Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)