Background:
prophylactic central neck dissection (pCND) is a subject of discussion for papillary thyroid carcinoma T1-2 N0, our study proves that pCND should be recommended as it is associated with less postoperative residual tumour with increasing recurrence-free survival.
Objective:
The primary endpoint is the recurrence free survival, study exclusively compares the outcome of surgical ablation with and without CND in PTC T1-2N0. Another endpoint is whether patients with residual disease, need to receive repeated radioactive iodine ablation or completion surgery.
Subject and method:
A Randomized controlled trial multi-centre study, assigned the patients into two arms, Group I was the control arm underwent total thyroidectomy only, whereas the other arm, included Total thyroidectomy and central neck dissection. Univariate and multivariate analysis was performed to declare risk group for recurrence. Recurrence Free Survival was the main issue of the study and calculated as the time elapsed from the date of surgery to the date of relapse; patients with residual and uTg 0.2–2 ng/ml received radio-active iodine (RAI) therapy versus completion surgery.
Results:
Loco-regional recurrence cases were found more in male patients aged more than 45 years old. Size of the primary tumour and the extent of surgery was a significant factor for RFS, patients with PCND in group II, had lower loco-regional recurrence and longer RFS, mean RFS was 25 months with (95%CI) is (23.61–26.38 months). Recurrence was high in the controlled group 38.1%.
Conclusion:
N0 patients will benefit by total thyroidectomy and pCND. pCND is recommended to decreases the residual tumour, increase the RFS. Completion surgery versus RAI for postoperative recurrence needs more number of patients.
Highlights:
Background: Anastomotic disruption after bowel resection anastomosis is a devastating and a feared complication, so it is of utmost importance to identify perioperative parameters predisposing to such complication.Methods: A prospective cohort study was performed in two institutes, and there were 287 patients eligible and included in the study which done from April 2017 to December 2018, 87 patients underwent intervention in the first institute in Zagazig University Hospitals, Egypt. And 200 patients underwent intervention in Riyadh, KSA. Statistical analysis used: Percent of categorical variables were compared using Pearson’s Chi-square test or Fisher's exact test when was appropriate. Risk estimation was done by Odds ratio (OR) calculation. All tests were two sided. A p-value <0.05 was considered significant. All statistics were performed using SPSS 22.0 for Windows (SPSS Inc., Chicago, IL, USA) and MedCalc windows (MedCalc Software bvba 13, Ostend, Belgium).Results: Of the parameters analyzed risk factors for anastomotic leakage that studied in 287 patients, 6 perioperative parameters have significant statistical difference: hypo-albuminaemia (Odd ratio: 6.544 and p-value <0.001), acute intra-abdominal contamination (Odd ratio: 3.921 and P-value <0.004), High WBC'S with high presepsin with p-value <0.001, hyponatremia p<0.004, perioperative blood transfusion and anastomotic tension were found to be independent factors.Conclusions: Knowledge of independent perioperative predictive factors for leakage is of utmost importance for its early detection, decision making for surgical time,our study concluded the possibility to detect a subgroup of high-risk patients for anastomotic leakage after emergency bowel resection anastomosis.
Background:The numbers of elderly persons have greatly increased worldwide due to improvement of medical health. Elderly complains of cardiopulmonary diseases and the incidence of emergent gall bladder diseases increase with age. Laparoscopic cholecystectomy is the usual approach in dealing with cholithiasis that greatly replace open approach even in acute emergency gall bladder diseases.Aim: compare between initial Fundus first cholecystectomy followed by Calot dissection VS Calot first cholecystectomy in Emergency laparoscopic cholecystectomy with low pressure pneumo-peritoneum in cardiopulmonary risk patients as regard intraoperative data and postoperative complications.Patients and methods:This prospective randomized controlled study was carried out in the Department of Emergency General Surgery on 470 cases with acute cholecystitis, biliary colic, mucocele and pyocele of gall bladder. The patients were divided into two groups, Group A: fundus-Calot group (235cases) and Group B (235cases): classical Calot first approach.ResultsIn most cases of group A, the operating time was up to 90 minutes, while in group B, most cases were more than 90 minutes. Intraoperative bleeding, visceral injury and biliary injury were higher in group B than in group A and therefore the conversion was higher in group B than in group A (14% vs. 4%). Postoperative sequelae were reported to be greater than in group B in regard to bleeding, biliary leakage and wound infections. Remote complications were more pronounced for biliary restrictions in Group B (14%) than in Group A (2%)Conclusion:Laparoscopic low-pressure pneumoperitoneum cholecystectomy with initial Fundus first method is an excellent and safe approach in treating acute gallbladder diseases in cardiopulmonary risk patients.
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