Purpose It is suspected that delayed surgery after neoadjuvant chemotherapy (NACT) leads to a worse outcome in breast cancer patients. We therefore evaluated possible influencing factors of the time interval between the end of NACT and surgery. Methods All patients receiving NACT due to newly diagnosed breast cancer from 2015 to 2017 at the Department of Gynecology, Saarland University Medical Center, were included. The time interval between end of NACT and surgery was defined as primary endpoint. Possible delaying factors were investigated: age, study participation, outpatient and inpatient presentations, implants/expander, MRI preoperatively, discontinuation of chemotherapy, and genetic mutations. Results Data of 139 patients was analyzed. Median age was 53 years (22–78). The time interval between end of NACT and surgery was 28 days (9–57). Additional clinical presentations on outpatient basis added 2 days (p = 0.002) and on inpatient basis added 7 days to time to surgery (p < 0.001). Discontinuation of NACT due to chemotherapy side effects prolonged time to surgery by 8 days (p < 0.001), whereas discontinuation due to disease progress did not delay surgery (p = 0.6). In contrast, a proven genetic mutation shortened time to surgery by 7 days (p < 0.001). Patient’s age, participation in clinical studies, oncoplastic surgery, and preoperative MRI scans did not delay surgery. Conclusion Breast care centers should emphasize a reduction of clinical presentations and a good control of chemotherapy side effects for breast cancer patients to avoid delays of surgery after NACT.
This study presents the first scoring system for uterine fibroids that incorporates all possible fibroid locations and a standardized assessment of uterine reconstruction. Scoring systems were validated in a large cohort, and a correlation was identified between uterine fibroid and uterine reconstruction scores. In daily clinical practice, this scoring system allows a better planning of surgery, specifically of the estimated duration of surgery, blood loss, and time of hospitalization.
Purpose Endometrial cancer (EC) is the most common gynecological malignancy in women, with increasing incidence in the last decades. Surgical therapy is the mainstay of the initial management. The present study analyzed the evolving trends of surgical therapy in Germany in patients diagnosed with EC recorded in a nationwide registry. Methods All patients with the diagnosis of EC undergoing open surgery, laparoscopic surgery, and robotic-assisted laparoscopic surgery between 2007 and 2018 were identified by international classification of diseases (ICD) or specific operational codes (OPS) within the database of the German federal bureau of statistics. Results A total of 85,204 patients underwent surgical therapy for EC. Beginning with 2013, minimal-invasive surgical therapy was the leading approach for patients with EC. Open surgery was associated with a higher risk of in-hospital mortality (1.3% vs. 0.2%, p < 0.001), of prolonged mechanical ventilation (1.3% vs. 0.2%, p < 0.001), and of prolonged hospital stay (13.7 ± 10.2 days vs. 7.2 ± 5.3 days, p < 0.001) compared to laparoscopic surgery. A total of 1551 (0.04%) patients undergoing laparoscopic surgery were converted to laparotomy. Procedure costs were highest for laparotomy, followed by robotic-assisted laparoscopy and laparoscopy (8286 ± 7533€ vs. 7083 ± 3893€ vs. 6047 ± 3509€, p < 0.001). Conclusion The present study revealed that minimal-invasive surgery has increasingly become the standard surgical procedure for patients with EC in Germany. Furthermore, minimal-invasive surgery had superior in-hospital outcomes compared to laparotomy. Moreover, the use of robotic-assisted laparoscopic surgery is increasing, with a comparable in-hospital safety profile to conventional laparoscopy.
Nr. 5/1952]L e t t r t , Jungrnann, S a l f e l u 397 -__.-15 g des P h t h a l s g u r e e s t e r s wurden mit 19 g B r u c i n in Aceton gelost; nach Zusatz von Alkohol trat Kristallisation eines Salzgemisches ein, das den Schmp. 85O zeigte. Durch wiederholte Kristallisation (25rnal) aus Aceton + Alkohol konnte eine Fraktion vom Schmp. 151.5O erhalten werden, der sich bei weiterem Umkristallisieren nicht mehr iinderte; Ausb. 1 g. Diese Fraktion wurde mit verd. Salzsaure geschiittelt und der mure Monophthakureester des Diols in Ather aufgenommen. Der Riickstand der ather. Losung zeigte den Schmp. 137.5O und [aID : -39.2O. Das Produkt (0.384 g) wurde rnit w5Sr. 1-proz. Kalilauge 2 Stdn. unter RiickfluS gekocht. Die Lijsung wurde rnit verd. Salzsiiure neutralisiert und i.Vak. zur Trockne gedampft. Der Riickstand wurde mehrfach mit Chloroform ausgekocht und die Chloroform-Losung nach dem Trocknen eingedampft. Der Riickstand ergab nach zweimaligem Umkristallisieren aus wasser 110 rng
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