Decreasing use of epidural analgesia with increasing minimally invasive lobectomy: Impact on postoperative morbidity
The last decade has seen a transition in the surgical approach to lobectomy, from thoracotomy to minimally invasive surgery (MIS), for treating patients with early-stage non-small cell lung cancer (NSCLC) . Growing evidence has demonstrated that MIS lobectomy, including video-assisted thoracic surgery (VATS) and robotic-assisted thoracic surgery (RATS), is associated with fewer postoperative complications such as arrhythmias and pneumonia and shorter chest tube duration and length of hospital stay [2 –8].
DiscussionThe interventions of education and medication alerts resulted in a significant increase in the percentage of patients receiving appropriate doses of dilTIAZem and a nonsignificant decrease in the incidence of hypotension. This process-oriented intervention resulted in an improvement in appropriate dilTIAZem doses at our site. Rate control was not statistically significantly different between the 2 groups. Long-term sustainability of this intervention requires further study.
Among women with metastatic breast cancer, use of an investigational oral form of paclitaxel yielded a higher overall response rate than the IV form, but administration was unique and time-consuming.Medscape Medical News
Publication date: Available online 12 December 2019Source: The LancetAuthor(s): Jack Cuzick, Ivana Sestak, John F Forbes, Mitch Dowsett, Simon Cawthorn, Robert E Mansel, Sibylle Loibl, Bernardo Bonanni, D Gareth Evans, Anthony Howell, IBIS-II investigatorsSummaryBackgroundTwo large clinical trials have shown a reduced rate of breast cancer development in high-risk women in the initial 5 years of follow-up after use of aromatase inhibitors (MAP.3 and International Breast Cancer Intervention Study II [IBIS-II]). Here, we report blinded long-term follow-up results for the IBIS-II trial, which compared anastrozole with placebo...
Publication date: Available online 12 December 2019Source: Journal of Hospital InfectionAuthor(s): D.G. Wootton, S.J. Aston, T.W. Felton
ConclusionsMHSCC seems to show a better overall survival compared to OSCC of other locations and is less likely to develop regional and distant metastasis; END might not be necessary in early stage tumors.
ConclusionThe close relationship between HPV and oropharyngeal squamous cell carcinoma could not be shown in larynx malignancy in many studies, including our study. Our findings support a limited role of HPV in laryngeal carcinogenesis. Protein16 is not a reliable surrogate for HPV status in laryngeal cancers and is not a predictor of laryngeal cancer survival. Supraglottic localization of tumor was determined to be increased in protein16 positive cases. The correlation between protein16 positivity and supraglottic area location was determined to be statistically significant. There is a need for more populated clinical tri...
Publication date: Available online 12 December 2019Source: Pharmacological ResearchAuthor(s): Seid Hamzic, Dominic Kummer, Tanja K. Froehlich, Markus Joerger, Stefan Aebi, Claire Palles, Ian Thomlinson, Didier Meulendijks, Jan H.M. Schellens, Xandra García-González, Luis A. López-Fernández, Ursula Amstutz, Carlo R. LargiadèrAbstractTo assess the proposed associations of the c.742-227G > A (rs2612091) polymorphism within the Enolase Superfamily Member 1 gene (ENOSF1) and two variants in the adjacent Thymidylate Synthase gene (TYMS): the 5’VNTR 28bp-repeat (rs45445694...
Conclusion: Despite some disadvantages of videothoracoscopic surgery for large lung cancer, like less mobilization of the tumor and a reduced operating space, VATS lobectomy is a safe and technically feasible procedure even in for lung cancer of>5-cm diameter in experienced hands.
CONCLUSIONS: Compared with lobectomy by thoracotomy, thoracoscopic lobectomy is associated with a lower incidence of major complications, including lower rates of prolonged pneumonia, atrial arrhythmias and renal failure. Lobectomy via VATs may be the preferred strategy for appropriately selected NSCLC patients. The determinants of this advantage should be analyzed to improve the safety and outcomes of other thoracic procedures. PMID: 30987564 [PubMed - as supplied by publisher]
CONCLUSIONS: RATS result in better mortality as compared with VATS. However, robotics seems to have longer operative time and higher hospital costs, without superior advantages in morbidity rates and oncologic efficiency. Since the advantages of RATS has been performed in some area, the continuation of a comparative investigation with VATS may be necessary. And some effort need to be taken into consideration to reduce the operative time and cost. PMID: 30973106 [PubMed - as supplied by publisher]