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Langenbeck's Archives of Surgery Dec 2023Para-aortic lymph node metastasis associated with colorectal cancer is a very rare occurrence, but at the same time an important predictor of survival. Despite its... (Review)
Review
INTRODUCTION AND AIM
Para-aortic lymph node metastasis associated with colorectal cancer is a very rare occurrence, but at the same time an important predictor of survival. Despite its importance, there is still no gold standard management strategy, particularly for lymph nodes detected during follow-up, after resection of the primary tumour. Therefore, this review was undertaken to examine the evidence available on the surgical and non-surgical management of metachronous para-aortic lymph node metastasis (m-PALNM) in colorectal cancer treatment.
METHODS
This is a systematic review using the patient, intervention, comparison, outcome and study strategy. The literature search was undertaken using Cochrane, MEDLINE, EMBASE and PubMed databases with the following MeSH terms: lymph node excision, para-aortic lymph node, metastasis, metachronous and colorectal neoplasms.
RESULTS
Five original papers met the study criteria including 188 patients in total (55.3% male, 44.7% female). Surgical resection of the m-PALND was the management of choice in 64% of patients. Reporting styles on survival outcomes were heterogeneous. However, patients undergoing surgical management for m-PALNM had longer disease-free survival and overall survival rates.
CONCLUSION
There is significant paucity in the evidence available on the management of m-PALNM. However, the evidence reported by this review suggests that surgical management should be considered whenever possible, with the aim of prolonging survival. Future randomised trials are needed in order to provide further high-level evidence on m-PALNM management.
Topics: Humans; Male; Female; Lymphatic Metastasis; Lymph Node Excision; Lymph Nodes; Disease-Free Survival; Colorectal Neoplasms; Retrospective Studies
PubMed: 38091090
DOI: 10.1007/s00423-023-03185-9 -
Annals of Cardiothoracic Surgery Nov 2023Recent reports on sex differences in long-term outcomes after surgery for acute type A aortic dissection (ATAAD) are conflicting. We aimed to aggregate updated data on...
BACKGROUND
Recent reports on sex differences in long-term outcomes after surgery for acute type A aortic dissection (ATAAD) are conflicting. We aimed to aggregate updated data on long-term survival and reoperation stratified by sex.
METHODS
A literature search was conducted using Medline, Embase, and Cochrane Central. Studies reporting sex-stratified long-term survival and/or reoperation following surgery for ATAAD between January 1, 2000, to March 15, 2023 were included. Preoperative characteristics, intraoperative variables, and early perioperative outcomes were meta-analyzed using a random effects model and pooled risk ratio (RR) with men as the reference group. Individual patient-level data for long-term outcomes was reconstructed to generate sex-specific pooled Kaplan-Meier curves to assess long-term survival and freedom from reoperation.
RESULTS
A total of 15 studies with 7,608 male and 3,989 female patients were included in this analysis. Female patients were older, had higher rates of hypertension, and had less previous cardiac surgery. Intraoperatively, women received less extensive repairs with lower rates of aortic valve replacement and total arch replacement, and higher rates of hemiarch replacement. There were no sex differences for in-hospital/30-day mortality [risk ratio (RR), 1.18; 95% confidence interval (CI): 0.96, 1.45; P=0.12], stroke (RR, 1.07; 95% CI: 0.90, 1.28; P=0.46), and early reoperation (RR, 0.90; 95% CI: 0.75, 1.09; P=0.28). Female patients had lower long-term survival overall (P<0.001) and amongst survivors at 1-year (P=0.014). Overall survival at 5-year was 82.4% in men and 78.1% in women, and at 10-year was 68.1% for men and 63.4% in women. Male patients had higher rates of long-term reoperation (P<0.001). Freedom for reoperation at 5-year was 88.4% in men 93.1% in women.
CONCLUSIONS
Though perioperative early outcomes have equalized between the sexes following surgery for ATAAD, differences remain in long-term survival and reoperation.
PubMed: 38090347
DOI: 10.21037/acs-2023-adw-0098 -
Monaldi Archives For Chest Disease =... Sep 2023CHARGE syndrome (CS) is a rare genetic disease that affects many areas of the body. The aim of the present systematic review was to evaluate the prevalence and types of...
CHARGE syndrome (CS) is a rare genetic disease that affects many areas of the body. The aim of the present systematic review was to evaluate the prevalence and types of congenital heart diseases (CHDs) in CS and their impact on clinical outcome. A systematic review from 1981 to September 2022 was conducted. Clinical studies that reported the association between CS and CHDs were identified, including a case report of a rare congenital anomaly of the aortic arch (AA) with persistent fifth aortic arch (PFAA). Demographic, clinical and outcome data were extracted and analyzed. Sixty-eight studies (44 case reports and 24 case series; n=943 CS patients) were included. The prevalence of CHDs was 76.6%, patent ductus arteriosus (PDA) 26%, ventricular (VSD) 21%, atrial septal defects (ASD) 18%, tetralogy of Fallot 11%, aortic abnormalities 24%. PFAA has not been previously reported in CS. Cardiac surgery was performed in more than half of CS patients (150/242, 62%). In-hospital mortality rate was about 9.5% (n=86/900) in case series studies and 12% (n=5/43) in case reports, including cardiovascular (CV) and non-CV causes. CHDs and feeding disorders associated with CS may have a substantial impact on prognosis. CHDs were usually associated with CS and represent important causes of morbidity and mortality. PFAA, although rare, may also be present. The prognosis is highly dependent on the presence of cardiac and non-cardiac developmental abnormalities. Further studies are needed to better identify the main causes of the long-term outcome of CS patients.
PubMed: 37675914
DOI: 10.4081/monaldi.2023.2661 -
Journal of Clinical Medicine Jul 2023Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating... (Review)
Review
OBJECTIVE
Due to an ever-increasing ageing population and limited available data around the use of thoracic endovascular aortic repair (TEVAR) in elderly patients, investigating its efficacy and safety in this age cohort is of vital importance. We thus reviewed the existing literature on this topic to assess the feasibility of TEVAR in elderly patients with severe thoracic aortic pathologies.
METHODS
We identified all original research studies that assessed TEVAR in elderly patients published up to 2023. Morbidity, as assessed by neurological and respiratory complications, endoleaks, and length of stay, was the primary endpoint. Short-term mortality and long-term survival were the secondary endpoints. The Mantel-Haenszel random and fixed effects methods were used to calculate the odds ratios for each outcome. Further sensitivity and subgroup analyses were performed to validate the outcomes.
RESULTS
Twelve original studies that evaluated elective TEVAR outcomes in elderly patients were identified. Seven studies directly compared the use of TEVAR between an older and a younger patient group. Apart from a shorter hospital stay in older patients, no statistically significant difference between the morbidity outcomes of the two different cohorts was found. Short-term mortality and long-term survival results favoured the younger population.
CONCLUSIONS
The present meta-analysis indicates that, due to a safe perioperative morbidity profile, TEVAR should not be contraindicated in patients based purely on old age. Further research using large patient registries to validate our findings in elderly patients with specific aortic pathologies and both elective and emergency procedures is necessary.
PubMed: 37568406
DOI: 10.3390/jcm12155001 -
European Journal of Vascular and... Jan 2024Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Fenestrated and branched thoracic endovascular aortic repair (F/B-TEVAR) of the aortic arch is a viable approach in patients unsuitable for open repair. The aim was to summarise the published results of manufactured F/B-TEVAR devices for partial and total repair of the aortic arch, and to compare fenestrated with branched configurations.
DATA SOURCES
PubMed, Scopus and The Cochrane Library were searched for articles (2018 - 2021) about patients with elective, urgent, or emergency aortic requiring a proximal landing zone in the aortic arch (zone 0 - 1 - 2) and treated by F/B-TEVAR.
REVIEW METHODS
The systematic review and meta-analysis were performed according to the PRISMA guidelines. Open repair, supra-aortic trunk (SAT) debranching + standard TEVAR, and in situ physician modified and parallel grafts were excluded. Primary outcomes were technical success and 30 day mortality rate. Secondary outcomes were 30 day major adverse events, and overall survival and procedure related endpoints during follow up.
RESULTS
Of 458 articles screened, 18 articles involving 571 patients were selected. Indications for intervention were chronic dissections (50.1%), degenerative aneurysms (39.6%), penetrating aortic ulcers (7.4%), and pseudoaneurysms (2%). F-TEVAR, B-TEVAR, and F+B-TEVAR were used in 38.4%, 54.1%, and 7.5% of patients, respectively. Overall, technical success was 95.9% (95% confidence interval [CI] 0.93 - 0.97; I = 0%; p for heterogeneity (Het) = .77) and the 30 day mortality rate was 6.7% (95% CI 0.05 - 0.09; I = 0%; p Het = .66). No statistical differences were found comparing fenestrated with branched endografts, except for a higher rate of type I - III endoleaks in F-TEVAR (9.8% vs. 2.6%; p = .034). The overall survival rate and freedom from aortic related death at the one year follow up ranged between 82 - 96.4% and 94 - 94.7%, respectively. Thirteen and five studies were considered at moderate and high risk of bias, respectively.
CONCLUSION
F/B-TEVAR for the treatment of the aortic arch, according to experience in dedicated centres, now enjoys a satisfactory level of technical success together with a progressively reduced early mortality rate. There are several limitations, and further studies are needed to reach clearer conclusions.
Topics: Humans; Blood Vessel Prosthesis; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Treatment Outcome; Risk Factors; Endovascular Procedures; Postoperative Complications; Prosthesis Design; Retrospective Studies
PubMed: 37536517
DOI: 10.1016/j.ejvs.2023.07.048 -
Archives of Gerontology and Geriatrics Dec 2023We conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
We conducted this systematic review and meta-analysis to summarize the prevalence of sarcopenia and its impact on mortality in patients undergoing TAVI.
METHOD
Medline, EMBASE, and PubMed were searched from inception to October 14, 2022 to retrieve eligible studies that assessed sarcopenia in patients undergoing TAVI. Pooled sarcopenia prevalence was calculated with 95% confidence interval (CI), and heterogeneity was estimated using the I test. Associations of sarcopenia with mortality of post-TAVI were expressed as hazard ratio (HR) or odds ratios (OR) and 95% CI.
RESULTS
13 studies involving 5248 patients (mean age from 78.1 to 84.9 years) undergoing TAVI were included. There were eleven studies defined sarcopenia based on loss of skeletal muscle mass index (SMI), while only two studies used low muscle mass plus low muscle strength and/or low physical performance. Overall, the pooled prevalence of sarcopenia in patients undergoing TAVI was 49% (95% CI 41%-58%). Sarcopenia was associated with an increased risk of long-term (≥1 year) mortality in patients after TAVI (HR 1.57, 95% CI 1.33-1.85, P < 0.001), with similar findings in the subgroups stratified by follow-up time, definition of sarcopenia, study location, and study design. Furthermore, the 1-, 2-, and 3-year cumulative probabilities of survival in patients with sarcopenia were significantly lower than non-sarcopenia (74.0% vs 91.0%, 68.3% vs 78.0%, and 72.6% vs 79.8%, all P < 0.05).
CONCLUSIONS
Although there are substantial differences in diagnostic criteria, sarcopenia is highly prevalent in patients undergoing TAVI and its linked to increased long-term mortality after TAVI.
Topics: Aged; Aged, 80 and over; Humans; Aortic Valve Stenosis; Prognosis; Risk Factors; Sarcopenia; Transcatheter Aortic Valve Replacement; Treatment Outcome
PubMed: 37481845
DOI: 10.1016/j.archger.2023.105125 -
Archives of Gynecology and Obstetrics Jan 2024Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Fetal growth restriction (FGR) management and delivery planning is based on a multimodal approach. This meta-analysis aimed to evaluate the prognostic accuracies of the aortic isthmus Doppler to predict adverse perinatal outcomes in singleton pregnancies with FGR.
METHODS
PubMed, EMBASE, the Cochrane Library, ClinicalTrials.gov and Google scholar were searched from inception to May 2021, for studies on the prognostic accuracy of anterograde aortic isthmus flow compared with retrograde aortic isthmus flow in singleton pregnancy with FGR. The meta-analysis was registered on PROSPERO and was assessed according to PRISMA and Newcastle-Ottawa Scale. DerSimonian and Laird's random-effect model was used for relative risks, Freeman-Tukey Double Arcsine for pooled estimates and exact method to stabilize variances and CIs. Heterogeneity was quantified using I statistics.
RESULTS
A total of 2933 articles were identified through the electronic search, of which 6 studies (involving 240 women) were included. The quality evaluation of studies revealed an overall acceptable score for study group selection and comparability and substantial heterogeneity. The risk of perinatal death was significantly greater in fetuses with retrograde Aortic Isthmus blood flow, with a RR of 5.17 (p value 0.00001). Similarly, the stillbirth rate was found to have a RR of 5.39 (p value 0.00001). Respiratory distress syndrome had a RR of 2.64 (p value = 0.03) in the group of fetuses with retrograde Aortic Isthmus blood flow.
CONCLUSION
Aortic Isthmus Doppler study may add information for FGR management. However, additional clinical trial are required to assess its applicability in clinical practice.
Topics: Female; Humans; Pregnancy; Aorta, Thoracic; Fetal Growth Retardation; Fetus; Stillbirth; Ultrasonography, Doppler; Ultrasonography, Prenatal; Pregnancy Outcome; Fetal Death
PubMed: 37072584
DOI: 10.1007/s00404-023-06963-4 -
Perfusion Mar 2024Data on the postoperative outcomes for patients with infective endocarditis complicated by an aortic root abscess is sparse due to the condition's low incidence and high... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Data on the postoperative outcomes for patients with infective endocarditis complicated by an aortic root abscess is sparse due to the condition's low incidence and high mortality rates. This systematic review and meta-analysis aims to evaluate existing data on the impact of aortic root abscesses on the postoperative outcomes and to inform optimal surgical approach.
METHODS
The online databases MEDLINE, EMBASE and Cochrane library were searched from 1990 to 2022 for studies comparing cohorts of surgically managed infective endocarditis patients with and without an aortic root abscess. Data was extracted by two independent investigators and aggregated in a random-effects model. Risk of bias was assessed using an adapted version of the Newcastle-Ottawa scale.
RESULTS
Six clinical studies were included in the meta-analysis ( 1982). The abscess group was associated with increased in-hospital mortality (OR 1.74 95%: CI 1.18-2.56) and late mortality (HR 1.27 95% CI:1.03-1.58). The reoperation meta-analysis was complicated by high rates of heterogeneity (I = 59%) and found no significant differences in reoperation between abscess and no abscess groups (HR=1.48: 95% CI:0.92-2.40). Post-hoc scatter graph showed a strong linear relationship (r 0.998), suggesting hospitals with higher rates of aortic root replacement achieve lower rates of reoperation for aortic root abscess patients compared with patch reconstruction.
CONCLUSIONS
The presence of an aortic root abscess in aortic valve endocarditis is associated with elevated early and late mortality despite modern standards of care. Additionally, aortic root replacement should be considered to have a favourable postoperative profile for use in this context.
Topics: Humans; Aortic Valve; Abscess; Heart Valve Prosthesis Implantation; Aorta, Thoracic; Heart Valve Prosthesis; Endocarditis; Endocarditis, Bacterial; Reoperation; Treatment Outcome
PubMed: 36314050
DOI: 10.1177/02676591221137484 -
Journal of Endovascular Therapy : An... Feb 2024The objective of this systematic review was to report the cumulative incidence of endograft migration (EM), as well as the morbidity, reintervention rates, and mortality... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The objective of this systematic review was to report the cumulative incidence of endograft migration (EM), as well as the morbidity, reintervention rates, and mortality related to EM. This study aimed to provide evidence-based data on patient-relevant sequelae of EM after thoracic endovascular aortic repair (TEVAR) performed using contemporary aortic endografts.
MATERIALS AND METHODS
A systematic electronic search of literature in MEDLINE (via PubMed), Web of Science, and Cochrane Central Register of Controlled Trials was performed. The pooled synthesis of outcomes was performed using the inverse variance method.
RESULTS
Seven prospective non-randomized and 4 retrospective studies, including a total of 1783 patients presenting 70 EMs, were considered for the quantitative analysis. The pooled rate of EM was 4% (95% CI, 2%-7%; range, 0.2%-11%; I2=82%); pooled morbidity rate was 31% (95% CI, 12%-59%; range, 0%-100%; I2=64%) and pooled reintervention rate was 32% (95% CI, 15%-56%; range, 0%-100%; I2=55%). The pooled mortality rate due to EM was 5% (95% CI, 1%-21%; range, 0%-40%; I2=24%).
CONCLUSION
For the first time, this meta-analysis provides pooled reference estimates of EM after TEVAR. Thus, the results hold the potential to further characterize EM after TEVAR. The clinical relevance of EM is underlined by its association with high rates of endoleak-related morbidity, reintervention, and mortality. Close standardized surveillance after TEVAR for early detection of EM and prophylaxis of its sequelae is essential.
Topics: Humans; Blood Vessel Prosthesis; Endovascular Aneurysm Repair; Blood Vessel Prosthesis Implantation; Retrospective Studies; Prospective Studies; Treatment Outcome; Aorta, Thoracic; Risk Factors; Endovascular Procedures; Time Factors
PubMed: 35822261
DOI: 10.1177/15266028221109455