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Colonic Leiomyoma: Endoscopic Resection and Diagnosis of a Rare Lesion Found During Routine Colonoscopy.
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WHEN THE SKIN FIGHTS BACK: A COMPLEX CASE OF PYODERMA GANGRENOSUM IN A CHRONICALLY ILL PATIENT
No full textWorking Toward Defining Frailty in Breast Surgery: A Multi-institution Cohort Study Identifying Risk Factors of Free Flap Failure Following Autologous Breast Reconstruction.
No full textBACKGROUND: The integration of frailty assessments into preoperative evaluation protocols is essential for enhancing surgical procedure safety. As autologous breast reconstruction (ABR) increases in popularity, it is critical to stratify risk in patients with significant comorbidities with an ABR-specific frailty model. The aim of this study was to identify comorbidities associated with patients for unilateral or bilateral ABR flap failure, to develop a frailty index with a multi-institutional database.
METHODS: The TriNetX database was queried for patients who underwent free flap breast reconstruction (CPT code 19364) between 2016 and 2024 across 89 healthcare institutions. Patients who experienced unilateral or bilateral flap failure (ICD-10 T86.821) were identified; preoperative comorbidities that occurred at a significantly different frequency were detected. Subsequently, univariate and multivariable logistic regression analyses were used to identify independent risk factors of free flap failure. Odds ratios were converted into relative risk ratios and probabilities using the baseline frequency of flap failure without any comorbidity.
RESULTS: A total of 10,291 patients who underwent either unilateral or bilateral primary free flap ABR were identified. A total of 120 (1.17%) patients experienced partial or total flap failure. Comorbidities of interest were seen among infectious, oncologic, hematologic, cardiovascular, gastrointestinal, and dermatologic systems. Significant risk factors on multivariable logistic regression included history of anemia (OR, 2.87), breast abscess (OR, 2.98), chronic obstructive pulmonary disease (OR, 3.08), hypertension (OR, 1.69), and body mass index ≥30 (OR, 2.37) (P \u3c 0.05 for all). The baseline frequency of flap failure without any comorbidity was 0.73%. The presence of one or more risk factors increased the probability of 1-week flap failure anywhere from 1.23% (hypertension alone) to 43.69% (all five comorbidities).
CONCLUSIONS: Select preoperative comorbidities were identified as patient-specific risk factors for postoperative flap failure. A future direction may also include identifying complications specific to certain flap techniques and within partial and total flap failures, as well as prospectively tracking data per flap, rather than per patient through the TriNetX database
Factors Associated With Local Control and Toxicity of Hypofractionated Radiotherapy for Early and Late-Stage Ultracentral Lung Tumors.
No full textBACKGROUND: Treating ultracentral tumors near critical mediastinal structures is challenging due to severe toxicity risks. This retrospective study evaluates the safety and efficacy of hypofractionated body radiotherapy (HFRT) for ultracentral tumors at a single institution.
METHODS: Ultracentral tumors were defined as those invading, abutting, or having an overlapping planning target volume with the proximal bronchial tree (PBT), heart, great vessels, or esophagus. Patients with primary lung cancer or metastases from nonlung primaries, and received HFRT (6-15 fractions) or stereotactic body radiotherapy (SBRT, ≤5 fractions) were included. Radiation-associated toxicities were recorded. Outcomes included overall survival (OS), progression-free survival (PFS), and local control (LC). Prognostic factors were analyzed using Cox regression analysis.
RESULTS: Eighty-six patients with ultracentral tumors underwent 94 treatment courses (69 SBRT, 25 HFRT) between 2014 and 2023. Radiation pneumonitis (RP), pneumonia, and cardiotoxicities developed in 39.3%, 13.9%, and 9.6% of treatments, respectively. One patient experienced grade 3 pulmonary hemorrhage, with no cases of airway fistula or necrosis. Median follow-up was 17.9 months with 1-year and 2-year OS rates of 78.7% and 65.6%, and LC rates of 93.5% and 84.0%, respectively. BED
CONCLUSIONS: HFRT can be safely administered to ultracentral tumors with excellent local control and low toxicity. Further research is needed to optimize treatment strategies and investigate associations between RP and increased local failure
