Introduction: In 2019, 11% of breast cancers are diagnosed at age 80 or above and this group of older patients constitutes 27% of breast cancer deaths. Previous clinical trials demonstrated comparable survival in older patients given hormonal therapy alone versus standard surgical treatment. However, newer studies showed that surgical treatment in older patients is associated with reduced all-cause and cancer-related mortality. Our study aims to compare the survival of older patients with breast cancer who received surgery versus hormonal therapy alone or expectant management, analyse the factors affecting survival and compare the local complication rates.
Methods: Patients treated under the New Territories East Cluster breast clinic with breast cancer diagnosed at age 80 or above were included in the study. Patients with metastatic disease were excluded. All medical records on the Hospital Authority Clinical Management System were retrospectively reviewed. Predictors including whether surgery was performed, human epidermal growth factor receptor 2 (HER2) status, oestrogen receptor (ER) status, T stage, N stage and activities of daily living status were assessed.
Results: Seventy-eight consecutive patients with breast cancer (median age 85, range 80-99) from 2004 to 2020 were included. Of these, 39 (50%) received surgery, whereas 39 (50%) did not. Patients who received surgery have a longer survival time (median 113 months vs 62 months; log-rank test P = .001). Univariate analysis and multivariate Cox regression model demonstrated that surgery and ER status affect survival. Patients who received surgery also have a lower incidence of local tumour progression and skin ulceration (χ21 = 6.3, P = .012).
Conclusion: In older patients with newly diagnosed breast cancer, surgical treatment is associated with a better survival and lower rates of local progression and complications. Surgery is advised even in older patients as long as they are fit for surgery.
Aim: To assess the feasibility, efficacy and safety of performing photoselective vaporisation of the prostate (PVP) as a day-surgery procedure for patients with benign prostatic obstruction.
Patients and Methods: A prospective single-arm observational study was performed involving patients with benign prostatic obstruction (BPO) who received PVP between 2017 and 2021. Data were collected on demographics, prostate volume by transrectal ultrasonography, mean peak flow rate (Qmax), post-void residual urine volume, International Prostate Symptom Score (IPSS) with quality-of-life (QoL) index, length of stay, success in weaning off catheter on the day of operation and complications.
Results: PVP was performed successfully in all 37 men between 2017 and 2021. Their mean age was 67 years. The mean prostate volume was 54 mL. The mean duration of operation was 80 min. The mean peak urinary flow rate improved from 9.14 to 16.8, 17.3 and 15.4 mL/s at post-operative 1, 3 and 12 months, respectively (P = .001). The mean IPSS score improved from 19.5 to 8.94, 6.40 and 5.63 at post-operative 1, 3 and 12 months, respectively (P < .001). The mean QoL index improved from 4.07 to 2.43, 2.25 and 1.81 at post-operative 1, 3 and 12 months, respectively (P = .001). The mean duration of catheterisation after PVP was 5.81 h. Thirty-three (89.2%) patients were discharged on the same day. Overall, the 30-day complication rate was 27%. The most common complication was haematuria (6 patients, 16.2%). Five patients (13.5%) required readmission and inpatient care. There was one Clavien–Dindo grade III and IV complication (2.6%), respectively.
Conclusion: This study demonstrated the feasibility of performing PVP as a day-surgery procedure with good short- and medium-term functional outcomes and safety profiles.
Aim: To compare the differences between neoadjuvant chemotherapy with resection and upfront surgery for patients with resectable colorectal cancer with liver metastases.
Patients and Methods: The following electronic databases were searched for systematic literature: PubMed, Cochrane Library and Google Scholar. Studies fulfilling the following criteria were included in the analysis: compared neoadjuvant chemotherapy and upfront surgery; included patients with resectable metastases at the time of presentation; reported the long-term results, including overall survival (OS) and disease-free survival (DFS); and identified early adverse postoperative events, including 30-day mortality and overall postoperative complications.
Results: Over 24 studies with 8700 patients were analysed. Patients were divided into the neoadjuvant chemotherapy group (n = 3490, 40.1%) and the upfront surgery group (n = 5172, 59.4%). The meta-analysis showed no statistically significant difference in terms of overall morbidities [odds ratio (OR) 1.19, 95% confidence interval (CI) 0.84-1.67] and mortality (OR 1.48, 95% CI 0.75-2.92) between the neoadjuvant chemotherapy and upfront surgery groups. However, the meta-analysis showed a favourable OS in the upfront surgery group (OR 1.21, 95% CI 1.06-1.38) and favourable DFS in the upfront surgery group (OR 1.71, 95% CI 1.38-2.12), including the subgroups of 1-, 3-, 5-year DFS (OR 1.38, 95% CI 1.06-1.8; OR 2.06, 95% CI 1.35-3.14 and OR 1.65, 95% CI 1.18-2.29, respectively).
Conclusion: Neoadjuvant chemotherapy has no benefit for resectable colorectal cancer with liver metastases; therefore, upfront surgery should be considered as the treatment of choice.
Objective: This study compared the outcomes of using Mac-Loc catheters and non–Mac-Loc catheters for percutaneous nephrostomy (PCN). Mac-Loc catheters have a locking mechanism that forms a curl at the tip by pulling a suture and securing it in place.
Methodology: This retrospective study compared the outcomes of consecutive patients who received PCN with catheters equipped with Mac-Loc versus those with catheters without Mac-Loc. Catheter failure was the primary endpoint of the study and was defined as all cases of catheter malfunction after PCN. A propensity score was calculated from covariates based on clinical variables, and patients in each group were matched 1:1 based on the propensity score.
Results: During the follow-up period, a total of 289 cases underwent PCN, 72 with catheters equipped with Mac-Loc and 217 without Mac-Loc. Failure of the catheter occurred in 63 cases (22%). There were 44 cases (70%) of slippage, 18 cases (29%) of obstruction, and 1 case (2%) of catheter rupture. After propensity score matching, catheter failure–free survival was significantly higher in the group with catheters equipped with Mac-Loc than in the group without Mac-Loc (P = .003).
Conclusions: The use of catheters equipped with Mac-Loc for PCN reduces the risk of unintentional catheter slippage.
Objective: Included foreign bodies of a metallic nature are commonly found. They are often small, asymptomatic, with few or non-visible scars or even clinically invisible. Sometimes the patient does not remember their existence. The condition is benign and does not require special attention, unless a magnetic resonance imaging scan is necessary. Indeed, magnetic field interactions could pose significant risks, and the procedure is typically contraindicated unless the ferromagnetic foreign body (FFB) has been previously removed. For such purposes, the magnet that is commonly used in breast and plastic surgery units for breast expanders port injection site identification could represent a time-saving and cost-effective solution.
Methodology: This paper presents an alternative technique based on off-label application of the breast expander magnet to localize FFBs.
Results: Between April 2023 and June 2023, the breast expander magnet allowed successful pre-operative localisation and intra-operative guidance for removal of FFBs in four clinical cases. The post-operative ultrasound confirmed the absence of metal residues after the procedure in all cases.
Conclusion: Off-label application of the breast expander magnet allows for FFB pre-operative localisation and safe intra-operative surgical guidance, thus representing a promising off-label application of the device. After surgical removal of FFBs, the magnetic resonance imaging is allowed without any risk.
Paraganglioma of the thyroid gland is a rare disease entity, with only a handful of cases documented in the literature. We report on a middle-aged man with thyroid paraganglioma that presented as an incidental finding on the computed tomography scan of the thorax. Preoperative fine-needle aspiration cytology (FNAC) was suggestive of a neuroendocrine tumour. Hemithyroidectomy was performed and histological findings were most compatible with paraganglioma arising from the thyroid gland. The diagnosis of primary thyroid paraganglioma is rarely established by FNAC preoperatively due to architectural similarities with other thyroid tumours; the most important clinical technique for differentiating thyroid paraganglioma from other histology is immunohistochemistry. According to the literature, the first-line treatment for primary thyroid paraganglioma is surgical resection. The prognosis following surgical resection is generally good.
The eponym ‘Valentino's syndrome’ is used to describe patients with perforated peptic ulcer disease who present with right lower quadrant pain and suspected appendicitis. It is named for Rudolph Valentino, the film star who died on 23 August 1926 at the age of 31 from complications of perforated peptic ulcer disease. In the early 1920s, the Italian-born actor had a meteoric rise to fame in the burgeoning film industry. His first starring role in the 1921 silent film, The Four Horseman of the Apocalypse, was a sensation and was followed quickly by a string of commercially successful movies. He was in good health until he presented with an acute abdomen in early August of 1926. He underwent a laparotomy and was found to have a perforated peptic ulcer that was repaired with simple closure and an omental patch. He initially rallied after surgery but ultimately died on the eighth post-operative day from complications of sepsis. This manuscript will review Valentino's brief acting career, his medical history, and how the eponym which bears his name describes a disease presentation that is different from his actual clinical course.