Search

Background: Hypopharyngeal carcinoma is likely to spread to the lymph nodes, but there is no established strategy for management in transoral surgery. Methods: We compared oncologic and functional outcomes in a retrospective multicenter study of patients who underwent transoral surgery for hypopharyngeal carcinoma between 2015 and 2021. Results: Two‐hundred and thirty‐two patients were included. Comparing patients with and without adjuvant radiotherapy, 3‐year regional recurrence‐free survival (RRFS) was not significantly different in pN2b and pN2c, but was significantly worse in pN3b without adjuvant radiotherapy. In patients without neck dissection, the 3‐year RRFS was 85.6%, 76.8%, and 70.0% for T1, T2, and T3 primary lesions, respectively, and was significantly worse for T2 or higher (p = 0.035). Conclusions: In the absence of extracapsular invasion, regional control did not deteriorate without adjuvant therapy. If prophylactic neck dissection is not performed, careful follow‐up is necessary if the primary lesion is T2 or greater. [ABSTRACT FROM AUTHOR]

Purpose: The impact of preoperative patent inferior mesenteric artery (IMA) on late outcomes following endovascular aneurysm repair (EVAR) remains unclear. This study aimed to investigate the specific influence of IMA patency on 7-year outcomes after EVAR. Materials and Methods: In this retrospective cohort study, 556 EVARs performed for true abdominal aortic aneurysm cases between January 2006 and December 2019 at our institution were reviewed. Endovascular aneurysm repairs performed using a commercially available device with no type I or type III endoleak (EL) during follow-up and with follow-up ≥12 months were included. A total of 336 patients were enrolled in this study. The cohort was divided into the patent IMA group and the occluded IMA group according to preoperative IMA status. The late outcomes, including aneurysm sac enlargement, reintervention, and mortality rates, were compared between both groups using propensity-score-matched data. Results: After propensity score matching, 86 patients were included in each group. The median follow-up period was 56 months (interquartile range: 32–94 months). The incidence of type II EL at discharge was 50% in the patent IMA group and 19% in the occluded IMA group (p<0.001). The type II EL from IMA and lumbar arteries was significantly higher in the patent IMA group than in the occluded IMA group (p<0.001 and p=0.002). The rate of freedom from aneurysm sac enlargement with type II EL was significantly higher in the occluded IMA group than in the patent IMA group (94% vs 69% at 7 years; p<0.001). The rate of freedom from reintervention was significantly higher in the occluded IMA group than in the patent IMA group (90% vs 74% at 7 years; p=0.007). Abdominal aortic aneurysm–related death and all-cause mortality did not significantly differ between groups (p=0.32 and p=0.34). Conclusions: Inferior mesenteric artery patency could affect late reintervention and aneurysm sac enlargement but did not have a significant impact on mortality. Preoperative assessment and embolization of IMA might be an important factor for improvement in late EVAR outcomes. Clinical Impact: The preoperative patency of the inferior mesenteric artery was significantly associated with a higher incidence of sac enlargement and reintervention with type II endoleak following endovascular aneurysm repair, even after adjustment for patient background. Preoperative assessment and embolization of inferior mesenteric artery might be an important factor for improvement in late EVAR outcomes. [ABSTRACT FROM AUTHOR]

Background: Late laryngopharyngeal cancers after transoral surgery include not only local recurrences but also metachronous multiple cancers. Methods: We compared clinical information, surgical outcomes, and late laryngopharyngeal cancers in patients who underwent transoral nonrobotic surgery for laryngopharyngeal squamous cell carcinoma without lymph node metastases between 2015 and 2021 in a multicenter retrospective study. Results: Four hundred and fifty‐seven patients were included. Positive surgical margins were found in 121 patients (26.5%). Twenty‐two patients (4.8%) received additional treatment. Positive horizontal margins of invasive carcinoma (p = 0.003) and positive horizontal margins of carcinoma in situ only (p = 0.032) were independent risk factors for local recurrence, and prior radiotherapy (p = 0.001) for metachronous multiple cancers. Local control was significantly worse without additional treatment (p = 0.049), but there was no significant difference in survival. Conclusions: Patients with positive margins had an increased frequency of local recurrence, but salvage therapy was effective. [ABSTRACT FROM AUTHOR]

Sound speed reconstruction has been investigated for quantitative evaluation of tissue properties in breast examination. Full waveform inversion (FWI), a mainstream method for conventional sound speed reconstruction, is an iterative method that includes numerical simulation of wave propagation, resulting in high computational cost. In contrast, high-speed reconstruction of sound speed using a deep neural network (DNN) has been proposed in recent years. Although the generalization performance is highly dependent on the training data, how to generate data for sufficient generalization performance is still unclear. In this study, the quality and generalization performance of DNN-based sound speed reconstruction with a ring array transducer were evaluated on a natural image-derived dataset and a breast phantom dataset. The DNN trained on breast phantom data (BP-DNN) could not reconstruct the structures on natural image data with diverse structures. On the other hand, the DNN trained on natural image data (NI-DNN) successfully reconstructed the structures on both natural image and breast phantom test data. Furthermore, the NI-DNN successfully reconstructed tumour structures in the breast, while the BP-DNN overlooked them. From these results, it was demonstrated that natural image data enables DNNs to learn sound speed reconstruction with high generalization performance and high resolution. [ABSTRACT FROM AUTHOR]

Objective: End‐flexible‐rigidscopic transoral surgery (E‐TOS) is a new and minimally invasive transoral surgery for resection of Tis‐selected T3 pharyngolaryngeal cancers. We evaluated long‐term oncological outcomes and whether postoperative voice and swallowing function were preserved following E‐TOS. Methods: In this retrospective single‐center study, 154 patients treated with E‐TOS using a curved retractor, flexible‐tip rigid endoscope, and thin curved instruments were included. Their survival rate, larynx preservation rate, and disease control rate were estimated using the Kaplan–Meier method. Postoperative voice function was evaluated using both objective and subjective tests. Postoperative swallowing function was assessed using the Hyodo score and the functional outcome swallowing scale. Results: The 3‐year and 5‐year overall survival, disease‐specific survival, disease‐free survival, laryngectomy‐free survival, local control, and loco‐regional control rates post E‐TOS were 89.8% and 82.2%, 95.6% and 92.3%, 78.5% and 70.3%, 87.2% and 80.9%, 93.9% and 92.5%, and 87.2% and 85.7%, respectively. Both objective and subjective postoperative voice and swallowing function tests were within normal limits in more than 90% of the patients. Conclusion: E‐TOS is an effective, safe, low‐cost, and minimally invasive transoral surgery for Tis‐selected T3 pharyngolaryngeal cancer; it also preserves postoperative voice, larynx, and swallowing function. Level of Evidence: 4 Laryngoscope, 133:1415–1424, 2023 End‐flexible‐rigidscopic transoral surgery (E‐TOS) is a safe procedure for pharyngolaryngeal cancer resection, with a low postoperative complication rate. E‐TOS provides excellent oncological outcomes and functional preservation. [ABSTRACT FROM AUTHOR]

Purpose: Zone 0 landing in thoracic endovascular aortic repair (TEVAR) has recently gained increasing attention for the treatment of high-risk patients. The aim of this study was to compare the outcomes of total endovascular aortic arch repair between branched TEVAR (bTEVAR) and chimney TEVAR (cTEVAR) in the landing zone (LZ) 0. Materials and Methods: This was a single-center, retrospective, and observational cohort study. From January 2010 to March 2020, 40 patients (bTEVAR, n=25; cTEVAR, n=15; median age: 79 years) were enrolled in this study, with a median follow-up period of 4.1 years. These patients were considered unsuitable for open surgical treatment. Results: All procedures were successful and no cases of conversion to open repair were noted during the 30-day postoperative period. The 30-day mortality was 2.5% (n=1; bTEVAR [0 of 25, 0%] vs cTEVAR [1 of 15, 6.7%]; p=0.375), the perioperative stroke rate was 10.0% (n=4; bTEVAR [4 of 25, 16.0%] vs cTEVAR [0 of 15, 0%], p=0.278), and type 1a endoleak rate was 15.0% (n=6; bTEVAR [0 of 25, 0%] vs cTEVAR [6 of 15, 40.0%], p=0.001). The risk factor for stroke was atheroma grade of ≥2 in the brachiocephalic artery (p<0.001). The risk factor for type 1a endoleak was cTEVAR (p=0.001). The 8-year survival rate was 49.9%. The aorta-related death-free rate and aortic event-free rate at 8 years were 94.4% (bTEVAR: 95.5% vs cTEVAR: 93.3%, p=0.504) and 60.7% (bTEVAR: 70.7% vs cTEVAR: 40.0%, p=0.048), respectively. Conclusions: Total endovascular aortic arch repair using bTEVAR and cTEVAR is feasible for the treatment of aortic arch diseases in high-risk patients who are unsuitable for open surgery. However, as the rate of stroke is high, strict preoperative evaluation to prevent stroke is needed. No rupture of the aneurysm was observed in cTEVAR, but patients should be selected carefully because of the high incidence of type 1a endoleak. [ABSTRACT FROM AUTHOR]