Background: High- risk neuroblastoma (NB; age, > 1 year; INSS stage 4) is associated with a poor outcome. At our institution, the current dose- intensive high- risk Children’ s Oncology Group protocol for advanced...Background: High- risk neuroblastoma (NB; age, > 1 year; INSS stage 4) is associated with a poor outcome. At our institution, the current dose- intensive high- risk Children’ s Oncology Group protocol for advanced NB appears to have a higher surgical complication rate as compared with previous protocols. Methods: All stage 4 patients (n = 51) entered in high- risk protocols between 1995 and 2005 were analyzed. Patients in the current high- risk protocol, Children’ s Oncology Group A3973 (n = 22), were compared with those in the 2 previous protocols, CCG 3891 and POG 9341 (n = 29). Results: Patients were comparable in their mean age and tumor markers, including Shimada histology, MYCN amplification, 1p deletion, tumor origin, and extent of metastasis. However, transfusion requirement (86% vs 45% ; P = 0.0019), postoperative infection rate (32% vs 3% ; P = 0.02), and other postoperative issues including nutritional support (45% vs 3% ; P = 0.0001) were significantly higher with the current protocol. No perioperative mortality was noted in either group, and the extent of resectability and margins were similar. Importantly, with the current protocol, the survival rate was higher (P = 0.0022) and the recurrence rate was significantly lower (P = 0.0003). Conclusions: Despite higher surgical morbidity associated with the current high- risk protocol (2.59 vs 0.86 complications/person; P < 0.01), the recurrence rate is lower and interim survival rate is improved for patients with high- risk NB. Therefore, the higher surgical complication rates associated with the current high- risk protocol are acceptable.展开更多
Aim of Study: Infants with repaired esophageal atresia and distal tracheoesophageal fistula (EA/TEF) are at risk for severe respiratory distress, which is related to tracheomalacia (TM), gastroesophageal reflux, or bo...Aim of Study: Infants with repaired esophageal atresia and distal tracheoesophageal fistula (EA/TEF) are at risk for severe respiratory distress, which is related to tracheomalacia (TM), gastroesophageal reflux, or both. This usually mandates an operation for TM and/or a fundoplication procedure (FP). Methods: We retrospectively performed a 26- year review of 288 patients with repaired EA/TEF. Research Ethic Board approval was obtained. Results: Postoperatively, 22 (7.6% ) infants with EA/TEF developed severe respiratory distress. Thirteen infants had an initial TM procedure and symptoms improved in 7 (54% ). The 6 (46% ) remaining patients with ongoing respiratory symptoms required an FP. Nine infants had an initial FP and the symptoms improved in 6 (67% ). The remaining 3 (33% ) patients with ongoing respiratory symptoms required a TM procedure. All patients improved with the second procedure. Several clinical parameters were assessed among the 4 patient groups (FP only, FP followed by TM procedure, TM procedure only, and TM procedure followed by FP); there were no significant differences noted. Conclusions: Whereas 54% to 67% of infants improved with a TM procedure or FP, 33% to 46% required both surgical procedures. No clinical parameters were identified that could predict which procedure should be performed first.展开更多
文摘Background: High- risk neuroblastoma (NB; age, > 1 year; INSS stage 4) is associated with a poor outcome. At our institution, the current dose- intensive high- risk Children’ s Oncology Group protocol for advanced NB appears to have a higher surgical complication rate as compared with previous protocols. Methods: All stage 4 patients (n = 51) entered in high- risk protocols between 1995 and 2005 were analyzed. Patients in the current high- risk protocol, Children’ s Oncology Group A3973 (n = 22), were compared with those in the 2 previous protocols, CCG 3891 and POG 9341 (n = 29). Results: Patients were comparable in their mean age and tumor markers, including Shimada histology, MYCN amplification, 1p deletion, tumor origin, and extent of metastasis. However, transfusion requirement (86% vs 45% ; P = 0.0019), postoperative infection rate (32% vs 3% ; P = 0.02), and other postoperative issues including nutritional support (45% vs 3% ; P = 0.0001) were significantly higher with the current protocol. No perioperative mortality was noted in either group, and the extent of resectability and margins were similar. Importantly, with the current protocol, the survival rate was higher (P = 0.0022) and the recurrence rate was significantly lower (P = 0.0003). Conclusions: Despite higher surgical morbidity associated with the current high- risk protocol (2.59 vs 0.86 complications/person; P < 0.01), the recurrence rate is lower and interim survival rate is improved for patients with high- risk NB. Therefore, the higher surgical complication rates associated with the current high- risk protocol are acceptable.
文摘Aim of Study: Infants with repaired esophageal atresia and distal tracheoesophageal fistula (EA/TEF) are at risk for severe respiratory distress, which is related to tracheomalacia (TM), gastroesophageal reflux, or both. This usually mandates an operation for TM and/or a fundoplication procedure (FP). Methods: We retrospectively performed a 26- year review of 288 patients with repaired EA/TEF. Research Ethic Board approval was obtained. Results: Postoperatively, 22 (7.6% ) infants with EA/TEF developed severe respiratory distress. Thirteen infants had an initial TM procedure and symptoms improved in 7 (54% ). The 6 (46% ) remaining patients with ongoing respiratory symptoms required an FP. Nine infants had an initial FP and the symptoms improved in 6 (67% ). The remaining 3 (33% ) patients with ongoing respiratory symptoms required a TM procedure. All patients improved with the second procedure. Several clinical parameters were assessed among the 4 patient groups (FP only, FP followed by TM procedure, TM procedure only, and TM procedure followed by FP); there were no significant differences noted. Conclusions: Whereas 54% to 67% of infants improved with a TM procedure or FP, 33% to 46% required both surgical procedures. No clinical parameters were identified that could predict which procedure should be performed first.
