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- 저자 : Bishnoi Sukhram (검색결과 2 건)
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Meta-Analysis of Limited Thymectomy versus Total Thymectomy for Masaoka Stage I and II Thymoma
Pulle Mohan Venkatesh,Asaf Belal Bin,Puri Harsh Vardhan,Bishnoi Sukhram,Arvind Kumar 대한흉부외과학회 2021 Journal of Chest Surgery (J Chest Surg) Vol.54 No.2
Background: This meta-analysis aimed to evaluate the incidence of tumor recurrence, postoperative myasthenia gravis, postoperative complications, and overall survival after limited versus total thymectomy for Masaoka stage I and II thymoma. Methods: A systematic search of the literature was conducted using the PubMed, Em- base, MEDLINE, and Cochrane databases to identify relevant studies that compared limited and total thymectomy in Masaoka stage I–II patients. The quality of the included obser- vational studies was assessed using the Newcastle-Ottawa Scale. The results of the me- ta-analysis were expressed as log-transformed odds ratios (log ORs), with 95% confidence intervals (CIs). Results: Seven observational studies with a total of 2,310 patients were included in the meta-analysis. There was an overall non-significant difference in favor of total thymectomy in terms of tumor recurrence (pooled log OR, 0.40; 95% CI, -0.07 to 0.87; p=0.10; I2=0%) and postoperative myasthenia gravis (pooled log OR, 0.12; 95% CI, -1.08 to 1.32; p=0.85; I2=22.6%). However, an overall non-significant difference was found in favor of limited thymectomy with respect to postoperative complications (pooled log OR, -0.21; 95% CI, -1.08 to 0.66; p=0.64; I2=36.1%) and overall survival (pooled log OR, -0.01; 95% CI, -0.68 to 0.66; p=0.98; I2=47.8%). Conclusion: Based on the results of this systematic review and meta-analysis, limited thymectomy as a treatment for stage I and II thymoma shows similar oncologic outcomes to total thymectomy.
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Predictors of Mortality after Surgery for Empyema Thoracis in Chronic Kidney Disease Patients
Mohan Venkatesh Pulle,Harsh Vardhan Puri,Belal Bin Asaf,Sukhram Bishnoi,Manish Malik,Arvind Kumar 대한흉부외과학회 2020 Journal of Chest Surgery (J Chest Surg) Vol.53 No.6
Background: Surgical treatment of empyema thoracis in patients with chronic kidney disease is challenging, and few studies in the literature have evaluated this issue. In this study, we aim to report the surgical outcomes of empyema and to analyze factors predict- ing perioperative mortality in patients with chronic kidney disease. Methods: This retrospective study included data from 34 patients with chronic kidney disease (estimated glomerular filtration rate <60 mL/min/1.73 m2 for 3 or more months) who underwent surgery for empyema between 2012 and 2020. An analysis of demo- graphic characteristics and perioperative variables, including complications, was carried out. Postoperative mortality was the primary outcome measure. Results: Patients’ age ranged from 20 to 74 years with a 29-to-5 male-female ratio. The majority (n=19, 55.9%) of patients were in end-stage renal disease (ESRD) requiring main- tenance hemodialysis. The mean operative time was 304 minutes and the mean intraop- erative blood loss was 562 mL. Postoperative morbidity was observed in 70.5% of patients (n=24). In the subgroup analysis, higher values for operative time, blood loss, intensive care unit stay, and complications were found in ESRD patients. The mortality rate was 38.2% (n=13). In the univariate and multivariate analyses, poor performance status (East- ern Cooperative Oncology Group >2) (p=0.03), ESRD (p=0.02), and late referral (>8 weeks) (p<0.001) significantly affected mortality. Conclusion: ESRD, late referral, and poor functional status were poor prognostic factors predicting postoperative mortality. The decision of surgery should be cautiously assessed given the very high risk of perioperative morbidity and mortality in these patients.
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