Partial versus total adrenalectomy for pheochromocytoma: a population-based comparison of outcomes.
International urology and nephrology
PURPOSE: The literature assessing outcomes of partial adrenalectomy (PA) among patients with pheochromocytoma patients is largely limited to isolated, single-institution series. We aimed to perform a population-level comparison of outcomes between patients undergoing PA versus those undergoing total adrenalectomy (TA).METHODS: The Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) was queried to identify adults with pheochromocytoma who underwent either PA or TA. Survival was assessed using multivariable Cox proportional hazards regression, Fine and Gray competing-risks regression, propensity score matching, Kaplan-Meier analysis, and cumulative incidence plots.RESULTS: 286 patients (PA: 101, TA: 185) were included in this study. As compared to those undergoing TA, patients undergoing PA had fewer tumors≥8cm in size (28.7% versus 42.7%, p=0.048) and were more likely to have localized disease (61.4% versus 44.3%, p=0.01). In multivariable analysis, patients undergoing PA demonstrated similar all-cause mortality (HR=0.71, 95% CI 0.44-1.14, p=0.16) and cancer-specific mortality (HR=0.64, 95% CI 0.35-1.17, p=0.15) compared to those who underwent TA. Following 1:1 propensity score matching, Kaplan-Meier analysis revealed no difference in overall survival between PA and TA groups (p=0.26) nor was there a difference in the cumulative incidence of cancer-specific mortality (p=0.29).CONCLUSIONS: In this first population-level comparison of outcomes among patients with pheochromocytoma undergoing PA and those undergoing TA, we found no long-term differences in any survival metric between groups. PA circumvents the need for lifelong corticoid replacement therapy and remains a promising option for patients with bilateral or recurrent pheochromocytoma.
View details for DOI 10.1007/s11255-021-03004-4
View details for PubMedID 34623590
Comparing Outcomes of Wise-Pattern, Two-Stage Breast Reduction-Reconstruction with and without Acellular Dermal Matrix.
Plastic and reconstructive surgery
2021; 148 (3): 511-521
BACKGROUND: Aesthetic results in breast reconstruction for ptotic/obese breasts may be improved when using Wise-pattern closures compared with nipple-sparing mastectomies. In two-stage reconstruction, acellular dermal matrix is commonly used to support the prosthesis. This study tests the efficacy of an alternate technique that uses deepithelialized excess breast skin in lieu of acellular dermal matrix. To better understand whether acellular dermal matrix is necessary, the authors compared postoperative outcomes from reduction-reconstructions that used matrix to those that did not.METHODS: The authors retrospectively reviewed the outcomes of patients who underwent staged breast reconstruction following Wise-pattern closures between September of 2016 and October of 2019. Two cohorts were created based on whether acellular dermal matrix was used. Charts were reviewed for incidence of postoperative complications.RESULTS: A total of 164 breasts were reconstructed in 85 female patients. The acellular dermal matrix cohort consisted of 68 breasts, whereas the non-acellular dermal matrix cohort included 96 breasts. After the first stage, the incidence of one or more complications was similar between cohorts (acellular dermal matrix, 32.4 percent; nonmatrix, 35.4 percent; p = 0.684). Minor infection rates were significantly higher in reconstructions using acellular dermal matrix (16.2 percent versus 6.3 percent; p = 0.040). After the second stage, the complication incidence was also similar between cohorts (acellular dermal matrix, 16.2 percent; nonmatrix, 13.5 percent; p = 0.638). Final follow-up time was 445.2 days.CONCLUSIONS: Overall complication rates following both stages of reconstruction were similar with and without acellular dermal matrix. When acellular dermal matrix was used, minor infection rates were higher following expander placement. In patients desiring a reduction-reconstruction, the authors find the deepithelialized dermal flap provides ample prosthesis support, without the need for acellular dermal matrix..CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
View details for DOI 10.1097/PRS.0000000000008298
View details for PubMedID 34432681
PROSTERIA: A CLAIMS-BASED STUDY OF DEMOGRAPHIC AND TEMPORAL TRENDS IN FREQUENT PROSTATE SPECIFIC ANTIGEN TESTING
LIPPINCOTT WILLIAMS & WILKINS. 2021: E851
View details for Web of Science ID 000693689000201
REAL-WORLD VALIDATION AND GENERALIZABILITY OF A PSAK PREDICTION TOOL FOR ACTIVE SURVEILLANCE RECLASSIFICATION
LIPPINCOTT WILLIAMS & WILKINS. 2021: E1094-E1095
View details for Web of Science ID 000693689000678
- Assessing abdominoplasty aesthetics in women with eye-tracking technology-do patients see things differently? EUROPEAN JOURNAL OF PLASTIC SURGERY 2021
Assessing Gaze Patterns in Common Cosmetic Procedures With Eye-Tracking Technology.
Annals of plastic surgery
2020; 84 (5S Suppl 4): S268–S272
Understanding the salient features that draw focus when assessing aesthetics is important for maximizing perceived outcomes. Eye-tracking technology provides an unbiased method for determining the features that draw attention when evaluating aesthetic plastic surgery. This study aimed to characterize viewing patterns of plastic surgery patients and laypeople when assessing facial cosmetic procedure images.Twenty women who previously underwent cosmetic procedures and twenty women without a history of cosmetic procedures were shown sixteen pairs of preprocedure and postprocedure images of patients who underwent laser resurfacing or lip augmentation. Image pairs were randomized to whether preprocedural or postprocedural images came first. Participants viewed each image until they decided upon an aesthetic rating (scored 1-10), while an eye-tracking device recorded participants' gaze.The patient group's average ratings were 8.2% higher for preprocedural images and 13.3% higher for postprocedural images (P < 0.05 for both). The patient group spent 20.4% less time viewing images but spent proportionally more time evaluating the relevant features of each procedure (41.7% vs 23.3%, P < 0.01), such as the vermillion border of the upper lip, labial commissure, or periorbital region (P < 0.05 for each). For both groups, the most common site of first fixation was the nose for laser resurfacing images (26.6%) and the labial commissure for lip augmentation images (37.7%). Both groups spent more time fixated on nasolabial folds, marionette lines, and the periorbital region when viewing pre-laser resurfacing images than postprocedural images. Overall, each group had similar viewing patterns for time to first fixation on and frequency of fixations for a particular feature.Women who previously underwent cosmetic procedures view postprocedural images more favorably and require less time to assess images, likely related to familiarity with aesthetic procedures. These women spend more time fixated on relevant features, such as the vermillion border of the upper lip, the labial commissure, and the periorbital region, than the control group. Notably, each group spent less time focused on regions associated with wrinkles, such as the marionette and periorbital areas in post-laser resurfacing images, suggesting that the procedure reduces attention-drawing features in these areas.
View details for DOI 10.1097/SAP.0000000000002387
View details for PubMedID 32294074