No abstract

Patient's education, high index of suspicion, and an aggressive surgical approach is needed if the outcome among the elderly population is to be improved.

Purpose The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources. Methods This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis. Results 1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET. Discussion This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.

Introduction: Gastroesophageal reflux disease (GERD) has been the main health concern in the last few years, both in term of quality of life and symptomatology and also causing longterm health concern like cancer. In our current practice laparoscopic Nissen fundoplication is the most commonly performed operative procedure for reflux disease. Aim and methodology: We performed our review to predict the future of robot-assisted laparoscopic fundoplication (RALF) by looking at this new technology from different angles namely, comparison with conventional laparoscopic Nissen fundoplication (CLF), in term of operative complications and postoperative outcome, training aspect of RALF, application in complicated cases and difficult tasks, and also in pediatric population. Conclusion: We are in the opinion that there is a promising future for RALF, despite the increased cost and longer operation time. It has been found that RALF can function better in smaller spaces and more capable in finer dissection and it has shorter and steeper learning curve. The time and the cost issue is expected to reduce with further development and upgrades of the robotic surgery, and increase in surgeons experience in RALF. Therefore, we think the trend should be more toward RALF as a future of antireflux surgery.

No abstract