Introduction Adjuvant therapy is recommended in duodenal adenocarcinoma (DA), but the role of neoadjuvant therapy remains undefined. We compared the effect of neoadjuvant therapy to adjuvant therapy on overall survival, 30-day, and 90-day mortality following the resection of DA. Methods A retrospective review of the National Cancer Database was performed on patients with DA who received either adjuvant or neoadjuvant therapy in addition to surgical resection. Propensity score matching was done for patient, socioeconomic, and tumor characteristics. Overall survival, 30-day, and 90-day mortality were compared. Results A total of 112 patients were identified; 55 received adjuvant therapy; 57 received neoadjuvant therapy. There was no difference in 30-day (0% vs. 1.75%; P = 1.00), 90-day mortality (1.82% vs. 7.02%; P = .36), nor overall survival (1 yr: 86% vs. 76; 3 yr: 49% vs. 46%; 5 yr: 42% vs. 39%; P = .28). Conclusions There was no difference in overall survival after propensity score matched analysis.
Periprosthetic joint infection (PJI) is a rare postoperative complication that is treated with antibiotic spacers. Some patients develop severe, treatment‐resistant, chronic PJI despite multiple attempts at salvaging the joint. Permanent resection of the joint or amputation may be the only definitive treatment. The purpose of this study is to describe the outcomes, infection resolution rate, and complications of two‐stage revision, utilizing extensive resection of the affected bone and application of antibiotic megaspacers as a modality for limb‐salvage. A review of 12 patients, initially referred for amputation due to chronically failed PJI, was conducted. All patients underwent extensive resection of the bone and surgical implantation of a custom‐made antibiotic megaspacer between December 2016 and June 2019. Thirteen megaspacers were placed in 13 infected joints in 12 patients with a history of chronic PJI. Six patients (50%) had a diagnosis of osteomyelitis. Eradication of the infection leading to limb‐salvage was successful in nine patients. Visual Analog Scale pain scores improved by 3.5, or 50%, after two‐stage revision with megaprosthesis reimplantation (p = .008), and six patients (54.5%) had improvement in ambulation. Complication rates, not including reinfection or recurrence, following megaspacer and megaprosthesis reimplantation were 58.3% and 27.3%, respectively. One patient underwent amputation due to a life‐threatening infection while two other patients underwent amputation due to debilitating complications following limb‐salvage surgery. Statement of Clinical Significance: In patients whose PJI becomes treatment‐resistant after multiple failed attempts at traditional two‐stage exchange, performing extensive boney resection with placement of an antibiotic‐laden megaspacer can be an effective method of achieving limb‐salvage.
Objectives We present a case of a 59-year-old male with an actively bleeding aortoenteric fistula (AEF) that was temporized using an endovascular stent prior to staged open reconstruction. Methods Verbal informed consent was given by the patient’s family for publication of this case report. The patient presented with pulseless electrical activity secondary to hemorrhagic shock due to a massive gastrointestinal bleed. His past surgical history included an aortobifemoral bypass (ABFB) that subsequently underwent extra-anatomic reconstruction with right axillofemoral artery bypass for right femoral infected pseudoaneurysm. Two months prior to presentation, he underwent a second revision with in-situ reconstruction for left limb graft infection. CTA now demonstrated actively bleeding AEF. He was emergently treated with endovascular stenting. Once stabilized, a two-stage revision with extra-anatomic bypass and aortic stump closure for management of his AEF was performed. Result The patient was adequately stabilized using endovascular techniques followed by two-stage revision but unfortunately expired secondary to septic shock 20 days postoperatively. Conclusion This case highlights the utility of endovascular stent graft to successfully obtain hemodynamic stability and optimization prior to open repair of AEFs.
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