OBJECTIVE: Patients with deep-seated arteriovenous malformations (AVMs) have a higher rate of unfavorable outcome and lower rate of nidus obliteration after primary stereotactic radiosurgery (SRS). The aim of this study was to evaluate and quantify the effect of AVM location on repeat SRS outcomes. METHODS: This retrospective, multicenter study involved 505 AVM patients managed with repeat, single-session SRS. The endpoints were nidus obliteration, hemorrhage in the latency period, radiation-induced changes (RICs), and favorable outcome. Patients were split on the basis of AVM location into the deep (brainstem, basal ganglia, thalamus, deep cerebellum, and corpus callosum) and superficial cohorts. The cohorts were matched 1:1 on the basis of the covariate balancing score for volume, eloquence of location, and prescription dose. RESULTS: After matching, 149 patients remained in each cohort. The 5-year cumulative probability rates for favorable outcome (probability difference -18%, 95% CI -30.9 to -5.8%, p = 0.004) and AVM obliteration (probability difference -18%, 95% CI -30.1% to -6.4%, p = 0.007) were significantly lower in the deep AVM cohort. No significant differences were observed in the 5-year cumulative probability rates for hemorrhage (probability difference 3%, 95% CI -2.4% to 8.5%, p = 0.28) or RICs (probability difference 1%, 95% CI -10.6% to 11.7%, p = 0.92). The median time to delayed cyst formation was longer with deep-seated AVMs (deep 62 months vs superficial 12 months, p = 0.047). CONCLUSIONS: AVMs located in deep regions had significantly lower favorable outcomes and obliteration rates compared with superficial lesions after repeat SRS. Although the rates of hemorrhage in the latency period and RICs in the two cohorts were comparable, delayed cyst formation occurred later in patients with deep-seated AVMs.

• MeSH
• dospělí MeSH
• intrakraniální arteriovenózní malformace * chirurgie   radioterapie   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• radiochirurgie * metody   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

INTRODUCTION: Thoracic aorta false aneurysms (TAFA) are unexplored complications after cardiac surgery associated with significant morbidity and mortality. Therefore, the purpose of this study was to examine the clinical profiles, surgical techniques, and operative outcomes, of patients treated for TAFA at a single institution. METHODS: From 1996 to 2022, 112 patients were treated for aortic pseudoaneurysm (mean age 55 ± 14 years, 78 patients were male). In the majority of the patients (90%) TAFA developed after previous cardiovascular surgery, the most common diagnosis and surgical procedure preceding the TAFA development was an aortic dissection (52%) and Bentall procedure (47%). In the rest of the cohort, the leading cause was trauma. RESULTS: Sixty-one percent of patients were indicated for reintervention (surgical reoperation, endoluminal graft implantation, septal occluder implantation, coil embolization, or a combination of procedures). Overall, 52 patients had undergone cardiac reoperation. TAFA was resected and the aorta was repaired in 55% or replaced in 45%. Operative mortality was 5.7%. In postoperative follow-up, a hypoechogenic lesion encircling aortic prosthesis was present in 94%, therefore it was determined as a negative prognostic factor. The mean follow-up was 13.2 ± 19.4 years. CONCLUSION: Although there is no specific approach how to prevent TAFA development, maintaining normal blood pressure and regular follow-up should be applied. More frequent follow-ups should be performed in patients with a hypoechogenic lesion encircling and aortic prosthesis. Early detection during long-term postoperative follow-up, an individually tailored approach of a multidisciplinary team is necessary for favorable treatment outcomes.

• MeSH
• aneurysma hrudní aorty * chirurgie   MeSH
• aorta thoracica chirurgie   diagnostické zobrazování   MeSH
• časové faktory MeSH
• cévy - implantace protéz škodlivé účinky   MeSH
• dospělí MeSH
• endovaskulární výkony škodlivé účinky   MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepravé aneurysma * chirurgie   etiologie   diagnostické zobrazování   terapie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVE: We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external annuloplasty, according to aorta phenotype. METHODS: Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency (AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary aorta replacement (with or without hemiroot remodeling), and root remodeling with external subvalvular ring annuloplasty. RESULTS: Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years). At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30). BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%, P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation, compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively, at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio, 6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio, 1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029). CONCLUSIONS: BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes if both annulus and STJ are reduced and stabilized with external ring annuloplasty. Commissural angle <160° is not associated with reoperation if symmetrical repair is achieved.

• MeSH
• anuloplastika srdeční chlopně * škodlivé účinky   mortalita   metody   MeSH
• aortální aneurysma chirurgie   diagnostické zobrazování   mortalita   MeSH
• aortální chlopeň chirurgie   abnormality   diagnostické zobrazování   patofyziologie   MeSH
• aortální insuficience * chirurgie   patofyziologie   diagnostické zobrazování   mortalita   MeSH
• bikuspidální aortální chlopeň * chirurgie   patofyziologie   MeSH
• časové faktory MeSH
• chirurgická náhrada chlopně škodlivé účinky   přístrojové vybavení   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• pooperační komplikace etiologie   MeSH
• reoperace statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE: There is lack of evidence regarding the indication for re-transurethral resection of bladder tumor (reTURBT) for Ta high grade (HG) non-muscle invasive bladder cancer (NMIBC). This study aims to evaluate the oncological outcomes of patients with TaHG NMIBC to determine the benefit from performing reTURBT. METHODS: We relied on a multicenter cohort of 317 TaHG NMIBC from 12 centers who underwent TURBT and a subsequent complete Bacillus Calmette-Guérin induction from 2009 to 2021. Kaplan Meier analyses estimated recurrence free survival (RFS) and progression free survival (PFS) according to reTURBT. Sub-analyses evaluated PFS in patients with multiple risk factors indicating necessity for reTURBT according to international guidelines (multifocality, size > 3 cm, recurrent cancer, carcinoma in situ, lymph vascular invasion, histological variant, incomplete and absence of muscle layer at index TURBT). Multivariable cox-regression analysis predicted recurrence and progression. RESULTS: Of the 317 patients, 123 (39%) underwent reTURBT, while 194 (61%) did not. Residual disease was detected in 46% of cases, with a 3.2% upstaging rate. Median follow-up was 30 months. The 3-year RFS was higher in patients who underwent reTURBT (79% vs. 58%, p < 0.001), but no significant difference was observed in PFS. ReTURBT reduced the risk of recurrence [multivariable hazard ratio: 0.45, 95% Confidence interval (CI) 0.29-0.71]. Among patients who did not undergo reTURBT, those with ≥ 2 risk factors had lower 3-year PFS (73% vs. 92%, p < 0.001) than those with 0-1 risk factor, whereas no difference in 3-year PFS was observed in patients who underwent reTURBT regardless of the number of risk factors (85% vs. 87%, p = 0.8). CONCLUSION: ReTURBT demonstrated efficacy in reducing recurrence among patients with TaHG NMIBC, yet its impact on progression remained uncertain. Our study underscores the importance of adhering to current international guidelines, particularly for patients with multiple risk factors indicating necessity for reTURBT.

• MeSH
• cystektomie * metody   MeSH
• invazivní růst nádoru * MeSH
• lidé středního věku MeSH
• lidé MeSH
• lokální recidiva nádoru epidemiologie   MeSH
• nádory močového měchýře * chirurgie   patologie   MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stupeň nádoru MeSH
• transuretrální resekce močového měchýře MeSH
• uretra MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: High-level evidence supporting the role of repeat transurethral resection (reTUR) in non-muscle-invasive bladder cancer (NMIBC) is lacking. A randomized controlled trial (RCT) assessing whether immediate reTUR has an impact on patient prognosis is essential. However, since such a RCT will require enrollment of a high number of patients, a preliminary feasibility study is appropriate. OBJECTIVE: To assess the feasibility of an RCT investigating the impact of immediate reTUR + adjuvant bacillus Calmette-Guérin (BCG) versus upfront induction BCG after initial TUR in NMIBC. DESIGN, SETTING, AND PARTICIPANTS: Eligible patients were randomly assigned to receive either reTUR + adjuvant BCG or upfront induction BCG after TUR. Patients with macroscopically completely resected high-grade T1 NMIBC, with or without concomitant carcinoma in situ, and with detrusor muscle (DM) present in the initial TUR specimen were considered eligible for inclusion. Exclusion criteria included lymphovascular invasion (LVI), histological subtypes, hydronephrosis, concomitant upper tract urothelial carcinoma (UTUC), or urothelial carcinoma within the prostatic urethra. The aim was to enroll 30 patients in this feasibility study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The patient recruitment rate was the primary outcome. Oncological outcomes (recurrence-free and progression-free survival) were secondary endpoints. RESULTS AND LIMITATIONS: Overall, 30 patients (15 per arm) were randomized over a period of 14 mo (August 2020-October 2021). Two eligible patients refused the randomization, resulting in a patient compliance rate of 93.3% for the study protocol. We excluded 49 ineligible patients before randomization because of histological subtypes (n = 16, 33%), LVI (n = 9, 18%), DM absence in the TUR specimen (n = 12, 24%), metastatic disease (n = 5, 10%), concomitant UTUC (n = 3, 6%), or hydronephrosis (n = 4, 8%). At reTUR, persistent disease was found in four patients (29%) and upstaging to muscle-invasive disease in one (7%). Over median follow-up of 17 mo, disease recurrence was detected in three patients (23%) in the reTUR arm and six patients (40%) in the upfront BCG arm. Progression to muscle-invasive disease was observed in one patient treated with upfront BCG. CONCLUSIONS: The feasibility of conducting an RCT comparing upfront BCG versus reTUR + BCG in high-grade T1 NMIBC has been demonstrated. Our results underline the need to screen a large number of patients owing to characteristics meeting the exclusion criteria in a high percentage of cases. PATIENT SUMMARY: We found that a clinical trial of the role of a repeat surgical procedure to remove bladder tumors through the urethra would be feasible among patients with high-grade non-muscle-invasive bladder cancer. These preliminary results may help in refining the role of this repeat procedure for patients in this category.

• MeSH
• adjuvancia imunologická * terapeutické užití   MeSH
• BCG vakcína * terapeutické užití   aplikace a dávkování   MeSH
• cystektomie metody   MeSH
• invazivní růst nádoru * MeSH
• kombinovaná terapie MeSH
• lidé středního věku MeSH
• lidé MeSH
• nádory močového měchýře neinvadující svalovinu MeSH
• nádory močového měchýře * chirurgie   patologie   farmakoterapie   MeSH
• reoperace MeSH
• senioři MeSH
• studie proveditelnosti * MeSH
• uretra MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• randomizované kontrolované studie MeSH
• srovnávací studie MeSH

BACKGROUND AND OBJECTIVES: Trigeminal Neuralgia (TN) is a debilitating facial pain disorder, often necessitating surgical interventions when medication proves insufficient. Stereotactic Radiosurgery (SRS) is an established therapeutic option. Limited studies explored the feasibility of a third SRS procedure. Our study investigates the safety and efficacy of a third SRS procedure for recurrent TN. METHODS: We performed a retrospective analysis across multiple centers using databases collected prospectively. Pain status was evaluated utilizing the BNI Pain Intensity Scales. The Kaplan-Meier method was employed to estimate the time to recurrence, with group comparisons conducted using log-rank tests. Associations were explored using Chi-square and logistic regression models. RESULTS: Ten institutions contributed with a total of 35 patients. A third SRS revealed sustained effectiveness with a pain control rate of 82.7%. The median time to recurrence was 35.5 months. New sensory dysfunction following the third procedure occurred in 22% of patients who had preserved sensory function after the second procedure. When considering those who developed sensory dysfunction after the second procedure, 40% of the entire cohort was affected. There were no significant differences in pain recurrence intervals among the three procedures. A meta-analysis, combining data from previous studies, showed that 89.6% of patients achieved some degree of pain control after a third SRS, with 27.4% experiencing new sensory dysfunction and a median time to recurrence of 31.6 months. CONCLUSION: Our study, the largest on the topic, affirms the sustained effectiveness of a third SRS for TN, providing comparable pain relief to initial procedures. Notably, an extended pain-free interval after the third SRS session was observed. Facial sensory dysfunction emerged as the primary side effect. Larger studies are warranted to explore correlations with demographics and treatment parameters for a comprehensive understanding of repeat SRS in managing recurrent TN.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• neuralgie trigeminu * chirurgie   MeSH
• radiochirurgie * metody   škodlivé účinky   MeSH
• recidiva * MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

BACKGROUND: Reduction mammoplasty is popular among people of various age groups, yet the impact of age on postoperative outcomes remains debated. METHODS: The American College of Surgeons National Surgical Quality Improvement Program (2008-2021) was queried to identify adult female patients who underwent reduction mammoplasty. Patients were categorized into 10-year age brackets (i.e., 18-29, 30-39, 40-49, 50-59, 60-69, and >70 years). We compared age-dependent 30-day outcomes via confounder-adjusted multivariate analyses. RESULTS: 40,958 female patients (mean age: 41 ± 14 years and mean body mass index: 31 ± 6.1 kg/m2) were identified. Complications occurred in 6.4% (n = 2635) of cases, with 770 (1.9%) and 483 (1.2%) patients requiring reoperation and readmission, respectively. 1706 (4.2%) women experienced surgical complications, whereas medical complications were generally rare (n = 289; 0.7%). Compared with women aged 18-29 years, risks of any, surgical, and medical complications were higher for patients aged 30-39 years (OR: 1.22, p < 0.01; OR: 1.05, p = 0.51; OR: 1.84, p < 0.01), 40-49 years (OR: 1.34, p < 0.01; OR: 1.17, p = 0.04; OR: 1.54, p = 0.03), 50-59 years (OR: 1.45, p < 0.01; OR: 1.31, p < 0.01; OR: 1.78, p < 0.01), 60-69 years (OR: 1.38 years, p < 0.01; OR: 1.29, p = 0.01; OR: 1.71, p < 0.01), and >70 years (OR: 1.25, p = 0.18; OR: 1.01, p = 0.98; OR: 1.86, p = 0.14). Patients aged >30 years were also more likely to require readmissions and reoperations. CONCLUSION: Patient age significantly affects outcomes after reduction mammoplasty, with the lowest risk in patients aged <30 years. Importantly, the association between age and postoperative morbidity was not linear. These findings can help guide informed decisions, recognizing that while age is a factor, it is not the sole determinant of risk.

• MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mamoplastika * metody   statistika a číselné údaje   škodlivé účinky   MeSH
• mladiství MeSH
• mladý dospělý MeSH
• pooperační komplikace * epidemiologie   MeSH
• reoperace * statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• věkové faktory MeSH
• výsledek terapie MeSH
• znovupřijetí pacienta statistika a číselné údaje   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Geografické názvy
• Spojené státy americké MeSH

BACKGROUND: Face transplantation has emerged as a viable solution for reconstructing the most complex facial injuries. Previous work has demonstrated that surgical revisions are necessary to optimize outcomes. The authors' group has updated the previous report of revisions in their cohort, quantified and described which revisions were performed for functional, aesthetic, or mixed indications, and described the rationale, safety, and long-term outcomes of these revisions. METHODS: A retrospective analysis of the authors' 10 face transplants from April of 2009 to February of 2023 was performed. The patients' medical records, preoperative facial defects, and operative reports (index and secondary revisions) were reviewed. RESULTS: Nine patients were included. One patient underwent irreversible acute-on-chronic allograft rejection and received a second face transplant. The average number of revisions was 5.2 per patient (range, 2 to 11 procedures). The median time interval from transplantation to first revision was 4 months (range, 1 to 21 months). Median follow-up was 106 months (range, 39 to 142 months). Most interventions consisted of debulking the allograft or revising the periorbital tissues. CONCLUSIONS: In the current study, the authors report longer-term data on revision procedures needed in face transplant recipients. Patients should expect to undergo revisions for both functional and aesthetic considerations. Although the majority of revisions are performed within 2 years after transplantation, revisions can be safely performed at any time point. Shared decision-making between the patient and provider team is essential in deciding which revisions are performed and when. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

• MeSH
• časové faktory MeSH
• dospělí MeSH
• estetika MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• poranění obličeje * chirurgie   MeSH
• rejekce štěpu MeSH
• reoperace * statistika a číselné údaje   MeSH
• retrospektivní studie MeSH
• transplantace obličeje * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS: This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS: Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS: AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.

• MeSH
• anuloplastika srdeční chlopně metody   MeSH
• aortální chlopeň * chirurgie   MeSH
• aortální insuficience * chirurgie   MeSH
• chirurgická náhrada chlopně metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• reoperace statistika a číselné údaje   MeSH
• replantace * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tendenční skóre * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

Cíl: Cílem této retrospektivní studie je ověřit, zda provedení vícečetné transuretrální resekce (reTUR) u pacientů s T1 uroteliálním karcinomem močového měchýře nevede ke zhoršení prognózy, dále zhodnotit význam jednotlivých prognostických faktorů při první a druhé reTUR. Metoda: Do retrospektivní studie bylo zařazeno celkem 363 pacientů s diagnózou T1 uroteliál- ního karcinomu v letech 2001 až 2022, z toho 260 pacientů podstoupilo aspoň jednu reTUR, u 103 pacientů nebyl reTUR proveden. Standartně v případě nálezu pT1 nádoru v TUR byla indikována reTUR až do doby, kdy byl výsledek histologie pT0, pTa, CIS nebo byl diagnostikován svalovinu infiltrující nádor (stadium pT2 a více). Ke srovnání jednotlivých skupin dle počtu reTUR jsme použili Kaplan-Meierovu metodu odhadu distribuční funkce přežití a Log-rank test. Vliv jednotlivých prognostických faktorů při vícečetné reTUR byl testován pomocí Coxova regresního modelu. Výsledky: Při srovnání skupin pacientů bez provedené reTUR se skupinou s jednou reTUR, se dvě- ma reTUR a se třemi a více reTUR nebyl v rámci celého souboru 363 pacientů zjištěn významný rozdíl v celkovém přežití (OS), pro nemoc specifickém přežití (DSS) a přežití bez progrese (PFS). Přežití bez recidivy (RFS) se významně prodlužovalo s počtem provedených výkonů (p = 0,02). Podání intravezikální léčby vakcínou BCG bylo v multivariantní analýze jediným z nezávislých prognostických faktorů ve vztahu k OS a PFS. U 147 pacientů s T1 uroteliálním karcinomem léčených intravezikální vakcínou BCG rovněž nebyl zjištěn významný rozdíl v OS (p = 0,72), DSS (p = 0,75), PFS (p = 0,76), ani RFS (p = 0,85) při srovnání odpovídajících skupin pacientů. Podání intravezikální léčby vakcínou BCG u pacientů s nálezem T0, Ta a CIS v reTUR významně souviselo s delším OS (p = 0,03) a PFS (p = 0,01). Nález karcinomu během první a druhé reTUR zvyšoval riziko budoucí recidivy. Závěr: Provedení další doby transuretrální resekce v případě opakovaného nálezu T1 karcinomu v reTUR je možné považovat za bezpečné. Dle našich dat, případné komplikace plynoucí z provedení další doby TUR či oddálení případné intravezikální terapie, nezhoršují OS. Nález nádoru při první a druhé reTUR je u pacientů s T1 karcinomem močového měchýře rizikem pro budoucí recidivu.

Aim: The aim of this retrospective study is to investigate whether multiple transurethral resection (reTUR) in patients with T1 urothelial carcinoma of the bladder leads to worse prognosis and to evaluate the significance of individual prognostic factors in the first and second reTUR. Methods: A total of 363 patients diagnosed with T1 urothelial carcinoma between 2001 and 2022 were included in this retrospective study, of whom 260 patients underwent at least one reTUR and 103 patients did not undergo reTUR. By default, if a pT1 tumor was found in TUR, reTUR was indicated until histology was pT0, pTa, CIS, or a muscle-infiltrating tumor was diagnosed (stage pT2 or more). We used the Kaplan-Meier survival distribution function estimation method and the log-rank test to compare each group according to the number of reTURs. The effect of individual prognostic factors in multiple reTUR was tested using Cox regression model. Results: When comparing the groups of patients without reTUR with the groups with one reTUR, two reTUR, and three or more reTUR, there was no significant difference in overall survival (OS), disease-specific survival (DSS), and progression-free survival (PFS) in the entire cohort of 363 patients. Recurrence-free survival (RFS) significantly increased with the number of procedures performed (p = 0.02). Administration of intravesical BCG vaccine was the only independent prognostic factor in multivariate analysis in relation to OS and PFS. In 147 patients with T1 urothelial carcinoma treated with intravesical BCG vaccine, there was also no significant difference in OS (p = 0.72), DSS (p = 0.75), PFS (p = 0.76), or RFS (p = 0.85) when comparing matched groups of patients. Administration of intravesical BCG vaccine in patients with T0, Ta and CIS findings in reTUR was significantly associated with longer OS (p = 0.03) and PFS (p = 0.01). Finding cancer during the first and second reTUR increased the risk of future recurrence. Conclusion: Performing an additional period of transurethral resection in case of recurrence of T1 carcinoma at reTUR can be considered safe. According to our data, potential complications resulting from performing an additional TUR period or delaying any intravesical therapy do not worsen OS. Tumor finding at first and second reTUR is a risk for future recurrence in patients with T1 bladder cancer.

• MeSH
• BCG vakcína MeSH
• karcinom z přechodných buněk chirurgie   MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony metody   MeSH
• nádory močového měchýře * chirurgie   MeSH
• prognóza MeSH
• reoperace MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• transuretrální resekce močového měchýře * metody   MeSH
• Check Tag
• lidé MeSH