10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Conclusions: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
CONCLUSIONS: 10-Year survival after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Combined Esophagogastrectomies: Survival Outcomes in Patients with Local Adva...Oleg Kshivets
CONCLUSIONS: 5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognos
Kshivets O. Esophageal and Cardioesophageal Cancer SurgeryOleg Kshivets
5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY SIGNIFICANTLY DEPENDED ON PHASE TRANSITION “EARLY-INVASIVE CANCER”, LYMPH NODE METASTASES AND CELL RATIO FACTORS
Gastric Cancer: 10-Year Survival
Kshivets Oleg Surgery Department, Roshal Hospital, Moscow, Russia
CONCLUSIONS: 10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Esophageal cancer patients’ survival after surgery significantly depended on cell ratio factors, blood cell circuit, biochemical factors, hemostasis system, adjuvant chemoimmunoradiotherapy, cancer characteristics, localization, anthropometric data
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 556 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2022 (m=415, f=141; esophagogastrectomies (EG) Garlock=287, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=167; adenocarcinoma=318, squamous=228, mix=10; T1=129, T2=115, T3=184, T4=128; N0=281, N1=70, N2=205; G1=157, G2=141, G3=258; early EC=110, invasive=446; only surgery=424, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1877±2221.6 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45%, 20 years – 33.4%, 30 years – 27%. 186 ECP lived more than 5 years (LS=4283.3±2412.6 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 227 ECP died because of EC (LS=631.8±323.4 days). AT significantly improved 5YS (60.3% vs. 42%) (P=0.0029 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and P PT early-invasive EC (rank=1); healthy cells/CC (2), erythrocytes/CC (3), PT N0—N12 (4) thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); leucocytes/CC (10); eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Combined Esophagogastrectomies: Survival Outcomes in Patients with Local Adva...Oleg Kshivets
CONCLUSIONS: 5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognos
Kshivets O. Esophageal and Cardioesophageal Cancer SurgeryOleg Kshivets
5-YEAR SURVIVAL OF ESOPHAGEAL AND CARDIOESOPHAGEAL CANCER PATIENTS AFTER RADICAL SURGERY SIGNIFICANTLY DEPENDED ON PHASE TRANSITION “EARLY-INVASIVE CANCER”, LYMPH NODE METASTASES AND CELL RATIO FACTORS
Gastric Cancer: 10-Year Survival
Kshivets Oleg Surgery Department, Roshal Hospital, Moscow, Russia
CONCLUSIONS: 10-Year survival of GCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC characteristics; 9) anthropometric data; 10) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Esophageal cancer patients’ survival after surgery significantly depended on cell ratio factors, blood cell circuit, biochemical factors, hemostasis system, adjuvant chemoimmunoradiotherapy, cancer characteristics, localization, anthropometric data
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 556 consecutive ECP (age=56.5±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2022 (m=415, f=141; esophagogastrectomies (EG) Garlock=287, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=167; adenocarcinoma=318, squamous=228, mix=10; T1=129, T2=115, T3=184, T4=128; N0=281, N1=70, N2=205; G1=157, G2=141, G3=258; early EC=110, invasive=446; only surgery=424, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1877±2221.6 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45%, 20 years – 33.4%, 30 years – 27%. 186 ECP lived more than 5 years (LS=4283.3±2412.6 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 227 ECP died because of EC (LS=631.8±323.4 days). AT significantly improved 5YS (60.3% vs. 42%) (P=0.0029 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.021). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and P PT early-invasive EC (rank=1); healthy cells/CC (2), erythrocytes/CC (3), PT N0—N12 (4) thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); leucocytes/CC (10); eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) tumor localization; 10) anthropometric data; 11) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common
cancers of the world and surgery is an effective treatment for that.
However, long-term complications, such as diarrhea, are the focus
on the postoperative quality of life. Until now, the etiologies of
diarrhea after esophagectomy are still ill-defined.
Analyses of Risk Factors of Diarrhea in Patients with Esophagectomysemualkaira
Esophageal cancer is one of the most common cancers of the world and surgery is an effective treatment for that. However, long-term complications, such as diarrhea, are the focus on the postoperative quality of life. Until now, the etiologies of diarrhea after esophagectomy are still ill-defined.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 557 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2023 (m=415, f=142; esophagogastrectomies (EG) Garlock=288, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=168; adenocarcinoma=319, squamous=228, mix=10; T1=130, T2=115, T3=184, T4=128; N0=282, N1=70, N2=205; G1=157, G2=142, G3=258; early EC=111, invasive=446; only surgery=425, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1876.9±2219.8 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45.5%, 20 years – 33.4%, 30 years – 26.9%. 187 ECP lived more than 5 years (LS=4271±2411.9 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (67.8% vs. 48.7%) (P=0.00084 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and
healthy cells/CC (rank=1), PT early-invasive EC (2); PT N0—N12 (3), erythrocytes/CC (4), thrombocytes/CC (5); stick neutrophils/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10); monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant ch
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP) (T1-4N0-2M0) was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 557 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2023 (m=415, f=142; esophagogastrectomies (EG) Garlock=288, EG Lewis=269, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=168; adenocarcinoma=319, squamous=228, mix=10; T1=130, T2=115, T3=184, T4=128; N0=282, N1=70, N2=205; G1=157, G2=142, G3=258; early EC=111, invasive=446; only surgery=425, adjuvant chemoimmunoradiotherapy-AT=132: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1876.9±2219.8 days and cumulative 5-year survival (5YS) reached 52%, 10 years – 45.5%, 20 years – 33.4%, 30 years – 26.9%. 187 ECP lived more than 5 years (LS=4271±2411.9 days), 99 ECP – more than 10 years (LS=5883±2296.6 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (67.8% vs. 48.7%) (P=0.00084 by log-rank test). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and
healthy cells/CC (rank=1), PT early-invasive EC (2); PT N0—N12 (3), erythrocytes/CC (4), thrombocytes/CC (5); stick neutrophils/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), eosinophils/CC (9), leucocytes/CC (10); monocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5)AT
5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC characteristics; 9) EC cell dynamics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...JohnJulie1
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...Oleg Kshivets
5-year survival of GCP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) GC cell dynamics; 9) GC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for GC are: 1) screening and early detection of GC; 2) availability of sufficient quantity of experienced abdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunotherapy for GCP with unfavorable prognosis.
Local Advanced Esophageal Cancer (T3-4N0-2M0): Artificial Intelligence, Syner...Oleg Kshivets
5YS of local advanced ECP after combined radical procedures significantly depended on: tumor characteristics, blood cell circuit, cell ratio factors, biochemical factors, hemostasis system, anthropometric data and adjuvant treatment. Optimal strategies for local advanced ECP are: 1) availability of very experienced thoracoabdominal surgeons because of complexity radical procedures; 2) aggressive en block surgery and adequate lymph node dissection for completeness; 3) precise prediction; 4) AT for ECP with unfavorable prognosis.
Esophageal Cancer: Artificial Intelligence, Synergetics, Complex System Analy...Oleg Kshivets
5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and treatment strategies for EC are: 1) screening and early detection of EC; 2) availability of experienced thoracoabdominal surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for ECP with unfavorable prognosis.
Kshivets Oleg Optimization of Management for Esophageal Cancer Patients (T1-...Oleg Kshivets
Optimization of Management for Esophageal Cancer Patients (T1-4N0-2M0).
Kshivets Oleg Surgery Department, Bagrationovsk Hospital, Bagrationovsk, Kaliningrad, Russia
ABSTRACT
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for esophageal cancer (EC) pa¬tients (ECP)(T1-4N0-2M0) - alive supersysems was analyzed. The importance must be stressed of using complex system analysis, artificial intelligence (neural networks computing), simulation modeling and statistical methods in combination, because the different approaches yield complementary pieces of prognostic information.
METHODS: We analyzed data of 563 consecutive ECP (age=56.6±8.9 years; tumor size=6±3.5 cm) radically operated (R0) and monitored in 1975-2024 (m=419, f=144; esophagogastrectomies (EG) Garlock=289, EG Lewis=274, combined EG with resection of pancreas, liver, diaphragm, aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy=170; adenocarcinoma=323, squamous=230, mix=10; T1=131, T2=119, T3=185, T4=128; N0=285, N1=71, N2=207; G1=161, G2=143, G3=259; early EC=112, invasive=451; only surgery=428, adjuvant chemoimmunoradiotherapy-AT=135: 5-FU+thymalin/taktivin+radiotherapy 45-50Gy). Multivariate Cox modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 1915.4±2284.8 days and cumulative 5-year survival (5YS) reached 52.6%, 10 years – 46.3%, 20 years – 33.3%, 30 years – 27.5%. 193 ECP lived more than 5 years (LS=4309.1±2507.4 days), 105 ECP – more than 10 years (LS=5860.8±2469.2 days). 228 ECP died because of EC (LS=629.8±324.1 days). AT significantly improved 5YS (69% vs. 49.1%) (P=0.0007 by log-rank test). 5YS of ECP of upper/3 was significantly better than others (65.3% vs.50.3%) (P=0.003). Cox modeling displayed that 5YS of ECP significantly depended on: phase transition (PT) N0—N12 in terms of synergetics, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), T, G, histology, age, AT, localization, prothrombin index, hemorrhage time, residual nitrogen, protein (P=0.000-0.019). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and healthy cells/CC (rank=1), PT N0—N12 (2), PT early-invasive EC (3), erythrocytes/CC (4), thrombocytes/CC (5); segmented neutrophils/CC (6), stick neutrophils/CC (7), lymphocytes/CC (8), eosinophils/CC (9), monocytes/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5-year survival of ECP after radical procedures significantly depended on: 1) PT “early-invasive cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) EC cell dynamics; 9) EC characteristics; 10) tumor localization; 11) anthropometric data; 12) surgery type. Optimal diagnosis and trea
5-year survival of GCP after radical procedures
significantly depended on: 1) PT “early-invasive
cancer”; 2) PT N0--N12; 3) Cell Ratio Factors; 4) blood
cell circuit; 5) biochemical factors; 6) hemostasis
system; 7) AT; 8) GC characteristics; 9) GC cell
dynamics; 10) tumor localization; 11) anthropometric
data; 12) surgery type. Best diagnosis and treatment
strategies for GC are: 1) screening and early detection
of GC; 2) availability of experienced abdominal
surgeons because of complexity of radical procedures;
3) aggressive en block surgery and adequate lymph
node dissection for completeness; 4) precise
prediction; 5) adjuvant chemoimmunotherapy for GCP
with unfavorable prognosis.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: PT early-invasive cancer; PT N0--N12; cell ratio factors; blood cell circuit; biochemical factors; hemostasis system; AT; LC characteristics; surgery type; anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
OBJECTIVE: 5-survival (5YS) and life span after radical surgery for non-small cell lung cancer (LC) pa¬tients (LCP) (T1-4N0-2M0) was analyzed.
METHODS: We analyzed data of 771 consecutive LCP (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated and monitored in 1985-2022 (m=662, f=109; upper lobectomies=278, lower lobectomies=178, middle lobectomies=18, bilobectomies=42, pneumonectomies=255, mediastinal lymph node dissection=771; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=194; only surgery-S=620, adjuvant chemoimmunoradiotherapy-AT=151: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=322, T2=255, T3=133, T4=61; N0=518, N1=131, N2=122, M0=771; G1=195, G2=243, G3=333; squamous=418, adenocarcinoma=303, large cell=50; early LC=215, invasive LC=556; right LC=413, left LC=358; central=291; peripheral=480. Variables selected for study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Regression modeling, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine significant dependence.
RESULTS: Overall life span (LS) was 2240.9±1748.8 days and cumulative 5-year survival (5YS) reached 73%, 10 years – 64.2%, 20 years – 43%. 503 LCP lived more than 5 years (LS=3126.6±1536 days), 145 LCP – more than 10 years (LS=5068.5±1513.2 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.7% vs.63.4%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.035). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), eosinophils/CC (4), erythrocytes/CC (5),healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data.
Survival of Lung Cancer Patients after Lobectomies was Significantly Superior...Oleg Kshivets
OBJECTIVE: This study aimed to determine surgery type influence for 5-year survival (5YS) of non-small cell lung cancer (LC) patients (LCP) after complete en block (R0) lobectomies and pneumonectomies.
METHODS: We analyzed data of 765 consecutive patients (age=57.6±8.3 years; tumor size=4.1±2.4 cm) radically operated (R0) and monitored in 1985-2022 (m=659, f=106; bi/lobectomies=512, pneumonectomies=253, mediastinal lymph node dissection=765; combined procedures with resection of trachea, carina, atrium, aorta, VCS, vena azygos, pericardium, liver, diaphragm, ribs, esophagus=192; only surgery-S=616, adjuvant chemoimmunoradiotherapy-AT=149: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy; T1=318, T2=255, T3=133, T4=59; N0=514, N1=131, N2=120, M0=765; G1=194, G2=241, G3=330; squamous=417, adenocarcinoma=298, large cell=50; early LC=212, invasive LC=553. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 2240.1±1751.6 days and cumulative 5-year survival (5YS) reached 72.8%, 10 years – 64.2%, 20 years – 42.9%. 499 LCP lived more than 5 years (LS=3126.8±1540 days), 143 LCP – more than 10 years (LS=5083.3±1518.6 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (77.6% vs.63.1%, P=0.00001 by log-rank test). AT significantly improved 5YS (64.4% vs. 34.8%) (P=0.00003 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). 5YS of LCP after Lobectomies (77.6%) was significantly superior in comparison with LCP after pneumonectomies (63%) (P=0.00001 by log-rank test). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12(rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), segmented neutrophils/CC (7), lymphocytes/CC (8), monocytes/CC (9); stick neutrophils/CC (10), leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) surgery type: lobectomy/pneumonectomy; 10) anthropometric data.
• Gastric cancer prognosis and cell ratio factors Oleg Kshivets
OBJECTIVE: We examined cell ratio factors (CRF) significantly affecting gastric cancer (EC) patients GCP) survival. CRF - ratio between cancer cells (CC) and blood cells subpopulations.
METHODS: We analyzed data of 799 consecutive GCP (T1-4N0-2M0) (age=57.1±9.4 years; tumor size=5.4±3.1 cm) radically operated (R0) and monitored in 1975-2022 (m=558, f=241; total gastrectomies=173, distal gastrectomies=461; proximal gastrectomies=165; combined gastrectomies=247 with resection of esophagus, pancreas, liver, duodenum, diaphragm, colon transversum, splenectomy, etc; only surgery-S=624, adjuvant chemoimmunotherapy-AT=175 (5-FU + thymalin/taktivin); T1=238, T2=220, T3=184, T4=157; N0=437, N1=109, N2=253, M0=799; G1=222, G2=164, G3=413. Variables selected for prognosis study were input levels of 45 blood parameters, sex, age, TNMG, cell type, tumor size. Survival curves were estimated by the Kaplan-Meier method. Differences in curves between groups of GCP were evaluated using a log-rank test. Multivariate Cox modeling, discriminant analysis, clustering, SEPATH, Monte Carlo, bootstrap and neural networks computing were used to determine any significant dependence.
RESULTS: Overall life span (LS) was 2128.9±2300.3 days and cumulative 5-year survival (5YS) reached 58.4%, 10 years – 51.9%, 20 years – 39%, 30 years – 27.2%. 318 GCP lived more than 5 years (LS=4304.5±2290.6 days), 169 GCP – more than 10 years (LS=5919.5±2020 days). 290 GCP died because of GC (LS=651±347.2 days). Cox modeling displayed that G CP survival significantly depended on CRF: healthy cells/CC, erythrocytes/CC, monocytes/CC, phase transition (PT) in terms of synergetics early—invasive cancer; PT N0--N12, age, G1-3, hemorrhage time, ESS, sex, AT, prothrombin index, residual nitrogen. Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early—invasive cancer (rank=1); PT N0--N12 (2); healthy cells/CC (3), erythrocytes/CC (4), thrombocytes/CC (5), monocytes/CC (6), segmented neutrophils/CC (7), leucocytes/CC (8), lymphocytes/CC (9), stick neutrophils/CC (10), eosinophils/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: GCP survival after radical procedures significantly depended on CRF.
CONCLUSIONS: 10-Year survival of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) anthropometric data; 10) surgery type; 11) tumor localization. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
Page 2 of 10
Volume 11 • Issue 10 • 1000661
J Gastrointest Dig Syst, an open access journal
ISSN: 2161-069X
previous treatment with chemotherapy, immunotherapy or radiotherapy
or if there were two primary tumors of the time of diagnosis. Patients
after non-radical procedures, postoperative died ECP were excluded to
provide a homogeneous patient group. The preoperative staging protocol
included clinical history, physical examination, complete blood count
with differentials, biochemistry and electrolyte panel, chest X-rays,
roentgenoesophagogastroscopy, abdominal ultrasound, bronchoscopy,
fibroesophagogastroscopy, electrocardiogram. Computed tomography,
NMR-tomography scan of upper abdomen, liver and bone radionucle
scan were performed whenever needed. All ECP were diagnosed with
histologically confirmed EC. All had measurable tumor and ECOG
performance status 0 or 1. Before any treatment each patient was carefully
examined by medical panel composed of thoracoabdominal surgeon and
chemotherapeutist to confirm the stage of disease. All patients signed a
written informed consent form approved by the local Institutional Review
Board.
The initial treatment was started with radical procedures. We
performed two types of procedures: 267 complete esophagogasrectomies
with lesser and partially major omentum with preservation of right
gastroepiploic vessels and lymph node dissection through separate
abdominal and right thoracic incision (Lewis, Lewis-McKeown) and 284
through left thoracoabdominal incision (Garlock). The present analysis
was restricted to ECP with complete resected tumors with negative
surgical resection margin and with N1 and celiac lymph node metastases
(N2). Complete surgical resection consisted of esophagogastrectomy with
one stage intrapleural esophagogastrostomy in 361 (Lewis, Garlock), and
with anastomosis on the neck in 190 (Lewis-McKeown, Garlock). EC was
localized in lower third of esophagus in 361, middle third in 61, upper
third in 75, total 54. Among these, 154 ECP underwent combined and
extensive radical procedures with resection of pancreas, liver, diaphragm,
aorta, VCS, colon transversum, lung, trachea, pericardium, splenectomy.
The extent of lymphadenectomy in the upper abdominal compartment and
lower posterior mediastinum was identical for all surgical approaches and
comprised a suprapancreatic lymphadenectomy, including all lymph nodes
along the common hepatic artery, celiac axis, and splenic artery toward
the splenic hilum. The left gastric artery was always transected at its origin
and remained with the specimen. Also included were all lymph nodes
along the proximal two thirds of the lesser gastric curvature and the gastric
fundus, left and right paracardiac nodes, distal paraesophageal nodes, and
nodes in the lower posterior mediastinum up to the tracheal bifurcation.
Patients with the right thoracoabdominal approach had an additional
formal extended mediastinal lymphadenectomy comprising all nodes at
the tracheal bifurcation along the left and right main stem bronchi, the
upper mediastinal compartment, and along the left recurrent nerve. A
systematic cervical lymphadenectomy was performed routinely for ECP
with neck anastomosis (190). Routine twofield lymphadenectomy (in
terms of EC surgery) was performed in 361, three fields in 190. The present
analysis was restricted to ECP with complete resected tumors with negative
surgical resection margin (R0) and with N1-N2 nodes. All ECP were
postoperatively staged according to the TNM-classification. Histological
examination showed adenocarcinoma in 314, squamous cell cancer 227
and mixed carcinoma in 10 patients. The pathological T stage was T1 in
128, T2 in 115, T3 in 181, T4 in 127 cases; the pathological N stage was N0
in 278, N1 in 70, N2 in 203 patients. The tumor differentiation was graded
as G1 in 157, G2 in 141, G3 in 253 cases. Early EC was in 109 patients,
invasive EC in 442. We understand as the early cancer the tumor up to 2
cm in diameter, witch invades submucosa without lymph node and distant
metastases [10]. After surgery postoperative chemoimmunoradiotherapy
were accomplished ECP in ECOG performance status 0 or 1.
All patients (551 ECP) were divided between the two protocol
treatments: (1) surgery and adjuvant chemoimmunoradiotherapy (128
ECP group A); (2) surgery alone without any adjuvant treatment 423 ECP
group (B) the control group.
All 128 patients completed adjuvant chemoimmunoradiotherapy
(group A): 1 cycle of bolus chemotherapy was initiated 10 days-14 days
after complete resections and consisted of fluorouracil (5-FU) 500 mg/
m2 intravenously (IV) for 5 days. Immunotherapy consisted thymalin
or taktivin 20 mg intramuscularly on days 1, 2, 3, 4 and 5. These
immunomodulators produced by Pharmaceutics of Russian Federation
(Novosibirsk) and approved by Ministry of Health of Russian Federation.
Thymalin and taktivin are preparations from calf thymus, which stimulate
proliferation of blood T-cell and B-cell subpopulations and their response
[11]. The importance must be stressed of using immunotherapy in
combination with chemotherapy, because immune dysfunctions of the cell
mediated and humoral response were induced by tumor, surgical trauma,
radiotherapy and chemotherapy [5,10]. Such immune deficiency induced
generalization of EC and compromised the long term therapeutic result. In
this sense immunotherapy shielded human organism from side and adverse
effects of basic treatment. 4-5 courses of adjuvant chemoimmunotherapy
were repeated every 28 day. Concurrent radiotherapy (60 CO; ROKUS,
Russia) with a total tumor dose 45 Gy-50 Gy starting 5 weeks-7 weeks
after surgery. Radiation consisted of single daily fractions of 180 cGy-
200 cGy 5 days weekly. The treatment volume included the ipsilateral
hilus, the supraclavicular fossa and the mediastinum from the incisura
jugularis to 8 cm below the carina. The lower mediastinum and upper
abdomen were included in cases of primary tumors in the lower third of
esophagus or N2. The resected tumor bed was included in all patients.
Parallel opposed AP-PA fields were used. All fields were checked using the
treatment planning program COSPO (St. Petersburg, Russia). Doses were
specified at middepth for parallel opposed technique or at the intersection
of central axes for oblique technique. No prophylactic cranial irradiation
was used. During chemoimmunotherapy antiemetics were administered.
Gastrointestinal side effects, particularly nausea and vomiting, were mild,
and chemoimmunotherapy was generally well tolerated. Severe leukopenia,
neutropenia, anemia and thrombocytopenia occurred infrequently. There
were no treatment related deaths.
A follow up examination was; generally, done every 3 months for the
first 2 years, every 6 months after that and yearly after 5 years, including
a physical examination, a complete blood count, blood chemistry, chest
roentgenography. Endoscopy and abdominal ultrasound were done every
6 month for the first 3 years and yearly after that. Zero time was the data of
surgical procedures. No one was lost during the follow up period and we
regarded the outcome as death through personal knowledge, physician's
reports, and autopsy or death certificates. Survival time (days) was
measured from the date of surgery until death or the most recent date of
follow up for surviving patients.
Variables selected for 10 YS and life span study were sex, age, TNM,
cell type, tumor size. Survival curves were estimated by the Kaplan Meier
method. Differences in curves between groups of GCP were evaluated
using a log rank test. Multivariate proportional hazard Cox regression,
structural equation modeling (SEPATH), Monte Carlo simulation and
neural networks computing were used to determine any significant
dependence [12-16]. Neural networks computing, system, biometric and
statistical analyses were conducted using CLASS MASTER program (Stat
Dialog, Inc., Moscow, Russia), SANI program (Stat Dialog, Inc., Moscow,
Russia), STATISTICA and STATISTICA Neural Networks program (Stat
Soft, Inc., Tulsa, OK, the USA), DEDUCTOR program (BaseGroup Labs,
Inc., Riazan, Russia), SPSS (SPSS Inc., Chicago, IL, USA), Table Curve
3. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
3D (Systat Software Inc., San Hose, CA, USA), SIMSTAT2.6 (Provalis
Research, Montreal, Canada). All tests were considered significant when
the resulting P value was less than 0.05.
Results
For the entire sample of 551 patients’ overall life span (mean ±
standard error) was 1881.1 ± 2230.6 days (95% CI, 1694.4-2067.8;
median=854) and cumulative 5 year survival reached 52.1%, 10 year
survival 45.9%, 20 year survival 33.7% (Figure 1). 184 ECP (life
span=4308.7 ± 2413.3 days) lived more than 5 years and 99 (life span=5883
± 2296.6 days) more than 10 years without any features of EC progressing.
226 ECP (life span=628.3 ± 319.9 days) died due to the cancer
generalization within the first 5 years after complete gastrectomies.
Figure 1: General cumulative survival of ECP with stage T1-4N0-2M0, n=551
after radical esophagogastrectomies: cumulative 5 year survival=52.1%, 10 year
survival=45.9%, 20 year survival=33.7%.
It is necessary to pay attention on the five very important prognostic
phenomenons. First, 95.7% 10 year survival (10 YS) for ECP with the early
cancer as against 32.1% for the others ECP after esophagogastrectomies
(P=0.000 by log rank test) (Figure 2).
Figure 2: 10 year survival of ECP with early cancer (n=109) (95.7%) was
significantly better compared with invasive cancer (n=442) (32.1%) (P=0.0000 by log
rank).
Second, good 10 YS for ECP with N0 (68.6%) as compared with ECP
with N1-2 (10 year survival was 20.8%) after radical procedures (P=0.000
by log rank test) (Figure 3)
.
Figure 3: 10 year survival of ECP with N0 (n=278) (68.6%) was significantly
better compared with N1-N2 metastases (n=273) (20.8%) (P=0.0000 by log rank).
Third, for the 128 ECP in adjuvant chemoimmunoradiotherapy (AT)
arm (group A) cumulative 10 YS reached 68.8% vs. 48.5% (group B)
(P=0.00025 by log rank test) (Figure 4)
.
Figure 4: 10 year survival of ECP after esophagectomies in group A (adjuvant
chemoimmunoradiotherapy) (n=128) and B (surgery alone) (n=423). 10 Survival
of ECP in group A was (68.8%) significantly better compared with group B (48.5%)
(P=0.00025 by log rank).
4. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
Fourth, we revealed 61.4% 10 YS for ECP with upper third of
esophagus versus 42.4% for other ECP after surgery (P=0.00339 by log
rank test) (Figure 5)
Figure 5: General cumulative10 year survival of ECP with upper third of esophagus (n=75) was 61.4% versus 42.4% for other ECP after surgery (n=476) (P=0.00339 by log
rank test).
Figure 6: General cumulative10 year survival of ECP (n=262) was 60.6% versus 30.2% for cardioesophageal cancer patients after surgery (n=289) (P=0.000 by log rank test).
In the fifth we found 60.6% 10 YS for ECP versus 30.2% for
cardioesophageal cancer patients after surgery (P=0.000 by log rank test)
(Figure 6).
5. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
All clinicopathologic characteristics and treatment modalities
were evaluated in traditional Cox multivariate prognostic factor
analysis. In accordance with Cox regression model, the 17 variables
significantly explained ECP 10 YS with N0-2 (n=551) after complete
esophagogastrectomies. Cox modeling displayed that 10 YS of ECP
significantly depended on: phase transition (PT) N0-N12 in terms of
synergetics, cell ratio factors (ratio between cancer cells CC and blood
cells subpopulations), G1-3, T1-4, AT, prothrombin index, protein,
hemorrhage time, residual nitrogen, age, histology, tumor localization
(P=0.000-0.021) (Table 1).
Cox Regression n=551
Parameter
Estimate
Standard
Error
Chi-
square
P value
95% Lower
CL
95% Upper
CL
Hazard
Ratio
Hemorrhage Time 0.0014 0.000402 12.18223 0.000482 0.00062 0.002192 1.0014
Residual Nitrogen 0.05156 0.01111 21.54182 0.000003 0.02979 0.073339 1.05292
Protein 0.02145 0.008664 6.12841 0.013303 0.00447 0.038428 1.02168
Prothrombin Index 0.02606 0.006403 16.55867 0.000047 0.01351 0.038605 1.0264
T1-4 0.43221 0.08598 25.26934 0 0.26369 0.600727 1.54066
N0---N12 0.59826 0.161755 13.67911 0.000217 0.28122 0.91529 1.81894
Age 0.02845 0.007746 13.48557 0.00024 0.01326 0.043627 1.02885
Histology -0.28768 0.12496 5.30016 0.021323 -0.5326 -0.042767 0.75
G1-3 0.42034 0.088794 22.41002 0.000002 0.24631 0.594377 1.52248
Adjuvant
Chemoimmunoradiotherapy
-0.93274 0.197277 22.35461 0.000002 -1.31939 -0.546082 0.39348
Segmented Neutrophils/
Cancer Cells
4.04524 1.582385 6.53527 0.010576 0.94382 7.146654 57.12473
Localization -0.53528 0.190887 7.86335 0.005045 -0.90941 -0.161147 0.58551
Leucocytes/Cancer cells -4.11797 1.590909 6.70002 0.009641 -7.2361 -0.999847 0.01628
Eosinophils/Cancer Cells 4.26504 1.671458 6.51111 0.01072 0.98904 7.541033 71.1675
Stick Neutrophils/Cancer
Cells
4.33745 1.642549 6.97321 0.008274 1.11812 7.55679 76.51243
Lymphocytes/Cancer Cells 3.93332 1.604682 6.00815 0.01424 0.7882 7.078439 51.07626
Monocytes/Cancer Cells 4.34006 1.643347 6.97483 0.008266 1.11916 7.560962 76.71226
Table1: Results of multivariate proportional hazard Cox regression modeling in prediction of ECP 10-year survival after
esophagectomies (n=551).
All of these differences and discrepancies were further investigated by
structuralequationmodeling(SEPATH)aswellasMonteCarlosimulation.
For more exact analysis, 141 patients were excluded from sample, which
were alive less than 10 years after complete esophagogastrectomies without
relapse (Figure 7). It was revealed that the eleven clusters significantly
predicted 10 YS and life span of ECP with N0-2 status (n=410): (1) PT early
invasive EC; (2) PT N0-N12; (3) Cell Ratio Factors; (4) EC characteristics;
(5) blood cell circuit; (6) biochemical homeostasis; (7) hemostasis
system; (8) surgery type; (9) adjuvant chemoimmunoradiotherapy; (10)
anthropometric data; (11) tumor localization.
Figure 7: Significant networks between ECP (n=410) 10 year survival, life span, cancer characteristics, blood cell circuit, cell ratio factors, hemostasis system, biochemic and
anthropometric data, phase transition “early cancer—invasive cancer”, phase transition “cancer with N0—cancer with N1-N2” and treatment protocols (SEPATH network model).
6. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
For comparative purposes, clinicopathological factors of ECP (n=410)
were tested by neural networks computing (4 layer perceptron) (Table
2). Obviously, analyzed data provide significant information about EC
prediction. High accuracy of classification (10 year survivors vs. losses)
was achieved 100% (baseline error=0.000, area under ROC curve=1.0). In
other words, it remains formally possible that at least 11 of these factors
might predate neoplastic generalization: PT N0-N12 (rank=1), healthy
cells/CC (2), PT early invasive EC (3), thrombocytes/CC (4), erythrocytes/
CC (5), lymphocytes/CC (6), eosinophils/CC (7), stick neutrophils/CC
(8), segmented neutrophils/CC (9), monocytes/CC (10), leucocytes/CC
(11). Moreover, bootstrap simulation confirmed the paramount value of
Cell Ratio Factors, PT N0-N12 and PT early-Invasive GC (Table 3). It is
necessary to note a very important law: both transitions of the early cancer
into the invasive cancer, as well as the cancer with N0 into the cancer with
N1-N2, have the phase character. These results testify by mathematical
and imitating modeling of system “EC-patient homeostasis” in terms of
synergetics (Figures 8-16). This also proves the first results received earlier
in the work [10]. Presence of the two phase transitions is evidently shown
on Kohonen self-organizing neural networks maps (Figure 17).
Factors: Correct
Classification
Rate=100%;
Error=0.0; Area
under ROC
Curve=1.0
Rank Sensitivity
Phase Transition
N0---N12
1 14768
Healthy Cells/
Cancer Cells
2 11853
Phase Transition
Early---Invasive
Cancer
3 10080
Thrombocytes/
Cancer Cells
4 8933
Erythrocytes/
Cancer Cells
5 8326
Lymphocytes/
Cancer Cells
6 7595
Eosinophils/
Cancer Cells
7 6406
Stick
Neutrophils/Cancer
Cells
8 5490
Segmented
Neutrophils/Cancer
Cells
9 3938
Monocytes/
Cancer Cells
10 2943
Leucocytes/
Cancer Cells
11 2658
Table 2: Results of neural networks computing in prediction of 10-
year survival of ECP after esophagectomies (n=410).
Significant
Factors
(Number of
Samples=3333)
Rank Kendal Tau-A P
Tumor Size 1 -0.316 0
Healthy Cells/
Cancer Cells
2 0.315 0
T1-4 3 -0.307 0
Erythrocytes/
Cancer Cells
4 0.307 0
Leucocytes/
Cancer Cells
5 0.298 0
Thrombocytes/
Cancer Cells
6 0.293 0
Lymphocytes/
Cancer Cells
7 0.289 0
Segmented
Neutrophils/
Cancer Cells
8 0.28 0
Residual
Nitrogen
9 -0.277 0
Phase
Transition N0-
--N12
10 -0.248 0
Monocytes/
Cancer Cells
11 0.24 0
Hemorrhage
Time
12 -0.233 0
Phase
Transition
Early---Invasive
Cancer
13 -0.225 0
Procedure Type 14 -0.192 0
Eosinophils/
Cancer Cells
15 0.163 0
Chlorides 16 0.163 0
G1-3 17 -0.14 0
Tumor Growth 18 -0.117 0.001
Stick
Neutrophils/
Cancer Cells
19 0.105 0.01
Erythrocytes 20 0.103 0.01
Weight 21 0.1 0.01
Combined
Procedure
22 0.098 0.01
Localization 23 0.07 0.05
Table3: Results of bootstrap simulation in prediction of 10-year
survival of ECP after esophagectomies (n=410).
7. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
Figure 8: Esophageal cancer cell dynamics: Presence of the two phase transitions
“early cancer—invasive cancer” and “cancer with N0—cancer with N1-N2” in terms of
synergetics.
Figure 9: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), phase transition N0-N1-2 and blood Lymphocytes/Cancer cells
(P=0.000).
Figure 10: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), phase transition N0-N1-2 and phase transition “early-invasive
cancer” (P=0.000).
Figure 11: Prognostic equation model of 10 year survival of esophageal
cancer patients (n=410), phase transition phase transition “early invasive
cancer” and Lymphocytes/Cancer cells (P=0.000).
8. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
Figure 12: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), esophageal cancer cell dynamics and lymphocytes (P=0.000).
Figure 13: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), phase transition N0-N1-2 and Erythrocytes/Cancer cells (P=0.000).
Figure 14: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), phase transition N0-N1-2 and Healthy Cells/Cancer cells (P=0.000).
Figure 15: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), esophageal cancer cell dynamics and monocytes (P=0.000).
Figure 16: Prognostic equation model of 10 year survival of esophageal cancer
patients (n=410), esophageal cancer cell dynamics and healthy cells (P=0.000).
9. Citation: Kshivets O, (2021) Esophageal Cancer: 10 Year Survival after Surgery. J Gastrointest Dig Syst.11:661
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ISSN: 2161-069X
Figure 17: Results of Kohonen self-organizing neural networks computing in prediction of ECP 10 year survival after esophagectomies (n=410).
Discussion
Central goal of the present research was to estimate the
efficiency of adjuvant chemoimmunoradiotherapy after complete
esophagogastrectomies. The importance must be stressed of using complex
system analysis, artificial intelligence (neural networks computing),
statistical methods and simulations in combination, because the different
approaches yield complementary pieces of prognostic information
[3,10,16,17].
Although there is no consensus on adjuvant treatment followed
by radical procedures two of the most commonly employed strategies
are surgery alone and adjuvant chemo radiotherapy with or without
immunotherapy.
Actually surgical removal of tumor and its metastases remains basic
management of this very aggressive cancer giving the real chance for
recovery in spite of quite intensive researches developed during the last 30
years in terms of chemotherapy, radiotherapy and immunotherapy [18,19].
Unfortunately, the effectiveness of complete esophagogastrectomies
(Lewis, Garlock, Lewis McKeown) has already reached its limit and
leaves much to be desired: the average real 5 year survival rate of radically
operated ECP even after combined and extensive procedures is 20%-30%
and practically is not improved during the past 50 years, as the great
majority of patients has already EC with stage II-III [9,20].
In the last 10 years-20 years a number of new drugs have been shown
to have good activity against EC, including mitomycin C, UFT, epirubicin,
etoposide, cisplatin, doxetacel, irinotecan, etc. [21-23]. On the other
hand new immunomodulators, checkpoint inhibitors, new adoptive
immunotherapeutic modalities with lymphokine activated killer cells,
tumor infiltrating lymphocytes and high dose interleukins have been
developed and antitumor effect have been successfully demonstrated in
advanced malignancies, including EC [7,24-26].
Theoretically chemoimmunoradiotherapy is most effective when
used in patients with a relatively low residual malignant cell population
(approximately 1 billion cancer cells per patient) in terms of hidden
micrometastases [10]. This is typical clinical situation at ECP with stage
II-III after complete esophagogastrectomies (R0). Present research only
confirmed this axiom.
In summary, when adjuvant chemoimmunoradiotherapy is applied
to complete esophagogastrectomies for EC, the following benefits
should be considered: (1) possibility of total elimination of residual
hidden micrometastases; (2) surgery and chemoradiotherapy can result
immunosuppressive state, which can be improved by immunotherapy; (3)
radical operated ECP with stage II-III are thought to be potentially good
candidates for adjuvant chemoimmunoradiotherapy as the majority of
these patients would be expected to have EC progressing.
Further investigations will be required to determine efficiency,
compatibility and tolerance of new drugs, immunomodulators and
checkpoint inhibitors after esophagogastrectomies. The results of the
present research will offer guidance for the design of future studies.
Conclusion
10 Year survival after radical procedures significantly depended on:
(1) PT “early invasive cancer”; (2) PT N0-N12; (3) Cell Ratio Factors; (4)
blood cell circuit; (5) biochemical factors; (6) hemostasis system; (7) AT;
8) EC characteristics; (9) tumor localization; (10) anthropometric data;
(11) surgery type.
Optimal diagnosis and treatment strategies for EC are: (1) screening
and early detection of EC; (2) availability of experienced thoracoabdominal
surgeons because of complexity of radical procedures; (3) aggressive en
block surgery and adequate lymph node dissection for completeness; (4)
precise prediction; (5) adjuvant chemoimmunoradiotherapy for ECP with
unfavorable prognosis.
Conflicts of Interests
I do not have any financial, commercial, legal, or professional
relationship with other organizations, or with the people working with
them, that could influence my research.
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ISSN: 2161-069X
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