Citations

Object Traditionally, hemisacrectomy and internal hemipelvectomy procedures have required both an anterior and a posterior approach. A posterior-only approach has the potential to complete an en bloc tumor resection and spinopelvic reconstruction while reducing surgical morbidity. Methods The authors describe 3 cases in which en bloc resection of the hemisacrum and ilium and subsequent lumbopelvic and pelvic ring reconstruction were performed from a posterior-only approach. Two more traditional anterior and posterior staged procedures are also included for comparison. Results In all 3 cases, an oncologically appropriate surgery and spinopelvic reconstruction were performed through a posterior-only approach. Conclusions The advantage of a midline posterior approach is the ability to perform a lumbosacral reconstruction, necessary in cases in which the S-1 body is iatrogenically disrupted during tumor resection.

What's known on the subject? and What does the study add? The safe and successful development of NOTES has the potential to create a paradigm shift in minimally invasive surgery. However, anecdotal diagnostic and therapeutic NOTES procedures, many of which were strictly performed in an investigative fashion, have taught us that continued, focused translational research is imperative to address myriad, and as yet unaddressed, technical issue. This study analyses the NOTES ‐related research in the medical literature over the last 5 years in an attempt to identify trends and/or progress towards its meaningful use. It shows that NOTES is still in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES , >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense clinical and experimental research in various surgical specialties. The aim of this study was to analyse natural orifice transluminal endoscopic surgery ( NOTES )‐related publications over the last 5 years. A systematic literature search was done to retrieve publications related to NOTES from 2006 to 2011. The following variables were recorded: year of publication; article type; study design; setting; Journal Citation Reports® journal category; authors area of surgical speciality; geographic area of origin; surgical procedure; NOTES technique; NOTES access route; number of clinical cases. A time‐trend analysis was performed by comparing early (2006–2008) and late (2009–2011) study periods. Overall, 644 publications were included in the analysis and most papers were found in general surgery journals (50.9%). Studies were most frequently clinical series (43.9%) and animal experimental (48%), with the articles focusing primarily on cholecystectomy, access creation and closure, and peritoneoscopy. Pure NOTES techniques were performed in most of the published reports (85%) with the remaining cases being hybrid NOTES (7.4%) and NOTES ‐assisted procedures (6.1%). The access routes included transgastric (52.5%), transcolonic (12.3%), transvesical (12.5%), transvaginal (10.5%), and combined (12.3%). From the early to the late period, there was a significant increase in the number of randomised controlled trials (5.6% vs 7.2%) or non‐randomised but comparative studies (5.6% vs 22.9%) ( P < 0.001) and there was also a significant increase in the number of colorectal procedures and nephrectomies ( P = 0.002). Pure NOTES remained the most studied approach over the years but with increased investigation in the field of NOTES ‐assisted techniques ( P = 0.001). There was also a significant increase in the adoption of transvesical access (7% vs 15.6%) ( P = 0.007). NOTES is in a developmental stage and much work is still needed to refine techniques, verify safety and document efficacy. Since the first description of the concept of NOTES , >2000 clinical cases, irrespective of specialty, have been reported. NOTES remains a field of intense clinical and experimental research in various surgical specialities.

Abstract Purpose: The study has two related purposes. To: 1. describe breast cancer risk factors and screening patterns in a sample of American Indian and Alaska Native (AI/AN) women from four tribes in the Northern Plains region; and 2. ascertain associations between women's risk factors and their adherence to mammographic screening guidelines with the intention of using the results to develop future interventions to increase screening, especially in higher risk non-adherent women. Background: The Indian Health Service (IHS) has noted that challenging economic factors make increases in AI/AN women's screening participation difficult. In this light, understanding the relationship between risk factors and screening adherence is an important first step in developing low-cost interventions to improve screening participation, especially for women at higher risk of breast cancer. Lending importance to the role of screening in reducing breast cancer deaths in Northern Plains AI/AN women are high rates of later stage (regional or distant disease) diagnoses that are equal to the Non-Hispanic White (NHW) population (95.8 and 95.4/100,000 respectively). Later stage at diagnosis is associated with worse survival profiles. We hypothesized that women at higher risk as compared to women at lower risk on the factors analyzed would be more likely to adhere to annual screening guidelines promoted by their clinics. Procedures/Methods: Criteria for inclusion in this study were: women with no history of breast cancer who were ≥ 40 years of age, and had at least one mammogram on file. We reviewed the charts of a representative sample of ∼20% of eligible women in four tribes (1250 records, 1088 of of which met inclusion criteria). The study collected Gail Model risk factor data and also assigned BIRADS scores to an early and late mammogram where they were available (888 pairs) for each woman. In addition, we collected age at menopause as an additional risk factor. For each Gail Model risk factor (age, age at menarche, age at first live birth, number of first degree relatives with a breast cancer history, breast biopsy—number of biopsies, history of atypical hyperplasia), women were assigned to higher or lower risk categories by comparison with calculated scores for women of the same age. Overall five-year and lifetime Gail Model risk scores, using standard criteria, also were calculated for each woman and compared with predicted risk for women of equivalent ages. For breast density, women were determined to be at lower risk if their BIRADS score was 1 or 2, and at higher risk if they were scored 3 or 4. To ascertain levels of screening adherence, we followed American Cancer Society (ACS) guidelines which recommend an annual mammogram beginning at age 40. We used this standard because it is the recommendation given to women in the clinics where the study was conducted. All women who received screening exams within 1.5 years (18 months) were considered adherent. Results are age-adjusted for each tribal site and across sites. Summary of Findings: Only P-values for older age at menopause (0.02), older chronological age (0.005), and 5-year Gail Model risk scores (0.02) were consistent with our hypotheses that women at higher risk would be more adherent with screening guidelines. There was no significant association between screening adherence and life-time risk (0.12), family history (0.28), age at menarche (0.99), age at first live birth (0.68), biopsy history (0.99), or BIRADS density scores (0.16). Conclusions: The minimal relationship between risk factors and adherence suggests that generally neither individual risk factors nor overall risk predict women's screening decisions. This suggests that personal and clinic-centered mediators should be identified to guide future interventions to increase the proportion of women who adhere to screening guidelines, especially women who are at greater risk. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B95.