ObjectiveTo compare the effectiveness of robot-assisted minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and open freehand TLIF for the treatment of single-level degenerative lumbar spondylolisthesis (DSL) and analyse the influence on postoperative adjacent segmental degeneration (ASD). Methods The clinical data of 116 patients with L4、5 DLS who were admitted between November 2019 and October 2021 and met the selection criteria were retrospectively analyzed. According to the surgical methods, they were divided into the robotic group (45 cases, who underwent robot-assisted MIS-TLIF) and the open group (71 cases, who underwent open freehand TLIF). There was no significant difference in baseline data such as gender, age, body mass index, DLS Meyerding grading, and preoperative Pfirrmann grading, Weishaupt grading, L3, 4 intervertebral disc height (DH), L3, 4 intervertebral mobility, sagittal parameters [including pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT)], and Cage height (P>0.05). The grade of facet joint violation (FJV) by pedicle screws on the superior articular process was assessed postoperatively. Sagittal parameters, L3, 4 DH, L3, 4 DH loss, and L3, 4 intervertebral mobility were measured preoperatively and at last follow-up in order to determine whether ASD occurred. Based on the occurrence of postoperative ASD, logistic regression analysis was used to identify the risk factors for ASD after TLIF. Results Patients in both groups were followed up 21-47 months, with a mean of 36.1 months; there was no significant difference in the follow-up time between the two groups (P>0.05). The occurrence of postoperative FJV was significantly better in the robotic group than in the open group (P<0.05). At last follow-up, the difference in the change values of sagittal parameters PI, PT, SS, and LL was not significant when comparing the two groups of patients (P>0.05); the change values of L3, 4 DH and L3, 4 DH loss in the robotic group were smaller than those in the open group, and the change value of L3, 4 intervertebral mobility was larger than that in the open group, and the differences were significant (P<0.05). At last follow-up, ASD occurred in 8 patients (17.8%) in the robotic group and 35 patients (49.3%) in the open group, and the difference in ASD incidence between the two groups was significant (P<0.05). logistic regression analysis showed that open surgery, preoperative Pfirrmann grading Ⅳ-Ⅴ, preoperative Weishaupt grading ≥2, and postoperative FJV grading ≥1 were risk factors for the development of ASD after TLIF (P<0.05). ConclusionCompared with traditional open surgery, orthopedic robot-assisted MIS-TLIF in the treatment of single-level DLS can more accurately insert pedicle screws, reduce the loss of DH and the occurrence of FJV, and effectively reduce the incidence of mid-postoperative ASD. Preoperative disc and synovial joint degeneration in adjacent segments, nonrobotic-assisted minimally invasive therapy, and FJV are risk factors for ASD after TLIF.
ObjectiveTo investigate the prognosis after breast conserving surgery (BCS) and modified radical mastectomy (MRM) in patients with stage Ⅰ–Ⅱ breast cancer, and analyze the factors related to locoregional recurrence (LRR).MethodsThe clinicopathologic and prognostic data of patients with stage Ⅰ–Ⅱ breast cancer who underwent the surgical treatment in the First Affiliated Hospital of Chongqing Medical University from January 2011 to December 2014 were analyzed. The clinicopathologic characteristics and prognostic differences of the BCS group and MRM group were compared. The factors related to LRR of patients underwent the BCS and MRM were analyzed.ResultsA total of 1 330 patients with stage Ⅰ–Ⅱ breast cancer were included in this study, including 230 in the BCS group and 1 100 in the MRM group. Compared with the MRM group, the patients in the BCS group had higher height (P<0.001), younger age (P<0.001), smaller tumor diameter (P<0.001), and less axillary lymph node metastasis (P<0.001). Up to August 2019, 149 cases (18 cases in the BCS group and 131 cases in the MRM group) were lost, with a follow-up rate of 88.8%. The median follow-up time was 71 months (4－103 months). The LRR rate of the BCS group was higher than that of the MRM group (6.1% versus 2.5%, χ2=7.002, P<0.01). The locoregional recurrence-free survival of the MRM group was better than that of the BCS group (χ2=7.886, P<0.01). However, there were no statistical differences between the two groups in terms of the distant metastasis-free survival and disease-free survival (P>0.05). In the patients underwent the BCS, the HER-2 was associated with the LRR (P<0.05), and the axillary lymph node metastasis was associated with the LRR in the patients underwent the MRM (P<0.05).ConclusionsAccording to results of this study, although there is a significant difference in locoregional recurrence-free survival between BCS group and MRM group in patients with stage Ⅰ–Ⅱ breast cancer, there are no statistical differences in distant metastasis-free survival and disease-free survival between the two groups. Therefore, it is safe and feasible for choosing appropriate patients with stage Ⅰ–Ⅱ breast cancer to underwent breast-conserving treatment.