The Royal Preston Hospital or RPH, is an acute general hospital in Preston, Lancashire, England. It is managed by the Lancashire Teaching Hospitals NHS Foundation Trust.
473 Background: KEYNOTE-564 demonstrated that adjuvant pembrolizumab improves outcomes after nephrectomy for clear-cell renal cell carcinoma (RCC). Whether this benefit extends to non–clear cell RCC (nccRCC) remains uncertain. We evaluated the association between adjuvant pembrolizumab and outcomes in patients with nccRCC who underwent nephrectomy in a multicenter study. Methods: We conducted a retrospective multicenter cohort study at six international institutions. Eligible adults had nccRCC treated with nephrectomy and were classified by receipt of adjuvant pembrolizumab. The primary endpoints were disease-free survival (DFS), defined as the time from nephrectomy to the first radiographic or clinical recurrence, and overall survival (OS), defined as the time from diagnosis to death or last follow-up. Survival functions were estimated with the Kaplan–Meier method and compared between groups using the log-rank test. Estimates of median DFS and OS were calculated using the Kaplan–Meier method. Results: Patient characteristics are shown in Table 1. Among 90 patients, 15 (17%) received adjuvant pembrolizumab, and 75 (83%) were observed; age at diagnosis was 56.0 years (IQR 44.0–63.0; mean 52.9 ± 13.1) and 62.0 years (IQR 52.0–71.0; mean 59.6 ± 14.7) respectively. Recurrence occurred in 7/15 (46.7%) with pembrolizumab and 25/75 (44.6%) with observation. There was no significant difference in median DFS (p = 0.75) or OS (p = 0.89) between groups. Median DFS was 90.7 months (95% CI, 27.2–NR) with pembrolizumab vs 41.9 months (95% CI, 39.4–NR) with observation; median OS was not reached (95% CI, 65.1–NR) with pembrolizumab vs 52.4 months (95% CI, 44.4–NR) with observation. Conclusions: In this descriptive retrospective six-center cohort of nccRCC post-nephrectomy, adjuvant pembrolizumab did not demonstrate a DFS or OS advantage over observation. A larger multi-institutional cohort is in progress to refine effect estimates using richer clinical detail, with adjusted analyses and prespecified subgroup assessment. Baseline characteristics by treatment group. Characteristic Overall (n=90) Observation (n=75) Pembrolizumab (n=15) Sex (Male/Female), n (ratio) 58 / 32 (1.8:1) 48 / 27 (1.8:1) 10 / 5 (2:1) T1, n (%) 11 (12.2%) 10 (13.3%) 1 (6.7%) T2, n (%) 10 (11.1%) 10 (13.3%) 0 (0.0%) T3, n (%) 64 (71.1%) 52 (69.3%) 12 (80.0%) T4, n (%) 3 (3.3%) 2 (2.7%) 1 (6.7%) Papillary RCC, n (%) 41 (45.6%) 36 (48.0%) 5 (33.3%) Chromophobe RCC, n (%) 31 (34.4%) 27 (36.0%) 4 (26.7%) Unclassified RCC, n (%) 7 (7.8%) 6 (8.0%) 1 (6.7%) Xp11 translocation, n (%) 8 (8.9%) 4 (5.3%) 4 (26.7%)
INTRODUCTION: In this manuscript, we evaluated the clinicopathological features of low-grade appendiceal mucinous neoplasm (LAMN), a unique type of appendiceal tumors. METHODS: This is a retrospective study that included patients with LAMN who were presented to our center from January 2008 to December 2024. The epidemiological, clinical, pathological, therapeutic, and prognostic data were analyzed. RESULTS: A total of 68 patients were included in the study, with a median age of 55.8 years. Forty patients (58.8%) had pseudomyxoma peritonei (PMP) at the time of diagnosis. Surgical cytoreduction was used in 44 patients (65.7%), while appendectomy was performed in 23 patients (34.3%). HIPEC was used only in fifteen patients (22.4%). Gross perforation was identified in 7 cases (10.3%). While microscopically, micro-perforation or rupture was noted in 20 patients (29.4%). Adjuvant systemic treatment was used in 50% of the patients. Over a median follow-up of 18 months, recurrence occurred in 21 patients (31.8%), while five patients (7.4%) developed distant metastasis. Mortality rate was 20.5% (n=14), including five patients who died postoperatively, while nine showed tumor-related mortality. On univariate analysis, only adjuvant treatments showed statistically significant correlation with the incidence of recurrence (p=0.007). CONCLUSIONS: The higher recurrence and mortality rates observed in our cohort compared with recent literature reflect the advanced disease burden and lower utilization of HIPEC. Future work should aim to refine patient selection for HIPEC, standardize operative approaches to minimize recurrence risk, and explore the role of adjuvant systemic therapy in reducing disease progression.
Retrograde cricopharyngeus dysfunction (R-CPD) is a newly classified syndrome in which a person is unable to burp, submitting them to socially debilitating symptoms of abdominal distension, gurgling noises from the throat and excessive flatulence. We discuss the case of a man in his 30s with Gilles de la Tourette syndrome, who acquires R-CPD following a period of transient dysphagia. The patient experienced years of inconclusive investigations and failed treatments before discovering the condition online and proposing it to his ENT specialist. He was treated with a botulinum toxin (BT) injection into the cricopharyngeus muscle, which showed an initial positive benefit. This case report emphasises the importance of considering R-CPD in patients presenting with similar symptoms. We discuss the diagnostic and therapeutic uses of BT and the additional challenges of a concurrent diagnosis of Tourette syndrome. The awareness of R-CPD amongst medical practitioners is vital to ensure its timely diagnosis, ultimately preventing unnecessary treatments and patient distress.
Femoral periprosthetic fractures (PPFs) are a significant complication following hip and knee arthroplasty, with an incidence of approximately 5.5–18%. These injuries require complex surgical management and are associated with persistent pain, impaired mobility, prolonged hospital stays, and poorer functional outcomes. Socio-economic factors are known to influence recovery, yet patient perspectives following PPFs remain underexplored. To explore patients’ experiences of recovery following femoral periprosthetic fracture during hospital admission, with particular attention to the influence of socio-economic factors. A qualitative study design was employed using semi-structured interviews with patients recovering from femoral PPFs during inpatient admission. Participants (n=9) were recruited from a major trauma hospital in the North West of England and categorised into socio-economic groups using the English Indices of Deprivation. Data were analysed using Braun and Clarke’s thematic analysis framework, supported by NVivo® software, with both inductive and deductive coding approaches. Seven core themes were identified across two overarching categories: Recovery Experience and Socio-economic Influences. Recovery experience included themes of persistent pain, restricted mobility, emotional distress, and a strong desire to regain independence characterised recovery experiences. Whereas, socio-economic factors influenced access to resources, communication with healthcare professionals, and reliance on family and social support networks. Participants from more socio-economically deprived backgrounds reported greater frustration related to delays, perceived resource limitations, and unmet recovery needs. Recovery following femoral PPF is shaped by an interaction of physical, psychological, and socio-economic factors during hospitalisation. These findings highlight the need for integrated and individualised care pathways that explicitly address socio-economic inequalities. Improved communication, tailored rehabilitation planning, and enhanced support mechanisms may contribute to more equitable and meaningful recovery outcomes for this vulnerable patient population. Recovery following femoral periprosthetic fracture: a qualitative study of patient experience and socio-economic influences during acute hospitalisation This study was conducted by a researcher based at a major trauma hospital in the North West of England. The study was part of a postgraduate academic project. There were no commercial sponsors or competing interests. We would like to sincerely thank the patients who took part in this study. Their time, honesty, and openness helped us better understand what recovery really feels like after a major injury. A femoral periprosthetic fracture is a serious complication that can happen after hip or knee replacement surgery. It often leads to a long recovery, pain, and difficulty returning back to everyday activities such as walking. We know that people from different backgrounds don’t always have the same access to care or support, which can affect how well they recover. However, very little is known about patients’ personal experiences, especially those from more deprived areas. This study aimed to fill that gap. What is it like for patients recovering from a femoral periprosthetic fracture while in hospital? Do patients from different socio-economic backgrounds experience recovery in different ways? The study took place in 2024 at a major NHS trauma hospital in the North West of England. Interviews were conducted with patients while they were still in hospital. Nine adult patients recovering in hospital after a femoral periprosthetic fracture took part. They were grouped according to where they lived, based on national measures of deprivation. This allowed the researcher to explore the effects of social and economic background. Participants took part in a one-on-one interview with the researcher. They were asked open questions about their recovery, how they felt physically and emotionally, what support they had, and how they were being treated during their hospital stay. The responses were analysed to find common themes and differences. The study found four key themes grouped under two main areas: the general recovery experience and the impact of socio-economic background. Most patients reported ongoing pain , problems with mobility , and emotional distress , such as anxiety or feeling a loss of independence. Many said that regaining independence — being able to move freely or go outside on their own — was their top recovery goal. Family support was essential. Those without strong social support, particularly from more deprived backgrounds, often struggled more. Patients from lower-income regions reported more delays , worse communication , and fewer resources available to help them recover. This study gives a voice to patients recovering from a complex injury and highlights how social and economic inequality can influence health outcomes. It shows the need for: Better emotional and psychological access and support during recovery following injury. Recovery goals that are personalised and focused on independence. More support systems (e.g., community care) for people without family or friend help. Clearer, more compassionate communication from healthcare staff particularly when awaiting surgery. Future studies should involve a larger and more diverse group of patients, follow their recovery over a longer period (including after discharge), and test specific solutions such as improved communication or social support programs whilst in hospital. You can find more information by contacting the research team at Lancashire Teaching Hospitals NHS Foundation Trust, Royal Preston Hospital, Core Therapies Department or by accessing future published versions of this study in academic journals or NHS research summaries.
