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Sample records for surgically resected tumours

  1. [Tubulo-villous rectal tumours. Results of surgical resection in relation to histotype (30 years' experience)].

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    Carditello, Antonio; Milone, Antonino; Paparo, Domenica; Anastasi, Giuliana; Mollo, Francesco; Stilo, Francesco

    2004-01-01

    Adenomas of the rectum are frequently found during endoscopic examination. We report on our 30 years of experience with the treatment of tubulo-villous adenomas based on histotype. Between 1971 and 2001, 104 villous tumours of the rectum were treated surgically. The patients' average age was 65 years. These were sessile tumours in 69% of cases, pedunculated in 17.5% and flowing tumours in 13.5%. The mean tumour size was 3 cm. They were associated with colon cancer in 15% of cases and with polyadenoma in 10%. They were located in the rectum within 0 to 6 cm of the anal margin in half the cases. These tumours were treated by local excision in 74 cases and by wide excision in 30 cases. The malignant potential of the tumours was 30%, including 10% invasive malignancy. There were no surgical fatalities, but a 6% medical fatality rate was registered. There was a 20% complication rate related to the surgical technique. Twenty patients were lost to follow-up. Out of 84 villous tumours, monitored over a mean survival period of 6.5 years, there were 24 recurrences: 18 underwent endoscopic excision and in 6 cases a wide resection. The various tumour resection techniques and the operative indications of variable difficulty are presented. It would seem, at present, that total resection of the rectum with a colo-anal anastomosis is the best treatment for large flowing villous tumours occupying almost the entire rectum. Thorough preoperative examination and the mastering of various surgical procedures should allow the most suitable choice of treatment for each individual case.

  2. Nutritional Status and Body Composition of Adult Patients with Brain Tumours Awaiting Surgical Resection.

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    McCall, Michele; Leone, Ashley; Cusimano, Michael D

    2014-09-01

    To measure the prevalence of malnutrition, risk factors for poor dietary intake and body composition in patients with brain tumours admitted to hospital for surgical resection. In this study, 316 patients admitted for brain tumour resection to the Neurosurgical service at St. Michael's Hospital were screened. Assessment tools included the Subjective Global Assessment (SGA) for nutritional status and Bioelectrical Impedance Analysis (BIA) for body composition. All measurements were performed by one research dietitian. Information regarding medical history, symptomology, and tumour pathology was recorded. One hundred and nine participants were recruited. Malnutrition was present in 17.6% of patients, of whom 94.7% were moderately malnourished (SGA-B) and 5.3% severely malnourished (SGA-C). Key symptoms contributing to malnutrition included weight loss, nausea, vomiting, dysphagia, headaches, and fatigue. Patients with malignant tumors were more likely to have weight loss and lower fat mass. This study demonstrated that patients admitted for brain tumour resection have a low prevalence of malnutrition compared with other cancer populations. Useful parameters for nutritional screening of inpatient admissions include weight loss >5% of usual weight, nausea, vomiting, dysphagia, and headaches.

  3. Augmented reality in bone tumour resection

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    Park, Y. K.; Gupta, S.; Yoon, C.; Han, I.; Kim, H-S.; Choi, H.; Hong, J.

    2017-01-01

    Objectives We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. Methods We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. Results The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137–143. PMID:28258117

  4. Augmented reality in bone tumour resection: An experimental study.

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    Cho, H S; Park, Y K; Gupta, S; Yoon, C; Han, I; Kim, H-S; Choi, H; Hong, J

    2017-03-01

    We evaluated the accuracy of augmented reality (AR)-based navigation assistance through simulation of bone tumours in a pig femur model. We developed an AR-based navigation system for bone tumour resection, which could be used on a tablet PC. To simulate a bone tumour in the pig femur, a cortical window was made in the diaphysis and bone cement was inserted. A total of 133 pig femurs were used and tumour resection was simulated with AR-assisted resection (164 resection in 82 femurs, half by an orthropaedic oncology expert and half by an orthopaedic resident) and resection with the conventional method (82 resection in 41 femurs). In the conventional group, resection was performed after measuring the distance from the edge of the condyle to the expected resection margin with a ruler as per routine clinical practice. The mean error of 164 resections in 82 femurs in the AR group was 1.71 mm (0 to 6). The mean error of 82 resections in 41 femurs in the conventional resection group was 2.64 mm (0 to 11) (p Augmented reality in bone tumour resection: An experimental study. Bone Joint Res 2017;6:137-143. © 2017 Cho et al.

  5. Protein expression of BIRC5, TK1, and TOP2A in malignant peripheral nerve sheath tumours--A prognostic test after surgical resection.

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    Kolberg, Matthias; Høland, Maren; Lind, Guro E; Ågesen, Trude H; Skotheim, Rolf I; Hall, Kirsten Sundby; Mandahl, Nils; Smeland, Sigbjørn; Mertens, Fredrik; Davidson, Ben; Lothe, Ragnhild A

    2015-06-01

    No consensus treatment regime exists beyond surgery for malignant peripheral nerve sheath tumours (MPNST), and the purpose of the present study was to find new approaches to stratify patients with good and poor prognosis and to better guide therapeutic intervention for this aggressive soft tissue cancer. From a total of 67 MPNSTs from Scandinavian patients with and without neurofibromatosis type 1, 30 MPNSTs were investigated by genome-wide RNA expression profiling and 63 MPNSTs by immunohistochemical (IHC) analysis, and selected genes were submitted to analyses of disease-specific survival. The potential drug target genes survivin (BIRC5), thymidine kinase 1 (TK1), and topoisomerase 2-alpha (TOP2A), all encoded on chromosome arm 17q, were up-regulated in MPNST as compared to benign neurofibromas. Each of them was found to be independent prognostic markers on the gene expression level, as well as on the protein level. A prognostic profile was identified by combining the nuclear expression scores of the three proteins. For patients with completely resected tumours only 15% in the high risk group were alive after two years, as compared to 78% in the low risk group. In conclusion, we found a novel protein expression profile which identifies MPNST patients with inferior prognosis even after assumed curative surgery. The tested proteins are drug targets; therefore the expression profile may provide predictive information guiding the design of future clinical trials. Importantly, as the effect is seen on the protein level using IHC, the biomarker panel can be readily implemented in routine clinical testing.

  6. Aggressive Multi-Visceral Pancreatic Resections for Locally Advanced Neuroendocrine Tumours. Is It Worth It?

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    Mohammed Abu Hilal

    2009-05-01

    Full Text Available Context Traditional surgical principles state that pancreatic resection should not be contemplated when malignancies arise in the pancreas and involve other organs. While this is logic for ductal adenocarcinoma and other tumours with aggressive biological behavior; for even large neuroendocrine tumours, aggressive multivisceral resection may achieve useful palliation and excellent survival. Design Case records were retrospectively analyzed. Patients and interventions Twelve consecutive patients (7 males, 5 females; median age 57 years, range: 37-79 years underwent multi-visceral en bloc resections for neuroendocrine tumour arising in the pancreas between 1994 and 2008. Results Three patients underwent pancreaticoduodenectomy; 9 patients had left sided pancreatic resections for neuroendocrine tumour of median diameter 9.5 cm ( 5-25 cm. They had a median of 3 (range: 1-4 additional organs resected. There were no post-operative deaths or late mortality with median follow up of 24 months. Five patients experienced a complication (major in 3 patients. Median disease free survival was not attained and 3 patients experienced recurrent disease mostly in the liver and may be candidates for further resection. Conclusion Aggressive multi-visceral resection for locally advanced neuroendocrine tumour involving the pancreas is technically feasible and in selected patients can be achieved with low mortality and acceptable morbidity, offering good disease free and overall survival. However this complex surgery should be only performed in specialist centers.

  7. Training for planning tumour resection: augmented reality and human factors.

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    Abhari, Kamyar; Baxter, John S H; Chen, Elvis C S; Khan, Ali R; Peters, Terry M; de Ribaupierre, Sandrine; Eagleson, Roy

    2015-06-01

    Planning surgical interventions is a complex task, demanding a high degree of perceptual, cognitive, and sensorimotor skills to reduce intra- and post-operative complications. This process requires spatial reasoning to coordinate between the preoperatively acquired medical images and patient reference frames. In the case of neurosurgical interventions, traditional approaches to planning tend to focus on providing a means for visualizing medical images, but rarely support transformation between different spatial reference frames. Thus, surgeons often rely on their previous experience and intuition as their sole guide is to perform mental transformation. In case of junior residents, this may lead to longer operation times or increased chance of error under additional cognitive demands. In this paper, we introduce a mixed augmented-/virtual-reality system to facilitate training for planning a common neurosurgical procedure, brain tumour resection. The proposed system is designed and evaluated with human factors explicitly in mind, alleviating the difficulty of mental transformation. Our results indicate that, compared to conventional planning environments, the proposed system greatly improves the nonclinicians' performance, independent of the sensorimotor tasks performed ( ). Furthermore, the use of the proposed system by clinicians resulted in a significant reduction in time to perform clinically relevant tasks ( ). These results demonstrate the role of mixed-reality systems in assisting residents to develop necessary spatial reasoning skills needed for planning brain tumour resection, improving patient outcomes.

  8. Combined operative technique with anterior surgical approach and video-assisted thoracoscopic surgical lobectomy for anterior superior sulcus tumours.

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    Yokoyama, Yuhei; Chen, Fengshi; Aoyama, Akihiro; Sato, Toshihiko; Date, Hiroshi

    2014-11-01

    Video-assisted thoracoscopic surgery (VATS) has been widely used, but surgical resections of superior sulcus tumours remain challenging because of their anatomical location. For such cases, less-invasive procedures, such as the anterior transcervical-thoracic and transmanubrial approaches, have been widely performed because of their excellent visualization of the subclavian vessels. Recently, a combined operative technique with an anterior surgical approach and VATS for anterior superior sulcus tumours has been introduced. Herein, we report three cases of anterior superior sulcus tumours successfully resected by surgical approaches combined with a VATS-based lobectomy. In all cases, operability was confirmed by VATS, and upper lobectomies with hilar and mediastinal lymph node dissections were performed. Subsequently, dissections of the anterior inlet of the tumours were performed using the transmanubrial approach in two patients and the anterior trans-cervical-thoracic approach in one patient. Both approaches provided excellent access to the anterior inlet of the tumour and exposure of the subclavian vessels, resulting in radical resection of the tumour with concomitant resection of the surrounding anatomical structures, including the chest wall and vessels. In conclusion, VATS lobectomy combined with the anterior surgical approach might be an excellent procedure for the resection of anterior superior sulcus tumours.

  9. Improving Outcomes with Surgical Resection and Other Ablative Therapies in HCC

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    Rahul Deshpande

    2011-01-01

    Full Text Available With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established.

  10. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

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    Dalgic, Tahsin; Bostanci, Erdal Birol; Cakir, Tebessum; Ozer, Ilter; Ulas, Murat; Aydog, Gulden; Akoglu, Musa

    2015-01-01

    Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases. PMID:25954564

  11. Solitary Plasmacytoma of the Cecum and the Ascending Colon: Surgical Resection as a Treatment Modality

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    Tahsin Dalgic

    2015-01-01

    Full Text Available Colonic solitary plasmacytoma is a rare disease, with few reports occurring in the literature. Solitary plasmacytoma is defined as a plasma cell tumour with no evidence of bone marrow infiltration. Plasmacytoma can present as a solitary tumour in bone or in other parts of the body. The gastrointestinal tract is rarely the site of the disease. We report on the case of a 51-year-old man presenting with a colonic symptomatic mass with unclear biopsy results. A resected specimen showed a solitary plasmacytoma. Surgical resection was an adequate treatment modality in this case. Endoscopic resection, radiotherapy, and chemotherapy are also preferred treatments in selected gastrointestinal plasmacytoma cases.

  12. [Surgical resection of gliomas in 2008].

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    Carpentier, A C

    2008-11-01

    Surgical resection of gliomas is a well-established treatment. It allows a histo-genetic diagnosis, a mass effect reduction, an intracranial hypertension treatment, a recovery of an eventual neurological deficit induced by the mass effect, but mostly brings a significant survival. New imaging sequences are optimizing the surgical management of brain tumors by bringing precisions on the tumor morphology, on cortical/subcortical eloquent areas (functional and diffusion MRI), on histology (spectroscopic MR). If the tumor is located in eloquent area, surgery is performed under electrostimulation control to take into account cerebral plasticity and to avoid postoperative functional deficits. Neuronavigation, per-operative echography, and per-operative MRI are recognized tools for optimizing the tumor resection. Ongoing researches concern the adjunction of local treatments within the surgical field (photodynamic therapy, chemotherapy, convection immunotherapy...), but also the development of minimal invasive procedures (radiosurgery, high intensity focalized ultrasounds, laser interstitial thermal therapy).

  13. Surgical resection of a giant cardiac fibroma.

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    Stamp, Nikki L; Larbalestier, Robert I

    2016-05-01

    A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively.

  14. Clinicoradiological outcomes of 33 cases of surgically resected pulmonary pleomorphic carcinoma: correlation with prognostic indicators

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    Nishida, Akifumi; Ashizawa, Kazuto [Nagasaki University Graduate School of Biomedical Sciences, Department of Clinical Oncology, Unit of Translational Medicine, Nagasaki (Japan); Abiru, Hajime [Saga National Hospital, Department of Radiology, Saga (Japan); Hayashi, Hideyuki; Uetani, Masataka [Nagasaki University Graduate School of Biomedical Sciences, Department of Radiological Science, Nagasaki (Japan); Matsumoto, Keitaro; Tsuchiya, Tomoshi; Yamasaki, Naoya; Nagayasu, Takeshi [Nagasaki University Graduate School of Biomedical Sciences, Department of Surgical Oncology, Nagasaki (Japan); Hayashi, Tomayoshi [Nagasaki Prefectural Shimabara Hospital, Department of Pathology, Shimabara (Japan); Kinoshita, Naoe [Nagasaki University Graduate School of Biomedical Sciences, Department of Pathology, Nagasaki (Japan); Honda, Sumihisa [Nagasaki University Graduate School of Biomedical Sciences, Department of Public Health, Nagasaki (Japan)

    2016-01-15

    To retrospectively review the clinical, radiological and pathological data in patients who underwent surgical resection for pulmonary pleomorphic carcinoma (PC), and to analyse the prognostic predictors of survival. The data were retrospectively examined for 33 consecutive patients (28 males and five females) who had undergone surgical resection for pulmonary PC. Cox's proportional-hazards model was used to analyse the prognostic predictors of survival. The size of the tumours ranged from 1.1 to 12.0 cm (mean 5.4 cm). The majority (26) of the tumours were located at the lung periphery, five tumours had cavitation, two had calcification and 14 had peritumoral ground-glass opacity. Most of the tumours showed heterogeneous enhancement and contained a low-density area (LDA) within the tumour. The 5-year overall survival of surgically resected PC was 36 % (standard error = 0.093). A multivariate analysis revealed the LDA grade [hazard ratio (HR), 2.019], pathological stage (HR, 7.552) and pathological N factor (HR, 0.370) to be significant predictors of a poorer prognosis. A greater component of LDA within the tumour on contrast-enhanced CT is associated with a poorer prognosis in patients with PC. (orig.)

  15. Function after pelvic tumour resection involving the acetabular ring.

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    Nilsonne, U; Kreicbergs, A; Olsson, E; Stark, A

    1982-01-01

    Seven patients subjected to pelvic tumour resection involving the acetabular ring were analyzed with respect to function. In addition to conventional clinical assessment gait was analyzed objectively by means of an electronic walk-way and residual hip-muscle power tested by means of a Cybex II dynamometer. Functional results reported by the patients with respect to pain, walking and working capacity appeared better than those elicited by clinical examination. All patients exhibited a marked pelvic tilt and a positive Trendelenburg sign. Only one patient walked without any kind of support. Leg-length discrepancy was on an average 6 cm. Objective gait analysis disclosed that all patients had reduced weight-bearing time on the operated side as compared to the non-operated. This, however, was clearly less pronounced for those patients who appeared best with respect to pain, walking and working capacity. These patients also showed the best hip extension power which appeared more important from a functional point of view than hip flexion and, surprisingly, hip abduction power. Radiographic examination showed that bony support for the proximal femur, provided either by the formation of a bone shelf from the remaining iliac bone or by the remaining iliac bone itself, was of decisive importance for function. The results of the present study show that pelvic tumour resection involving the acetabular ring, provided radical tumour removal can be achieved, constitutes a feasible alternative to hemipelvectomy from a functional point of view.

  16. Duration of adjuvant treatment following radical resection of metastases from gastrointestinal stromal tumours

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    NANNINI, MARGHERITA; PANTALEO, MARIA ABBONDANZA; MALEDDU, ALESSANDRA; SAPONARA, MARISTELLA; MANDRIOLI, ANNA; LOLLI, CRISTIAN; PALLOTTI, MARIA CATERINA; GATTO, LIDIA; SANTINI, DONATELLA; PATERINI, PAOLA; DI SCIOSCIO, VALERIO; CATENA, FAUSTO; FUSAROLI, PIETRO; PINNA, ANTONIO DANIELE; DEI TOS, ANGELO PAOLO; BIASCO, GUIDO

    2011-01-01

    Large-scale studies have demonstrated that continuative treatment in advanced and adjuvant settings results in a gain-of-survival. However, the discontinuation, and the duration of treatment in disease-free patients who have undergone radical surgical resection of metastases from gastrointestinal stromal tumours (GISTs) have yet to be evaluated. We retrospectively reviewed 40 patients with advanced and recurrent GIST, included in our GIST database, focusing on patients (5 males and 2 females; median age 56 years) who continued medical treatment following radical surgical resection of metastatic lesions. Seven out of 40 patients underwent surgery and continued medical treatment following radical surgical resection of metastatic lesions. The duration of adjuvant therapy was 3, 12, 16, 24, 35, 37 and 52 months, respectively, with a median of 26 months. No patients discontinued therapy and all were disease-free at the final CT-scan evaluation. Considering that the discontinuation of imatinib in responding patients with advanced GIST (even in complete remission) results in a rapid high risk of progression, and a short adjuvant therapy results in a shorter disease-free and overall survival in high-risk GIST patients, it is also likely that treatment should not be discontinued in this setting. However, large-scale studies are required to better assess the optimal duration of treatment, particularly after 5 years, by focusing on the identification of predictive factors for the selection of patients who may benefit from a prolonged or lifelong imatinib treatment. PMID:22740975

  17. An Intraoperative $\\beta^-$ Detecting Probe For Radio-Guided Surgery in Tumour Resection

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    Russomando, Andrea; Bocci, Valerio; Chiodi, Giacomo; Collamati, Francesco; De Lucia, Erika; Donnarumma, Raffaella; Faccini, Riccardo; Terracciano, Carlo Mancini; Marafini, Michela; Paramatti, Riccardo; Patera, Vincenzo; Pinci, %Davide; Recchia, Luigi; Sarti, Alessio; Sciubba, Adalberto; Camillocci, Elena Solfaroli; Voena, Cecilia; Morganti, Silvio

    2015-01-01

    The development of the $\\beta^-$ based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma, glioma, and neuroendocrine tumors already estimated the potentiality of this new treatment. To validate the technique, prototypes of the intraoperative probe required by the technique to detect $\\beta^-$ radiation have been developed. This paper discusses the design details of the device and the tests performed in laboratory. In such tests particular care has to be taken to reproduce the surgical field conditions. The innovative technique to produce specific phantoms and the dedicated testing protocols is described in detail.

  18. An Intraoperative beta (-) Detecting Probe for Radio-Guided Surgery in Tumour Resection

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    Russomando, Andrea; Bellini, Fabio; Bocci, Valerio; Collamati, Francesco; De Lucia, Erika; Faccini, Riccardo; Marafini, Michela; Mattei, Ilaria; Chiodi, Giacomo; Patera, Vincenzo; Recchia, Luigi; Sarti, Alessio; Sciubba, Adalberto; Solfaroli Camillocci, Elena; Paramatti, Riccardo; Voena, Cecilia; Donnarumma, Raffaella; Mancini-Terracciano, Carlo; Morganti, Silvio

    2016-10-01

    The development of the $\\beta^-$ based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma, glioma, and neuroendocrine tumors already estimated the potentiality of this new treatment. To validate the technique, prototypes of the intraoperative probe required by the technique to detect $\\beta^-$ radiation have been developed. This paper discusses the design details of the device and the tests performed in laboratory. In such tests particular care has to be taken to reproduce the surgical field conditions. The innovative technique to produce specific phantoms and the dedicated testing protocols is described in detail.

  19. Surgical decision criteria: Bednar tumour of the foot in a child.

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    Kubiak, Rainer; Weidner, Katrin; Bruder, Elisabeth; Kalbermatten, Daniel F; Haug, Martin

    2011-12-01

    An 8-year-old boy was admitted for excision of a putative 'blue nevus' on the left foot. Histological examination and immunohistochemistry revealed a Bednar tumour, the pigmented variant of dermatofibrosarcoma protuberans. Surgical options considered by a multidisciplinary team included wide local excision, Mohs micrographic surgery or a staged excision with examination of several histological sections. The third alternative procedure was chosen after consideration of tumour and patient factors to achieve the best possible clinical, cosmetic and functional outcome. After the final surgical procedure with resection of the third metatarsal bone, all peripheral margins were free of tumour, and the interdigital space was reconstructed with a pedicled pulpa flap. Three years after surgery, there was no tumour recurrence, and further long-term follow-up for this patient will be provided. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. MRI Evaluation of Resection Margins in Bone Tumour Surgery

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    Simon Vandergugten

    2014-01-01

    Full Text Available In 12 patients operated on for bone sarcoma resection, a postoperative magnetic resonance imaging of the resection specimens was obtained in order to assess the surgical margins. Margins were classified according to MRI in R0, R1, and R2 by three independent observers: a radiologist and two orthopaedic surgeons. Final margin evaluation (R0, R1, and R2 was assessed by a confirmed pathologist. Agreement for margin evaluation between the pathologist and the radiologist was perfect (κ=1. Agreement between the pathologist and an experienced orthopaedic surgeon was very good while it was fair between the pathologist and a junior orthopaedic surgeon. MRI should be considered as a tool to give quick information about the adequacy of margins and to help the pathologist to focus on doubtful areas and to spare time in specimen analysis. But it may not replace the pathological evaluation that gives additional information about tumor necrosis. This study shows that MRI extemporaneous analysis of a resection specimen may be efficient in bone tumor oncologic surgery, if made by an experienced radiologist with perfect agreement with the pathologist.

  1. CRIO-INFLUENCE IN SURGICAL TREATMENT OF BENIGN TUMOURS OF FOOT BONES

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    S. V. Dianov

    2010-01-01

    Full Text Available The material of investigation was the results of treatment of 131 patients with foot bones tumours. The largest number of patients referred, to age interval from 11 to 30 years (69,6%. More than half of cases were osteochondromas (54%, then solitary bone cyst (14,5% and chondromas (13%. Other nosologic forms were met significantly seldom. Two groups of patients were examined: the main group (with crio-influence - 44 patients and group of comparison (without crio-influence - 87 patients. The plot of operation was in flat, border-line, intrafocusal or segmental resection of damaged section, crio-instillation or contact curio-processing of bone and auto- or allopathic of respected defect. The results of treatment were estimated in a year after operation. After usage of curio-surgical method there were observed positive results in 41 patients, satisfactory - in 2 and unsatisfactory - in 1. The results of treatment with traditional method were positive in 79 cases, satisfactory - in 2, unsatisfactory - in 6. The worked-out method of curio-surgical treatment of foot bone tumours includes resection of pathological focus, itraoperative crio-influence on bone tissue and bone plastic transplantation of resected, defect. The analysis of criosurgical operations of foot gave the foundation to consider such interventions significant and perspective in treatment of patients with tumours and tumour similar damages of foot bone.

  2. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration

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    Ali, Nurayub Mohd; Azizan, Nornazirah; Zakaria, Andee Dzulkarnaen; Rahman, Mohd Ramzisham Abdul

    2016-01-01

    We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.

  3. Role of Cerebellum in Fine Speech Control in Childhood: Persistent Dysarthria after Surgical Treatment for Posterior Fossa Tumour

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    Morgan, A. T.; Liegeois, F.; Liederkerke, C.; Vogel, A. P.; Hayward, R.; Harkness, W.; Chong, K.; Vargha-Khadem, F.

    2011-01-01

    Dysarthria following surgical resection of childhood posterior fossa tumour (PFT) is most commonly documented in a select group of participants with mutism in the acute recovery phase, thus limiting knowledge of post-operative prognosis for this population of children as a whole. Here we report on the speech characteristics of 13 cases seen…

  4. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

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    Yukio Iwashita

    2012-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both post-operative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  5. Two-stage laparoscopic resection of colon cancer and metastatic liver tumour

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    Iwashita Yukio

    2005-01-01

    Full Text Available We report herein the case of 70-year-old woman in whom colon cancer and a synchronous metastatic liver tumour were successfully resected laparoscopically. The tumours were treated in two stages. Both postoperative courses were uneventful, and there has been no recurrence during the 8 months since the second procedure.

  6. Surgical resection for esophageal carcinoma: Speaking the language

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    Robert J. Korst

    2005-01-01

    The terminology used to describe esophagectomy for carcinoma can be confusing, even for specialists in gastrointestinal disease. As a result, specific terms are often used out of their intended context. To simplify the nomenclature, two points regarding procedures for surgical resection of the esophagus are critical: the extent of resection (radical vs standard) and the operative approach (choice of incisions). It is important to understand that the radicality of the resection may have little to do with the operative approach, with the exception of esophagectomy without thoracotomy (transhiatal esophagectomy), which mandates the performance of a standard or non-radical resection. Esophagectomy has emerged as the standard curative treatment option for patients with esophageal carcinoma; however, unlike the surgical resection of other types of solid tumors, many different surgical options and/or approaches exist for these patients. This heterogeneity of care may result from the fact that the esophagus is accessible through more than one body cavity (left hemithorax, right hemithorax, abdomen).In addition, and partially as a result of its accessibility,different types of surgical specialists harbor this operation in their armamentarium, including general surgeons,thoracic surgeons, and surgical oncologists. Despite this enthusiasm amongst surgeons, little consensus exists as to which option is most oncologically sound. Further, the details of the various surgical approaches and procedures for resection of the esophagus are often difficult to comprehend, even for specialists in gastrointestinal disease, with much of the relevant terminology used out of its intended context. To facilitate the understanding of the surgical options for esophageal carcinoma, it is useful to view the operation from two angles: the extent of resection (Aradical@ vs Astandard@) and the operative approach (choice of incisions).

  7. Delayed healing at transurethral resection of bladder tumour sites after immediate postoperative mitomycin C instillation

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    Aagaard, Mark F; Mogensen, Karin; Hermann, Gregers G

    2014-01-01

    The most common reactions to mitomycin C are dysuria and drug-related palmar and genital desquamation. This report describes two cases of delayed healing of the mucosa at resection sites after transurethral resection of bladder tumours, most likely due to immediate postoperative mitomycin C...

  8. Recent technological developments: in situ histopathological interrogation of surgical tissues and resection margins

    Directory of Open Access Journals (Sweden)

    Upile Tahwinder

    2007-03-01

    Full Text Available Abstract Objectives The tumour margin is an important surgical concept significantly affecting patient morbidity and mortality. We aimed in this prospective study to apply the microendoscope on tissue margins from patients undergoing surgery for oral cancer in vivo and ex vivo and compare it to the gold standard "paraffin wax", inter-observer agreement was measured; also to present the surgical pathologist with a practical guide to the every day use of the microendoscope both in the clinical and surgical fields. Materials and methods Forty patients undergoing resection of oral squamous cell carcinoma were recruited. The surgical margin was first marked by the operator followed by microendoscopic assessment. Biopsies were taken from areas suggestive of close or positive margins after microendoscopic examination. These histological samples were later scrutinized formally and the resection margins revisited accordingly when necessary. Results Using the microendoscope we report our experience in the determination of surgical margins at operation and later comparison with frozen section and paraffin section margins "gold standard". We were able to obtain a sensitivity of 95% and a specificity of 90%. Inter-observer Kappa scores comparing the microendoscope with formal histological analysis of normal and abnormal mucosa were 0.85. Conclusion The advantage of this technique is that a large area of mucosa can be sampled and any histomorphological changes can be visualized in real time allowing the operator to make important informed decisions with regards the intra-operative resection margin at the time of the surgery.

  9. Haglund Deformity – Surgical Resection by the Lateral Approach

    OpenAIRE

    Natarajan, S; VL Narayanan

    2015-01-01

    The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund de...

  10. Primary pancreatic lymphoma – pancreatic tumours that are potentially curable without resection, a retrospective review of four cases

    Directory of Open Access Journals (Sweden)

    Chin Melvin T

    2006-05-01

    Full Text Available Abstract Background Primary pancreatic lymphomas (PPL are rare tumours of the pancreas. Symptoms, imaging and tumour markers can mimic pancreatic adenocarcinoma, but they are much more amenable to treatment. Treatment for PPL remains controversial, particularly the role of surgical resection. Methods Four cases of primary pancreatic lymphoma were identified at Prince of Wales Hospital, Sydney, Australia. A literature review of cases of PPL reported between 1985 and 2005 was conducted, and outcomes were contrasted. Results All four patients presented with upper abdominal symptoms associated with weight loss. One case was diagnosed without surgery. No patients underwent pancreatectomy. All patients were treated with chemotherapy and radiotherapy, and two of four patients received rituximab. One patient died at 32 months. Three patients are disease free at 15, 25 and 64 months, one after successful retreatment. Literature review identified a further 103 patients in 11 case series. Outcomes in our series and other series of chemotherapy and radiotherapy compared favourably to surgical series. Conclusion Biopsy of all pancreatic masses is essential, to exclude potentially curable conditions such as PPL, and can be performed without laparotomy. Combined multimodality treatment, utilising chemotherapy and radiotherapy, without surgical resection is advocated but a cooperative prospective study would lead to further improvement in treatment outcomes.

  11. Validation of an algorithm for planar surgical resection reconstruction

    Science.gov (United States)

    Milano, Federico E.; Ritacco, Lucas E.; Farfalli, Germán L.; Aponte-Tinao, Luis A.; González Bernaldo de Quirós, Fernán; Risk, Marcelo

    2012-02-01

    Surgical planning followed by computer-assisted intraoperative navigation in orthopaedics oncology for tumor resection have given acceptable results in the last few years. However, the accuracy of preoperative planning and navigation is not clear yet. The aim of this study is to validate a method capable of reconstructing the nearly planar surface generated by the cutting saw in the surgical specimen taken off the patient during the resection procedure. This method estimates an angular and offset deviation that serves as a clinically useful resection accuracy measure. The validation process targets the degree to which the automatic estimation is true, taking as a validation criterium the accuracy of the estimation algorithm. For this purpose a manually estimated gold standard (a bronze standard) data set is built by an expert surgeon. The results show that the manual and the automatic methods consistently provide similar measures.

  12. Surgical treatment of benign parapharyngeal space tumours. Presentation of two clinical cases and revision of the literature.

    Science.gov (United States)

    Fernández Ferro, Martin; Fernández Sanromán, Jacinto; Costas López, Alberto; Sandoval Gutiérrez, Jesús; López de Sánchez, Annahys

    2008-01-01

    Parapharyngeal space (PPS) tumours, most of them benign, account for some 0.5% of tumours of the head and neck. The importance of these tumours lies mainly in two aspects: on the one hand, the difficulty of early diagnosis, due to the lack of symptoms in the initial stages and, on the other, the extreme complications of performing surgery in the parapharyngeal region. This article discusses two clinical cases of parapharyngeal space tumours: a 45 year old man and a 60 year old woman. We revise the scientific literature and analyse the diagnostic and therapeutic procedures used, placing special emphasis on describing the different surgical approaches to the parapharyngeal space: transcervical, transcervical-transparotid, transpalatal or transoral, transmandibular and orbitozygomatic, all of which, used alone or combined with others, allow for complete resection of these tumours with minimum morbidity.

  13. Giant Mediastinal Germ Cell Tumour: An Enigma of Surgical Consideration

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    Firdaus Hayati

    2016-01-01

    Full Text Available We present a case of 16-year-old male, who was referred from private centre for dyspnoea, fatigue, and orthopnea. The chest radiograph revealed complete opacification of left chest which was confirmed by computed tomography as a large left mediastinal mass measuring 14 × 15 × 18 cm. The diagnostic needle core biopsy revealed mixed germ cell tumour with possible combination of embryonal carcinoma, yolk sac, and teratoma. After 4 cycles of neoadjuvant BEP regime, there was initial response of tumour markers but not tumour bulk. Instead of classic median sternotomy or clamshell incision, posterolateral approach with piecemeal manner was chosen. Histology confirmed mixed germ cell tumour with residual teratomatous component without yolk sac or embryonal carcinoma component. Weighing 3.5 kg, it is one of the largest mediastinal germ cell tumours ever reported. We describe this rare and gigantic intrathoracic tumour and discuss the spectrum of surgical approach and treatment of this exceptional tumour.

  14. Dilemmas in autoimmune pancreatitis. Surgical resection or not?

    Science.gov (United States)

    Hoffmanova, I; Gurlich, R; Janik, V; Szabo, A; Vernerova, Z

    Surgical treatment is not commonly recommended in the management of autoimmune pancreatitis. The article describes a dilemma in diagnostics and treatment of a 68-year old man with the mass in the head of the pancreas that mimicked pancreatic cancer and that was diagnosed as a type 1 autoimmune pancreatitis (IgG4-related pancreatitis) after a surgical resection. Diagnosis of the autoimmune pancreatitis is a real clinical challenge, as in the current diagnostic criteria exists some degree of overlap in the findings between autoimmune pancreatitis and pancreatic cancer (indicated by the similarity in radiologic findings, elevation of IgG4, sampling errors in pancreatic biopsy, and the possibility of synchronous autoimmune pancreatitis and pancreatic cancer). Despite the generally accepted corticosteroids as the primary treatment modality in autoimmune pancreatitis, we believe that surgical resection remains necessary in a specific subgroup of patients with autoimmune pancreatitis (Fig. 4, Ref. 37).

  15. [The radicality of surgical resection in rectal cancer. Analysis of factors associated with incomplete mesorectal excision].

    Science.gov (United States)

    Ferko, A; Orhalmi, J; Nikolov, D H; Hovorková, E; Chobola, M; Vošmik, M; Cermáková, E

    2013-06-01

    Circumferential resection margin (pCRM) and the completeness of mesorectal excision (ME) are two independent prognostic factors significantly associated with the radicality of surgical treatment. Positive pCRM and incomplete mesorectal excision are associated with a significantly higher incidence of local recurrence and worse patient prognosis. The aim of this article is to analyze the risk factors associated with incomplete mesorectal excision. Patients operated on at the Department of Surgery, University Hospital Hradec Kralove between January 2011 and February 2013 were included in the study. The patients data were prospectively collected and entered in the Dg C20 registry. The following factors were analyzed: sex, age, BMI, cN, pT, clinical stage, the involved segment of the rectum, neoadjuvant therapy, circumferential tumour location, the type of surgical approach and the type of surgery. 168 patients were operated on during the above period. 9 (5.3%) palliative stomas and 159 (94.6%) resection procedures were performed in this group of 168 patients. 7 (4.4%) patients were excluded because the quality of excision was not assessed in them. 114 (75%) resections, including 5 intersphincteric resections, were performed in the group of the remaining 152 patients. 10 (7%) were Hartmanns procedures a 28 (18%) were amputation procedures. Out of 152 procedures, 69 (45%) were performed laparoscopically. Positive (y)pCRO was recorded in 26 (17%) patients, predominantly after abdominoperineal resection (APR) - 11 out of 27 (41%), and Hartmanns operation - 6 out of 10 (60%). Incomplete ME was observed in 45 patients (30%), complete ME in 81 patients (53%) and partially complete in 26 patients (17%). Univariate analysis confirmed statistically significant factors associated with incomplete mesorectal excision: (y)pT (P = 0.00027), type of surgery (P = 0.00001) and tumour location (P = 0.00001). Multivariate analysis then confirmed two independent prognostic factors

  16. A projective surgical navigation system for cancer resection

    Science.gov (United States)

    Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald

    2016-03-01

    Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

  17. Prognostic factors affecting disease-free survival rate following surgical resection of primary breast cancer

    Directory of Open Access Journals (Sweden)

    K Horita

    2009-12-01

    Full Text Available In order to identify the prognostic factors that significantly influence the disease-free survival rate after surgical resection of primary breast cancers, we determined tumour and lymph node grades, and immunohistochemical staining for estrogen and progesterone receptors (ER and PR, c-erbB-2, p53, bcl-2, bax and PCNA in 76 patients. Univariate analysis showed that increased grade of tumour and lymph nodes, negative immunostaining for ER, positive immunostaining for c-erbB-2, and a high PCNA index (³30% negatively influenced the disease- free survival rate, but PR, p53, bcl-2 and bax had no predictive value. Although p53 was not an independent prognostic factor by itself, the combination of p53, bcl-2, and bax proved to correlate with the disease-free survival, with the best prognosis noted in tumours negative for p53 and positive for both bcl-2 and bax, intermediate prognosis in tumours negative for p53 and positive for either bcl- 2 or bax and worst prognosis in tumors negative for p53 as well as bcl-2 and bax. Tumour grade correlated positively with PCNA index, while positive staining for ER correlated negatively with tumour grade as well as with PCNA index, although this was statistically insignificant. Immunostaining of breast cancers for Bcl-2 correlated negatively with tumour grade and PCNA index. Immunostaining for c-erbB-2 correlated positively with PCNA but not with tumour grade. Immunostaining for p53 tended to correlate positively with PCNA, but not with tumour grade. Immunostaining for PR and bax did not correlate with tumour grade and PCNA index. These results suggest that in addition to tumour size and lymph node involvement, immunostaining for ER, c-erbB-2, and a high PCNA index are important prognostic factors in human breast cancer. Wild-type p53 with preserved bcl-2 and bax gene products is also a favorable prognostic factor indicating breast cancer at an early stage of cancer progression.

  18. Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

    Energy Technology Data Exchange (ETDEWEB)

    Warmuth-Metz, M.; Solymosi, L. [Abteilung fuer Neuroradiologie, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Kuehl, J. [Paediatric Oncology, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Krauss, J. [Paediatric Neurosurgery, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany)

    2004-03-01

    In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery. (orig.)

  19. Magnetic resonance imaging cannot predict histological tumour involvement of a circumferential surgical margin in rectal cancer.

    Science.gov (United States)

    Dent, O F; Chapuis, P H; Haboubi, N; Bokey, L

    2011-09-01

    Several recent studies have attempted to evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting the likelihood of tumour involvement of the postoperative circumferential resection margin (CRM) in rectal cancer with the intention of selecting patients who might benefit from neoadjuvant therapy and as a guide to surgery. The aim of this study was to assess whether such studies can provide a valid answer as to whether preoperative MRI can accurately predict CRM involvement by tumour. The study design and methodology of studies on this topic were critically examined. Features identified as affecting the efficacy of these studies were: representativeness of patients, definition of the margin assessed by MRI and by histology, lack of blinding of surgeons and pathologists to MRI results, effect of neoadjuvant treatment, and number of patients studied. Because of methodological inadequacies in studies completed to date, there is insufficient evidence of the ability of a positive MRI result to predict an involved CRM. Although MRI may be able to identify a tumour that has extended to the mesorectal fascia and/or intersphincteric plane, logically, it cannot indicate where the surgical boundary of the resection will ultimately lie, and therefore cannot validly predict an involved CRM and should not be relied upon for this purpose. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

  20. Role of surgical resection in treatment of pancreatic adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Milošević Pavle

    2011-01-01

    Full Text Available Introduction. Pancreatic adenocarcinoma is the fifth leading cause of death from malignant diseases. The total five-year rate is bellow 5%, but in patients who underwent pancreatic resection, the fiveyear rate may be up to 20%. Surgical resection is still the only therapeutic option that offers the possibility of cure. In recent decades, the perioperative mortality rate has been significantly reduced in the institutions performing a number of these operations per year and has become less than 5%. Postoperative morbidity remains high. Material and Methods. The results of surgical resection in the treatment of pancreatic adenocarcinoma have been analyzed. A retrospective study included the patients operated at the Department for Abdominal, Endocrine and Transplantation surgery, Clinical Center of Vojvodina. Results. In the period from February 1st 1998 to February 1st 2007 a total of 67 patients with pancreatic adenocarcinoma underwent resection. The average age of patients was 58.81±1.42 years. There were 44 (65.7% male and 23 (34.3% female patients. The most common locations of cancer were the head, then the body and the tail of the pancreas and they were found in 57 (85.1% cases, 7 (10,4% cases and 3 (4,47% cases, respectively. The postoperative mortality appeared in 3 (4.47% cases and postoperative morbidity in 21 (31.3% cases. The average survival was 22.89± 3.87 months, the median being 9.0±2.18 months. The five-year survival rate was 13.5%. Conclusion. For patients with pancreatic cancer, surgical resection still remains the only chance of cure. These procedures are performed with acceptable postoperative mortality and morbidity rate. The percentage of cured patients is still unsatisfactorily low.

  1. Strain Assessment in Surgically Resected Inflammatory and Neoplastic Bowel Lesions

    DEFF Research Database (Denmark)

    Havre, R F; Leh, S; Gilja, O H

    2014-01-01

    Purpose: To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens.Materials and Methods: Resected surgical specimens from 27 patients electively operated for colorectal tumors...... or stenotic lesions from Crohn's disease were prospectively examined with ultrasonography using a Hitachi HV 900 US scanner with real-time elastography (RTE). Three different methods were applied to assess tissue strain: A four-level categorical visual classification, a continuous visual analog scale (VAS, 0...... - 100) and a strain ratio (SR) measurement between the lesion and surrounding reference tissue. The imaged sections were marked and subsequently examined by a pathologist. Results from RTE were evaluated according to diagnosis, degree of fibrosis, inflammatory parameters, tumor stage and grade...

  2. Reconstruction of the Distal Radius following Tumour Resection Using an Osteoarticular Allograft

    Directory of Open Access Journals (Sweden)

    Katharina Rabitsch

    2013-01-01

    Full Text Available Reconstruction of the distal radius following tumour resection is challenging and various techniques are recorded. We retrospectively analysed the outcome of five patients (one male and four females after reconstruction of the distal radius with osteoarticular allograft, following tumour resection. Mean followup was 32 months (range, 4–121. In three of the five patients the dominant limb was affected. Mean bone resection length was 6.5 centimetres (range, 5–11.5. Two grafts developed nonunion, both successfully treated with autologous bone grafting. No infection, graft fracture, or failure occurred. Mean flexion/extension was 38/60 degrees and mean pronation/supination was 77/77 degrees. The mean Mayo wrist score was 84 and the mean DASH score was 8, both representing a good functional result. Therefore we state the notion that osteoarticular allograft reconstruction of distal radius provides good to excellent functional results.

  3. P13.10SURGICAL TREATMENT FOR GLIOBLASTOMA MULTIFORME: OUTCOME AND ANALYSIS OF PROGNOSTIC FACTORS ESPECIALLY ORIENTED TO THE EXTENT OF SURGICAL RESECTION

    Science.gov (United States)

    Di Somma, L.; Iacoangeli, M.; Alvaro, L.; Di Rienzo, A.; Liverotti, V.; Della Costanza, M.; Brunozzi, D.; Polonara, G.; Scarpelli, M.; Scerrati, M.

    2014-01-01

    INTRODUCTION: The prognosis of Glioblastoma Multiforme (GBM) remains poor despite recent therapeutic advances. The surgical treatment of GBM (supported by functional imaging, neuronavigation and electrophysiological monitoring) remains a fundamental step. The methylation of the enzyme O6-methylguanine-DNA methyltransefrase (MGMT) seems to improve the effectiveness of alkylating agents on this tumour, but other factors can influence the survival. An evaluation of all prognostic factors is essential to individuate subgroups of patients for a better selection of different treatment modalities. Our study confirms the prognostic values of both new recognized factors (MGMT presence, IDH1, news schedule of TM2 etc.) and the well-recognized prognostic factors particularly to the extent of surgical removal with the help of new technologies and in the era where people is asking more and more a better quality of life. METHODS: We retrospectively analysed 172 operated patients (115 males and 57 females), 55 of which located in eloquent areas, between March 2008 and December 2012. For each patient age, sex, preoperative clinical evaluation (Karnofsky score, KPS), tumour location, extent of surgical removal, genetic and epigenetic profile (MGMT, IDH1,etc) and postoperative treatments were recorded. We used Kaplan Meier method for the univariate analysis and the Cox regression for the multivariate one. Surgical strategy was always planned for a total tumour resection, when allowed by the intrinsic characteristics of the tumour using the so called “extracapsular “ technique. RESULTS: Overall median survival time after surgery was 10 months. At univariate analysis the gross total removal (p70 (p<0,0001) and radiotherapy (p<0,0001) improve survivals. Deep structures involved or multifocal lesions (p<0,0001) resulted as negative factors in term of the quod vitam prognosis, whereas lesions arising in insula, deep structures or in primary motor cortex worse the quod valitudinem

  4. Melanotic neuroectodermal tumour of the pineal region

    Energy Technology Data Exchange (ETDEWEB)

    Gorhan, C.; Soto-Ares, G.; Pruvo, J.P. [Dept. of Neuroradiology, Hopital Roger Salengro, CHRU Lille, Lille (France); Ruchoux, M.M. [Dept. of Neuropathology, Hopital Roger Salengro, CHRU Lille (France); Blond, S. [Dept. of Neurosurgery, Hopital Roger Salengro, CHRU Lille (France)

    2001-11-01

    We describe CT and MR findings in a 23-month-old infant with a melanotic neuroectodermal tumour of the pineal gland. The tumour has been stereotactically biopsied and surgically resected. The pathological diagnosis was made on the resected piece. Embryology of the pineal gland and the histology of melanotic neuroectodermal tumour of infancy are discussed. (orig.)

  5. Chondrosarcoma of the hand: is a wide surgical resection necessary?

    Science.gov (United States)

    Mittermayer, Florian; Dominkus, Martin; Krepler, Petra; Schwameis, Eva; Sluga, Maria; Toma, Cyril; Lang, Susanna; Grampp, Stephan; Kotz, Rainer

    2004-07-01

    Chondrosarcomas of the hand are rare and generally treated with surgical resection. Thirteen patients with Grade 1 chondrosarcoma of the small bones of the hand were followed up for a mean of 99.8 months (range, 26-293 months). In eight patients (Group 1) curettage and reconstruction with cancellous bone was done and in five patients (Group 2) a wide resection was done. No patient experienced relapse in Group 2. In Group 1 one patient had a local relapse 18 months after intralesional resection. Using the Musculoskeletal Tumor Society score for evaluation, the clinical results showed an average of 98% and 95% of the normal function in Groups 1 and 2, respectively. None of the patients had evidence of systemic spread of the disease. With a relapse rate of 12.5% and no distant metastases after curettage, intralesional resection is the preferred method of treatment in Grade 1 chondrosarcoma of the hand, allowing the patient to avoid amputation and major loss of function.

  6. Surgical Management of Intramedullary Spinal Cord Tumors: Surgical Resection and Prognosis

    Institute of Scientific and Technical Information of China (English)

    Gui-huai Wang; Gui-huai Wang; Chung-cheng Wang; Chung-cheng Wang

    2003-01-01

    BACKGROUND & OBJECTIVE: The majority of intramedullary spinal cord tumors (IMSCT) are low-grade gliomas.Radical resection for IMSCTs remains challenging.Recently, improved neuroimaging and advanced microsurgical technique have made great success in surgical management of the intramedullary spinal cord tumors.METHODS & RESULTS: Twenty-nine patients with intramedullary spinal cord tumors were treated by radical resection during the past 4 years in our institute.The histological results were as follows: 12 ependymomas, 4 astrocytomas, 4 hemangioblastomas, 4 epidermoids, 1 cavernoma, 2 lipomas, 2 metastatics.A gross-total resection (> 95%) was achieved in 25 surgical procedures.Subtotal resections (80-95%) were performed in 4 cases.There was no surgical death.When comparing the preoperative and 3-month postoperative functional grades, 12 patients were stable 14 improved, and 3 deteriorated.Patients with either no deficit or only mild deficit before surgery were rarely impaired by the procedure, reinforcing the importance of early diagnosis and treatment.The major determinant of long-term survival was histological composition of the tumor.Patients in whom an IMSCT was only partially resected (< 80%) fared significantly worse.CONCLUSIONS: The long-term survival and quality of life for patients with low-grade gliomas treated by radical resection alone is comparable or superior to minimal resection plus radiotherapy.The optimal therapy for patients with high-grade glioma is yet to be determined.For benign lesion, such as hemangioblastoma and cavernoma could be cured by total resection of the tumor.For lipoma and epidermoid, fibrous adhesions to the cord make total removal difficult, and thus, removal is not the goal of surgery.The carbon dioxide laser is particularly useful during surgery for this lesion.

  7. Comparison of surgical resection and transarterial chemoembolization for patients with intermediate stage hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Chih-Lin Lin

    2016-06-01

    Conclusions: Our results indicated that surgical resection provided superior survival benefit than TACE to patients with intermediate-stage HCC. This is in part attributable to advances in liver surgery which make the resection of intermediate-stage HCC possible. Surgical resection should be considered first for patients with preserved liver function.

  8. Pediatric pituitary resection: characterizing surgical approaches and complications.

    Science.gov (United States)

    Hanba, Curtis; Svider, Peter F; Shkoukani, Mahdi A; Sheyn, Anthony; Jacob, Jeffrey T; Eloy, Jean Anderson; Folbe, Adam J

    2017-01-01

    Although there has been extensive study evaluating adult pituitary surgery, there has been scant analysis among children. Our objective was to evaluate a population-based resource to characterize nationwide trends in surgical approach, hospital stay, and complications among children undergoing pituitary surgery. The Kids' Inpatient-Database (KID) files (2009/2012) were evaluated for pituitary gland excisions. Procedure, patient demographics, length of inpatient stay, inpatient costs, hospital setting, and surgical complications were analyzed. A weighted incidence of 1071 cases were analyzed; the majority (77.6%) underwent transsphenoidal resections. These patients had significantly decreased hospital costs and lengths of stay. Patients undergoing transfrontal approaches had significantly greater rates of postoperative diabetes insipidus (DI) (66.5%), panhypopituitarism (38.8%), hydrocephalus, and visual deficits. Among transsphenoidal patients, males had greater rates of postoperative hydrocephalus (5.5%) and panhypopituitarism (17.5%) than females, and patients ≤10 years old had greater rates of these 2 complications (14.5%, 19.4%, respectively) as well as DI (61.3%). A greater proportion of children undergo transfrontal approaches for pituitary lesions than in their adult counterparts. This difference may harbor a potential to influence future sellar resection approaches in children toward a transsphenoidal operation when surgically feasible. Patients undergoing transfrontal procedures have greater risks for many intraoperative and postoperative complications relative to individuals undergoing transsphenoidal resections. Among patients undergoing transsphenoidal approaches, males had significantly greater rates of postoperative hydrocephalus and panhypopituitarism, and younger children had greater rates of postoperative DI, hydrocephalus, and panhypopituitarism. These data reinforce the need for greater vigilance in the postoperative care of younger children

  9. Intraoperative β{sup -} detecting probe for radio-guided surgery in tumour resection

    Energy Technology Data Exchange (ETDEWEB)

    Solfaroli Camillocci, Elena; Bellini, Fabio; Bocciy, Valerio; Collamatiyz, Francesco; Faccini, Riccardo; Paramattiy, Riccardo; Paterayz, Vincenzo; Pinciy, Davide; Recchiay, Luigi; Sciubbayz, Adalberto; Senzacqua, Martina; Voenay, Cecilia; Morgantiy, Silvio [INFN Sezione di Roma, Rome, (Italy); De Luciax, Erika; Matteixk, Ilaria; Sartizx, Alessio [Laboratori Nazionali di Frascati dell INFN, Frascati, (Italy); Russomando, Aandrea [INFN Sezione di Roma, Rome, (Italy); Center for Life Nano Science-at-Sapienza, Istituto Italiano di Tecnologia, Rome, (Italy); Marafiniy, Michela [INFN Sezione di Roma, Rome, (Italy); Museo Storico della Fisica e Centro Studi e Ricerche ' E. Fermi' , Rome, (Italy)

    2015-07-01

    The development of the β{sup -} based radio-guided surgery aims to extend the technique to those tumours where surgery is the only possible treatment and the assessment of the resection would most profit from the low background around the lesion, as for brain tumours. Feasibility studies on meningioma and gliomas already estimated the potentiality of this new treatment. To validate the technique, a prototype of the intraoperative probe detecting β{sup -} decays and specific phantoms simulating tumour remnant patterns embedded in healthy tissue have been realized. The response of the probe in this simulated environment is tested with dedicated procedures. This document discusses the innovative aspects of the method, the status of the developed intraoperative β{sup -} detecting probe and the results of the preclinical tests. (authors)

  10. Haglund Deformity – Surgical Resection by the Lateral Approach

    Directory of Open Access Journals (Sweden)

    S Natarajan

    2015-03-01

    Full Text Available The aim of this study was to analyse the outcome of surgical Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum. Haglund deformity is a prominence in the postero superolateral aspect of the calcaneum, causing a painful bursitis, which may be difficult to treat by non-operative measures alone. Various surgical methods are available for effective treatment of refractory Haglund’s deformity. This study is to evaluate whether adequate resection of Haglund deformity by a lateral approach provides good to excellent results. During the period from 2009 to 2012, 40 patients with 46 feet had undergone resection of Haglund deformity using lateral approach and the outcome was analysed using AOFAS Ankle-Hind Foot Scale. The mean AOFAS score at the follow up was 86/100, with the majority of patients reporting alleviation of pain at one year follow up. The lateral approach to calcaneal ostectomy can be an effective treatment for those suffering from refractory Haglund deformity. However, the patient must be made aware of the duration of recovery being long.

  11. Defining an optimal surgical strategy for synchronous colorectal liver metastases: staged versus simultaneous resection?

    Science.gov (United States)

    She, Wong Hoi; Chan, Albert Chi Yan; Poon, Ronnie Tung Ping; Cheung, Tan To; Chok, Kenneth Siu Ho; Chan, See Ching; Lo, Chung Mau

    2015-11-01

    We aimed to assess if simultaneous resection conferred any survival benefit in resection of synchronous colorectal liver metastases. From January 1990 to December 2008, 116 patients with synchronous colorectal liver metastases were identified. Among these 116 patients, 88 underwent staged resection (SR), while the remaining 28 patients underwent simultaneous resection (SIMR). Patients' follow-up data were reviewed. There were no significant differences between the groups in terms of patient and tumour characteristics. Major hepatectomy was performed in 54 patients (61%) undergoing SR, and 12 patients (43%) undergoing SIMR (P = 0.09). The median blood loss (SR 0.7 L versus SIMR 0.8 L) was similar. Post-operative morbidity rates and hospital mortality rates were not statistically different. The total length of hospital stay was shorter in SIMR patients (18.0 versus 11.5 days, P = 0.009). The 1-, 3- and 5-year overall survival for SR were 90.7%, 47.1% and 33.3%, whilst the corresponding survival rates for SIMR were 75.0%, 25.0% and 0%, respectively (P = 0.003). However, when the disease-free survival (DFS) was stratified according to the number of hepatic metastases, the survival benefit of SR and SIMR for solitary CRM were similar (3-year DFS: 28.3% versus 11.1%, P = 0.089). Our study showed that an operative strategy of SR generally offered better survival outcome than SIMR in the surgical management of CRM. © 2014 Royal Australasian College of Surgeons.

  12. Duodenal Wedge Resection for Large Gastrointestinal Stromal Tumour Presenting with Life-Threatening Haemorrhage

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    Alexander Shaw

    2013-01-01

    Full Text Available Background. Duodenal gastrointestinal stromal tumours (GISTs are an uncommon malignancy of the gastrointestinal (GI tract. We present a case of life-threatening haemorrhage caused by a large ulcerating duodenal GIST arising from the third part of the duodenum managed by a limited duodenal wedge resection. Case Presentation. A 61-year-old patient presented with acute life-threatening gastrointestinal bleeding. After oesophagogastroduodenoscopy failed to demonstrate the source of bleeding, a 5 cm ulcerating exophytic mass originating from the third part of the duodenum was identified at laparotomy. A successful limited wedge resection of the tumour mass was performed. Histopathology subsequently confirmed a duodenal GIST. The patient remained well at 12-month followup with no evidence of local recurrence or metastatic spread. Conclusion. Duodenal GISTs can present with life-threatening upper GI haemorrhage. In the context of acute haemorrhage, even relatively large duodenal GISTs can be treated by limited wedge resection. This is a preferable alternative to duodenopancreatectomy with lower morbidity and mortality but comparable oncological outcome.

  13. Three dimensional model for surgical planning in resection of thoracic tumors

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    Min P. Kim

    2015-01-01

    Conclusion: Three-dimensional printed model provide better visualization of complex thoracic tumors, aid in counseling the patient about the surgical procedure and assisted in surgical resection of thoracic malignancy.

  14. Anaesthetic challenges in carotid body tumour resection: a case report and review of literature

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    Anuradha Malliwal

    2015-12-01

    Full Text Available Carotid body tumour (CBT is an extremely rare, non-chromaffin paraganglioma arising from chemoreceptor cells at the carotid bifurcation. Reported incidence is 1-2 per 100,000. Surgical excision of the tumour, the definitive treatment, poses several anaesthetic challenges and a high incidence of perioperative morbidity and mortality (20-40%. Very few cases have been reported so far. We report the anaesthetic management of a case of CBT excision with a review of recent literature on the same. [Int J Res Med Sci 2015; 3(12.000: 3897-3900

  15. TECHNIQUE AND SURGICAL OUTCOMES OF ANATOMICAL LIVER RESECTIONS FOR COLORECTAL CANCER LIVER METASTASES

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    D. V. Sidorov

    2013-01-01

    Full Text Available Technique and surgical outcomes of anatomical liver resections using ERBEJET2® water-jet dissector were described. Overall 98 patients with colorectal cancer liver metastases were included in this study. In 43 patients resections were performed using water-jet dissection technique. Water-jet dissection seems to be safe and effective technique for anatomical liver resections.

  16. Preoperative surgical planning for intracranial meningioma resection by virtual reality

    Institute of Scientific and Technical Information of China (English)

    TANG Hai-liang; WANG Dai-jun; ZHU Hong-da; TANG Wei-jun; FENG Xiao-yuan; CHEN Xian-cheng; ZHOU Liang-fu; SUN Hua-ping; GONG Ye; MAO Ying; WU Jing-song; ZHANG Xiao-luo; XIE Qing; XIE Li-qian; ZHENG Ming-zhe

    2012-01-01

    Background The Dextroscope system by Volume Interactions (Singapore) had been applied to minimally invasive neurosurgery in many units.This system enables the neurosurgeon to interact intuitively with the three-dimensional graphics in a direct manner resembling the way one communicates with the real objects.In the paper,we explored its values in pre-operation surgical planning for intracranial meningiomas resection.Methods Brain compuled tomography (CT),magnetic resonance imaging (MRI),and magnetic resonance venography (MRV) were performed on 10 patients with parasagittal and falcine meningiomas located on central groove area; brain CT,MRI and magnetic resonance angiography (MRA) were performed on 10 patients with anterior skull base meningiomas and 10 patients with sphenoid ridge meningiomas.All these data were transferred to Dextroscope virtual reality system,and reconstructed.Then meningiomas,skull base,brain tissue,drainage vein and cerebral arteries were displayed within the system,and their anatomic relationships were evaluated.Also,the simulation operations were performed.Results For parasagittal and falcine meningiomas,the relationships of tumor with drainage vein and superior sagittal sinus were clearly displayed in the Dextroscope system.For anterior skull base and sphenoid ridge meningiomas,the relationships of tumor with bilateral internal carotid arteries,anterior cerebral arteries,middle cerebral arteries and skull base were vividly displayed within the virtual reality system.Surgical planning and simulation operation of all cases were performed as well.The real operations of all patients were conducted according to the simulation with well outcomes.Conclusions According to the virtual reality planning,neurosurgeons could get more anatomic information about meningioma and its surrounding structures,especially important vessels,and choose the best approach for tumor resection,which would lead to better prognosis for patients.

  17. Organising haematoma mimicking tumour on MRI following resection of acoustic neuroma

    Energy Technology Data Exchange (ETDEWEB)

    Higgins, J.N.P. [Radiology Dept., Royal Free Hospital, London (United Kingdom); Pigeon, C.N. [Dept. of Neurosurgery, St. Vincent`s Hospital, Dublin (Ireland); Moseley, I.F. [Lysholm Dept. of Radiology, National Hospital for Neurology and Neurosurgery, Queen Square, London (United Kingdom)

    1995-05-01

    We describe a 26-year-old woman in whom an enhancing, intradural extramedullary mass was found at the craniocervical junction on MRI 3 years after resection of a large acoustic neuroma. The radiological appearances suggested a new tumour, raising the possibility of neurofibromatosis 2, provoking a review of family members in an attempt to confirm the diagnosis, as well as further surgery. Histology of the lesion revealed an organising haematoma, with no evidence of malignancy. The imaging features can be explained by the process by which blood clot in the subarachnoid space is resorbed. Caution is advised in interpreting CT or MRI after neurosurgery. (orig.)

  18. Radical resection of a Shamblin type III carotid body tumour without cerebro-neurological deficit: Improved technique with preoperative embolization and carotid stenting.

    Science.gov (United States)

    Ong, H S; Fan, X D; Ji, T

    2014-12-01

    The surgical resection of a large unfavourable Shamblin type III carotid body tumour (CBT) can be very challenging technically, with many potential significant complications. Preoperative embolization aids in shrinking the lesion, reducing intraoperative blood loss, and improving visualization of the surgical field. Preoperative internal carotid artery (ICA) stenting aids in reinforcing the arterial wall, thereby providing a better dissection plane. A woman presented to our institution with a large right-sided CBT. Failure of the preoperative temporary balloon occlusion (TBO) test emphasized the importance of intraoperative preservation of the ipsilateral ICA. A combination of both preoperative embolization and carotid stenting allowed a less hazardous radical resection of the CBT. An almost bloodless surgical field permitted meticulous dissection, hence reducing the risk of intraoperative vascular and nerve injury. Embolization and carotid stenting prior to surgical resection should be considered in cases with bilateral CBT or a skull base orientated high CBT, and for those with intracranial extension and patients who have failed the TBO test.

  19. Does surgical resection of hepatocellular carcinoma accelerate cancer dissemination?

    Institute of Scientific and Technical Information of China (English)

    I-Shyan Sheen; Yi-Chun Tsai; Tsu-Yen Wu; Kuo-Shyang Jeng; Shou-Chuan Shih; Po-Chuan Wang; Wen-Hsiung Chang; Horng-Yuan Wang; Li-Rung Shyung; Shee-Chan Lin; Chin-Roa Kao

    2004-01-01

    recurrence (58% vs.39%, P=0.093). The correlation between perioperative hAFP mRNA positivity and recurrence related mortality had no statistical significance (P=0.836).CONCLUSION: From our study, perioperative detection of hAFP mRNA in peripheral blood of patients has no clinical relevance and significant role in the prediction of HCC recurrence. Surgical resection itself may not accelerate cancer dissemination and does not increase postoperative recurrence significantly either.

  20. Combining partial liver resection and local ablation of liver tumours: a preliminary Dutch experience

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    van Gulik Thomas M

    2006-07-01

    Full Text Available Abstract Background The combination of partial liver resection and radiofrequency ablation (RFA is a novel concept in the treatment of unresectable liver malignancies. The aim of this study is to evaluate the results of this combined strategy in the Netherlands. Methods Thirty-five patients treated with a combination of partial liver resection and RFA were identified from a prospectively registered pooled multicentre database. All patients were operated between June 1999 and November 2003 in 8 medical centres in the Netherlands. Main outcome parameters were morbidity, mortality, local success rate, and survival. Results Thirty-seven operations were performed in 35 patients. The group consisted of 20 male and 15 female patients with a median age of 59 years (range 41–76. Seventy-six lesions were resected and RFA was performed to ablate 82 unresectable liver tumours. Twelve patients developed a total of 24 complications, resulting in an overall perioperative morbidity rate of 32%. In two patients major complications resulted in postoperative death (postoperative mortality rate 5.4%. Local success rate after RFA was 88% and the estimated 1-, 2- and 3-year overall survival rates were 84%, 70% and 43%, respectively. Conclusion This strategy should only be performed following strict patient selection and within the context of prospective clinical trials.

  1. Approach to the medical management of surgically resectable gastric cancer.

    Science.gov (United States)

    Tesfaye, Anteneh; Marshall, John L; Smaglo, Brandon G

    2016-02-01

    The optimal adjuvant management of patients with resectable gastric cancer remains a therapeutic challenge. Although the benefit of adjuvant therapy for these patients is clearly established, recurrence and mortality rates remain high despite such treatment. Moreover, surgical comorbidities and treatment toxicities result in high rates of failure to complete treatment after surgery. Two divergent approaches to adjuvant treatment have emerged as standard: postoperative chemoradiotherapy and perioperative chemotherapy. Because these approaches have never been compared directly, recommendations for adjuvant treatment require multidisciplinary discussion. During this discussion, the characteristics of the symptoms, the histology, location, and stage of the tumor, and the feasibility of the patient's completing all recommended therapy may be considered. In our own practice, we favor perioperative chemotherapy for patients with asymptomatic, proximal, higher-stage disease and adjuvant chemoradiotherapy for patients with symptomatic, distal, lower-stage disease. Herein, we summarize the available data for approaches to the adjuvant treatment of gastric cancer, with special consideration of the characteristics of the patients enrolled in the various studies. We also describe how we developed our paradigm for recommending a particular approach to adjuvant treatment for each patient.

  2. SURGICAL RESECTION FOR SMALL-CELL CARCINOMA OF THE LUNG - A RETROSPECTIVE STUDY

    NARCIS (Netherlands)

    SMIT, EF; GROEN, HJM; TIMENS, W; POSTMUS, PE

    1994-01-01

    Background - A retrospective review was undertaken of the survival of 21 patients with histologically proven small cell carcinoma of the lung resected between 1977 and 1991. Methods - Twenty one patients (20 men) of median age 60 (range 44-73) years underwent surgical resection. Patients were subjec

  3. Intraoperative use of diffusion tensor imaging-based tractography for resection of gliomas located near the pyramidal tract: comparison with subcortical stimulation mapping and contribution to surgical outcomes.

    Science.gov (United States)

    Vassal, F; Schneider, F; Nuti, C

    2013-10-01

    For gliomas, the goal of surgery is maximal tumour removal with the preservation of neurological function. We evaluated the contribution of the combination of diffusion tensor imaging-based fibre tracking (DTI-FT) of the pyramidal tract (PT) integrated to the navigation and subcortical direct electrical stimulations (DESs) to surgical outcomes. Ten patients underwent surgery for gliomas located in close relationship with the subcortical course of the PT. Preoperative DTI was performed with a three-Tesla magnetic resonance scanner applying an echo-planar sequence with 20 diffusion directions. DTI-FT data were systematically loaded into the navigation for intraoperative guidance. When the resection closely approached the PT as illustrated on navigation images, subcortical DESs were used to confirm the proximity of the PT by observing motor responses. The location of all subcortically stimulated points with positive motor response was correlated with the illustrated PT. Motor deficits were evaluated pre- and postoperatively, and compared with the extent of tumour removal. DTI-FT of the PT was successfully performed in all patients. A total of fifteen positive subcortical DESs were obtained in 8 of 10 patients; in these cases, the mean distance from the stimulated point to the PT was 6.2 ± 3.6 mm. The mean tumoural volumetric resection was 90.8 ± 10.4%, with a gross total resection in four patients. At one month after surgery, only one patient had a slight impairment of motor function (decreased fine motor hand skills). DTI-FT is an accurate technique to map the PT in the vicinity of brain tumours. By combining anatomical (DTI-FT) and functional (subcortical DES) studies for intraoperative localization of the PT, the authors achieved a good volumetric resection of tumours located in eloquent motor areas, with low morbidity. Careful use of this protocol requires the knowledge of some pitfalls, mainly the occurrence of brain shift during removal of large tumours.

  4. Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

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    Katharina Rabitsch

    2013-01-01

    Full Text Available Reconstruction with massive bone allograft and autologous vascularised fibula combines the structural strength of the allograft and the advantages of fibula’s intrinsic blood supply. We retrospectively analysed the outcome of twelve patients (4 male, 8 female who received reconstruction with massive bone allograft and autologous vascularised fibula after tumour resection in lower limb. Mean age was 17.8 years (range 11–31 years, with following primaries: Ewing’s sarcoma (n=6, osteosarcoma (n=4, liposarcoma grade 2 (n=1, and adamantinoma (n=1. Mean followup was 38.7 months (median 25.7 months; range 2–88 months. Seven tumours were located in the femur and five in the tibia. The mean length of bone defect was 18.7 cm (range 15–25 cm. None of the grafts had to be removed, but there occurred four fractures, four nonunions, and two infections. Two patients developed donor side complication, in form of flexion deformity of the big toe. The event-free survival rate was 51% at two-year followup and 39% at three- and five-year followup. As the complications were manageable, and full weight bearing was achieved in all cases, we consider the combination of massive bone allograft and autologous vascularised fibula a stable and durable reconstruction method of the diaphysis of the lower limbs.

  5. Surgical resection versus radiofrequency ablation in treatment of small hepatocellular carcinoma

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    HE Xiuting

    2013-08-01

    Full Text Available ObjectiveTo compare clinical efficacy and recurrence between surgical resection and radiofrequency ablation (RFA in the treatment of small hepatocellular carcinoma (HCC. MethodsThe clinical data of 97 patients with small HCC, who underwent surgical resection or RFA as the initial treatment in The First Hospital of Jilin University from January 2002 to December 2008, were collected. Sixty-three cases, who survived 2 years after treatment, were followed up; of the 63 cases, 34 underwent surgical resection, and 29 underwent RFA. The recurrence of these patients was analyzed retrospectively. The measurement data were analyzed by chi-square test. The Cox regression analysis was used for determining the risk factors for recurrence. The log-rank test was used for disease-free survival (DFS difference analysis. ResultsThe 3-month, 1-year, and 2-year intrahepatic recurrence rates for the patients who underwent surgical resection were 15%, 38%, and 64%, respectively, versus 21%, 35%, and 45% for those who underwent RFA, without significant differences between the two groups of patients. The intrahepatic recurrence after initial treatment was not significantly associated with treatment method, sex, age, Child-Pugh grade, tumor size, number of nodules, presence of cirrhosis, and alpha-fetoprotein level. There was no significant difference in DFS between the two groups of patients. ConclusionRFA produces a comparable outcome to that by surgical resection in the treatment of small HCC. RFA holds promise as a substitute for surgical resection.

  6. Metastatic Pulmonary Adenocarcinoma 6 Years After Curative Resection for Ampullary Adenocarcinoma. Metastatic Disease from Initial Primary or Metachronous Tumour?

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    Alexandros Giakoustidis

    2011-01-01

    Full Text Available Context With patients surviving longer after pancreatic resection, the challenges now is the management of the unresolved longerterm issues. Case report A 53-year-old woman with painless obstructive jaundice, underwent a pylorous preserving pancreaticoduodenectomy for a pT3N0M0 ampullary adenocarcinoma in 2001 (patchy chronic pancreatitis with mucinous metaplasia of background pancreatic duct epithelium and acinar atrophy were noted. Despite adjuvant chemotherapy, at month 54 she required a pulmonary wedge resection for metastatic adenocarcinoma, followed by a pulmonary relapse at 76 months when she underwent 6 neoadjuvant cycles of gemcitabine/capecitabine and a left pneumonectomy. Finally 7 years after the initial Whipple’s, a single 18F fluorodeoxyglucose (FDG avid pancreatic tail lesion led to completion pancreatectomy for a well-differentiated ductal adenocarcinoma with clear resection margins albeit peripancreatic adipose tissue infiltration. On review all resected tumour cells had identical immunophenotype (CK7+/CK20-/MUC1+/MUC2- as that of the primary. She is currently asymptomatic on follow-up. Conclusions These findings suggest that in selected cases even in the presence of pulmonary metastasis, repeat resections could result in long-term survival of patients with metachronous ampullary cancer. Second, even ampullary tumours maybe should be regarded as index tumors in the presence of ductal precursor lesions in the resection specimen. Three distant metastases, particularly if long after the initial tumour, should instigate a search for metachronous tumour, especially in the presence of field change in the initial specimen. Risk-adapted follow-up protocols with recognition of such factors could result in cost-effective surveillance and potentially improved outcomes.

  7. Carotid body tumours. A 20-year single-institution experience.

    Science.gov (United States)

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico Giuseppe

    2006-01-01

    The aim of this single-institution retrospective study was to review the surgical outcomes of resection of carotid body tumours over the last 20 years in our hospital. From January 1985 to December 2004, 17 patients were admitted to our institution with carotid body tumours. All patients were treated by surgical resection of the tumour. No perioperative deaths occurred. Perioperative comorbidities were more frequent in patients with large carotid body tumours intimately associated with the carotid vessels. Surgical excision of carotid body tumours is safe and effective even in the long term.

  8. Carcinoid Klatskin tumour: A rare cause of obstructive jaundice.

    Science.gov (United States)

    Khuroo, Suhail; Rashid, Arshad; Bali, Rajandeep Singh; Mushtaque, Majid; Khuroo, Farzana

    2014-01-01

    Carcinoid tumours of the extrahepatic biliary ducts represent an extremely rare cause of bile duct obstruction. We report a case of obstructive jaundice secondary to carcinoid tumour arising at the hilar confluence. Resection of the primary tumour was done and the patient is doing well on follow-up. This case demonstrated that surgery offers the only potential cure for biliary carcinoid and aggressive surgical therapy should be the preferred treatment in cases of potentially resectable biliary tumours.

  9. Autobiographical memory loss following a right prefrontal lobe tumour resection: a case report and review of the literature.

    Science.gov (United States)

    Jamjoom, A A B; Gallo, P; Kandasamy, J; Phillips, J; Sokol, D

    2017-07-01

    The right prefrontal lobe has not traditionally been considered eloquent brain. Resection of tumours within this region does not typically lead to permanent functional impairment. In this report, we highlight the case of a patient who developed autobiographical memory loss following an uncomplicated resection of a right prefrontal tumour. A previously fit and well 15-year old presented with a persistent right-sided headache. An MRI demonstrated an expanded right mid-frontal gyrus with changes consistent with a low-grade tumour. The patient underwent a right-sided craniotomy and resection of the lesion which was confirmed as a WHO grade II diffuse astrocytoma. Postoperatively, the patient reported profound retrograde amnesia for a range of memory components, in particular autobiographical memory and semantic memory. Postoperative imaging showed a good resection margin with no evidence of underlying brain injury. Over an 18-month period, the patient showed no improvement in autobiographical memory; however, significant relearning of semantic knowledge took place and her academic performance was found to be in line with expectations for her age. In this report, we discuss a case and review the literature on the role of the right prefrontal cortex in memory and caution on the perception of right prefrontal non-eloquence.

  10. Cardiac tumours in children

    Directory of Open Access Journals (Sweden)

    Parsons Jonathan M

    2007-03-01

    Full Text Available Abstract Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10–20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT and Magnetic Resonance Imaging (MRI of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.

  11. Surgical resection for hepatocellular carcinoma in pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Chih-Chiang Hung

    2012-07-01

    Full Text Available Hepatocellular carcinoma (HCC occurring in pregnancy is very rare. The prognosis is usually poor because of unclear clinical presentation. A 30-year-old woman who suffered from HCC during pregnancy underwent hepatectomy twice, and resection for pulmonary metastasis once. A healthy infant was delivered after the first hepatectomy. Currently, she remains disease free 55 months after the second hepatectomy and 39 months after pulmonary metastatectomy. Moreover, she had another healthy infant 37 months after pulmonary metastatectomy. Aggressive resection of recurrent HCC may prolong life, and pregnancy should not alter the treatment strategy for HCC.

  12. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

    OpenAIRE

    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at th...

  13. The effect of surgical wounding on tumour development

    NARCIS (Netherlands)

    Hofer, SOP; Molema, G; Hermens, RAEC; Wanebo, HJ; Reichner, JS; Hoekstra, HJ

    1999-01-01

    For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of acti

  14. The effect of surgical wounding on tumour development

    NARCIS (Netherlands)

    Hofer, SOP; Molema, G; Hermens, RAEC; Wanebo, HJ; Reichner, JS; Hoekstra, HJ

    For more than a century, a role for wound healing in the outgrowth of tumours has been implied based on observations in both experimental and clinical studies. Wound healing can be divided into stages of inflammatory, proliferative, repair and remodelling processes. Through proper regulation of

  15. Surgical Resection for Hepatoblastoma-Updated Survival Outcomes.

    Science.gov (United States)

    Sunil, Bhanu Jayanand; Palaniappan, Ravisankar; Venkitaraman, Balasubramanian; Ranganathan, Rama

    2017-09-30

    Hepatoblastoma is the most common liver malignancy in the pediatric age group. The management of hepatoblastoma involves multidisciplinary approach. Patients with hepatoblastoma who underwent liver resection between 2000 and 2013 were analyzed and survival outcomes were studied. The crude incidence rate of hepatoblastoma at the Madras Metropolitan Tumor Registry (MMTR) is 0.4/1,00,000 population per year. Twelve patients underwent liver resection for hepatoblastoma during the study period; this included eight males and four females. The median age at presentation was 1.75 years (Range 5 months to 3 years). The median serum AFP in the study population was 20,000 ng/ml (Range 4.5 to 1,40,000 ng/ml). Three patients had stage I, one patient had stage II, and eight patients had stage III disease as per the PRETEXT staging system. Two patients were categorized as high risk and ten patients were categorized as standard risk. Seven of these patients received two to four cycles of neoadjuvant chemotherapy (PLADO regimen), and one patient received neoadjuvant radiation up to 84 Gy. Major liver resection was performed in nine patients. Nine patients received adjuvant chemotherapy. The most common histological subtype was embryonal type. Microscopic margin was positive in three cases. One patient recurred 7 months after surgery and the site of failure was the lung. The 5-year overall survival of the case series was 91%. The median survival was 120 months. Liver resections can be safely performed in pediatric populations after neoadjuvant treatment. Patients undergoing surgery had good disease control and long-term survival.

  16. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma.

    Science.gov (United States)

    Lakhanpal, S K; Glasier, C M; James, C A; Angtuaco, E J

    1995-01-01

    We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7% of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. Complete surgical resection, particularly of large tumors, is complicated by the fact that the lesions are usually found within the circle of Willis, with displacement and adherence to the adventitia of these vessels [1, 2]. Recent reports in the neurosurgical literature have described aneurysmal dilatation of the supraclinoid internal carotid arteries following aggressive surgical resection of craniopharyngioma [3, 4].

  17. Computational fluid dynamics as surgical planning tool: a pilot study on middle turbinate resection.

    Science.gov (United States)

    Zhao, Kai; Malhotra, Prashant; Rosen, David; Dalton, Pamela; Pribitkin, Edmund A

    2014-11-01

    Controversies exist regarding the resection or preservation of the middle turbinate (MT) during functional endoscopic sinus surgery. Any MT resection will perturb nasal airflow and may affect the mucociliary dynamics of the osteomeatal complex. Neither rhinometry nor computed tomography (CT) can adequately quantify nasal airflow pattern changes following surgery. This study explores the feasibility of assessing changes in nasal airflow dynamics following partial MT resection using computational fluid dynamics (CFD) techniques. We retrospectively converted the pre- and postoperative CT scans of a patient who underwent isolated partial MT concha bullosa resection into anatomically accurate three-dimensional numerical nasal models. Pre- and postsurgery nasal airflow simulations showed that the partial MT resection resulted in a shift of regional airflow towards the area of MT removal with a resultant decreased airflow velocity, decreased wall shear stress and increased local air pressure. However, the resection did not strongly affect the overall nasal airflow patterns, flow distributions in other areas of the nose, nor the odorant uptake rate to the olfactory cleft mucosa. Moreover, CFD predicted the patient's failure to perceive an improvement in his unilateral nasal obstruction following surgery. Accordingly, CFD techniques can be used to predict changes in nasal airflow dynamics following partial MT resection. However, the functional implications of this analysis await further clinical studies. Nevertheless, such techniques may potentially provide a quantitative evaluation of surgical effectiveness and may prove useful in preoperatively modeling the effects of surgical interventions.

  18. Computer-aided hepatic tumour ablation

    CERN Document Server

    Voirin, D; Amavizca, M; Leroy, A; Letoublon, C; Troccaz, J; Voirin, David; Payan, Yohan; Amavizca, Miriam; Leroy, Antoine; Letoublon, Christian; Troccaz, Jocelyne

    2001-01-01

    Surgical resection of hepatic tumours is not always possible. Alternative techniques consist in locally using chemical or physical agents to destroy the tumour and this may be performed percutaneously. It requires a precise localisation of the tumour placement during ablation. Computer-assisted surgery tools may be used in conjunction to these new ablation techniques to improve the therapeutic efficiency whilst benefiting from minimal invasiveness. This communication introduces the principles of a system for computer-assisted hepatic tumour ablation.

  19. Tumours and tumourous diseases; Tumoren, tumoraehnliche Erkrankungen

    Energy Technology Data Exchange (ETDEWEB)

    Winkelmann, W. (ed.)

    2005-07-01

    This book on tumours and tumourous diseases comprises two parts: 1. Bone tumours and tumourous lesions. 2. Soft tissue tumours and tumourous lesions. Details are presented on pathology, diagnosis, conservative and perioperative therapy, surgical therapy, complications after resection, indicators for amputation, recommendations for follow-up treatment, radiotherapy, radionuclide therapy, alternative therapies, therapy concepts in case of metastases, tissue engineering and plastic surgery. (uke) [German] Der vorliegende Band der Reihe Orthopaedie und orthopaedische Chirurgie behandelt das Thema Tumoren und tumoraehnliche Erkrankungen. Der Band teilt sich in zwei Kapitel: 1. Knochentumoren und tumorartige Laesionen und 2. Weichteiltumoren und tumorartige Laesionen. Dargestellt werden Pathologie, Diagnostik, konservative und perioperative Therapie, chirurgische Therapie, Komplikationen nach Resektion, Indikatoren zur Amputation, Nachsorgeempfehlung, Strahlentherapie, Radionuklidtherapie, alternative Therapieverfahren, Therapiekonzepte bei Metastasen, Tissue Engineering und plastisch-chirurgische Massnahmen. (uke)

  20. Lip commissure reconstruction after tumour resection with the use of the Platz-Wepner technique. Report of cases

    Directory of Open Access Journals (Sweden)

    Nikos Kechagias

    2013-04-01

    Full Text Available The lip commissure is a rare site for thedevelopment of malignant tumour lesions.Material and Methods. This paper presents the resectionof tumours in patients with commissure cancerand their rehabilitation using the Platz-Wepner technique.This technique has been used at our departmentin 4 cases. According to this method, tumour resectioninvolves a circular incision in full thickness of the commissuretissues, expanding into the cheek region, with awedge resection of the tissues in partial thickness. Thedeficit is reconstructed using promotional rotationalflaps from the neighbouring region of the commissurecheek.Results. All patients underwent complete tumourresection, followed by aesthetic and functional reconstructionof their commissures, both immediately postoperativelyand in the follow up period.Conclusions. What defines a satisfactory result in thismethod are the function, symmetry, aesthetics and sufficientwidth of the mouth opening. However, the smallnumber of cases presented here limits our ability todraw firm conclusions.

  1. High-resolution computed tomography findings of early mucinous adenocarcinomas and their pathologic characteristics in 22 surgically resected cases

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    Miyata, Naoko, E-mail: n.miyata@scchr.jp [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan); Endo, Masahiro [Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital (Japan); Nakajima, Takashi [Division of Pathology, Shizuoka Cancer Center Hospital (Japan); Kojima, Hideaki; Maniwa, Tomohiro; Takahashi, Shoji; Isaka, Mitsuhiro [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan); Kameya, Toru [Division of Pathology, Shizuoka Cancer Center Hospital (Japan); Ohde, Yasuhisa [Division of Thoracic Surgery, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi, Sunto-gun, Shizuoka 411-8777 (Japan)

    2015-05-15

    Highlights: • We clinicopathologically reviewed 22 cases of early mucinous adenocarcinoma. • Radiologically, all cases showed solid or part-solid nodules. • Lobular-bounded margins were observed in 7 cases. • The radiological features could be histologically attributed to mucin production. • One-third of the cases were preoperatively misdiagnosed as inflammatory nodules. - Abstract: Background: The pathological criteria of early-stage mucinous adenocarcinoma of the lung have recently been defined; however, its characteristic radiologic imaging findings are still poorly understood. Thus, this study aimed to clarify the radiologic and pathological findings of early-stage mucinous adenocarcinoma. Materials and methods: In this study, we clinicopathologically reviewed 22 cases of surgically resected mucinous adenocarcinoma in situ (AIS) and minimal invasive adenocarcinoma (MIA), and attempted to elucidate the characteristic radiologic features of early mucinous adenocarcinomas using high-resolution computed tomography (HRCT). Results: Radiologically, the mean value of the maximum diameter of 22 tumours was 2.1 cm (range, 1.0–2.9 cm). Based on the HRCT findings, the tumours were divided into part-solid ground glass nodules (n = 11) and solid nodules (n = 11). The mean CT attenuation value was 25.7 HU (range, 17–35 HU). All tumours, except 3 tumours pathologically diagnosed as AIS, showed air-containing features. According to the preoperative CT findings, 7 (35%) cases were diagnosed as inflammatory nodules. Of these, 4 cases had lobular-bounded margins, and 3 showed vaguely outlined ground glass shadows. Conclusion: The characteristic HRCT findings of mucinous AIS and MIA were solid or part-solid nodules with air-containing spaces. However, some AIS and MIA nodules showed lobular-bounded margins or marginally vaguely outlined ground glass shadows, and were difficult to differentiate from inflammatory nodules.

  2. Neoadjuvant therapy and surgical resection for locally advanced non-small cell lung cancer.

    Science.gov (United States)

    Meko, J; Rusch, V W

    2000-10-01

    During the past 15 years, treatment of stage IIIA (N2) non-small cell lung cancer has evolved considerably because of improvements in patients selection, staging, and combined modality therapy. Results of several clinical trials suggest that induction chemotherapy or chemoradiation and surgical resection is superior to surgery alone. However, the optimal induction regimen has not been defined. An intergroup trial is also underway to determine whether chemoradiation and surgical resection leads to better survival than chemotherapy and radiation alone. Future studies will assess ways to combine radiation and novel chemotherapeutic agents, and will identify molecular abnormalities that predict response to induction therapy.

  3. [Statistical study of mandibular resections].

    Science.gov (United States)

    Sidibe, C A; Dichamp, J; Razouk, O; Bertrand, J C; Guilbert, G

    1994-01-01

    A retrospective study of mandibular resections performed from 1980 to 1984 was conducted to evaluate age, sex, aetiology, etc. The number of mandibular resections appears to have declined at the Institute of Stomatology and Maxillofacial Surgery of the Pitié-Salpêtrière Hospital. Different factors are involved included early diagnosis, improved surgical techniques and better patient follow-up. Partial mandibular resections are increasingly performed (52% of the cases) compared with total resections. Finally, a better understanding of the pathologies involved, especially tumours, has led to an adaptation of the resection techniques to avoid extensive mutilations.

  4. Improving Surgical Resection of Metastatic Liver Tumors With Near-Infrared Optical-Guided Fluorescence Imaging.

    Science.gov (United States)

    Barabino, Gabriele; Porcheron, Jack; Cottier, Michèle; Cuilleron, Muriel; Coutard, Jean-Guillaume; Berger, Michel; Molliex, Serge; Beauchesne, Brigitte; Phelip, Jean Marc; Grichine, Alexei; Coll, Jean-Luc

    2016-08-01

    Objective The aim of this study was to investigate the feasibility and future clinical applications of near-infrared (NIR) fluorescence imaging to guide liver resection surgery for metastatic cancer to improve resection margins. Summary Background Data A subset of patients with metastatic hepatic tumors can be cured by surgery. The degree of long-term and disease-free survival is related to the quality of surgery, with the best resection defined as "R0" (complete removal of all tumor cells, as evidenced by microscopic examination of the margins). Although intraoperative ultrasonography can evaluate the surgical margins, surgeons need a new tool to perfect the surgical outcome. Methods A preliminary study was performed on 3 patients. We used NIR imaging postoperatively "ex vivo" on the resected liver tissue. The liver tumors were preoperatively labelled by intravenously injecting the patient with indocyanine green (ICG), a NIR fluorescent agent (24 hours before surgery, 0.25 mg/kg). Fluorescent images were obtained using a miniaturized fluorescence imaging system (FluoStic, Fluoptics, Grenoble, France). Results After liver resection, the surgical specimens from each patient were sliced into 10-mm sections in the operating room and analyzed with the FluoStic. All metastatic tumors presented rim-type fluorescence. Two specimens had incomplete rim fluorescence. The pathologist confirmed the presence of R1 margins (microscopic residual resection), even though the ultrasonographic analysis indicated that the result was R0. Conclusions Surgical liver resection guided by NIR fluorescence can help detect potentially uncertain anatomical areas that may be missed by preoperative imaging and by ultrasonography during surgery. These preliminary results will need to be confirmed in a larger prospective patient series.

  5. Surgical resection without dural reconstruction of a lumbar meningioma in an elderly woman

    Science.gov (United States)

    Takahashi, Jun; Kato, Hiroyuki; Ebara, Sohei; Takahashi, Hideto

    2009-01-01

    Meningiomas of the spine occur in the thoracic spine in approximately 80%, followed in frequency by the cervical and lumbar regions. The treatment of spinal meningiomas is complete surgical resection. As intraspinal meningiomas are almost always adherent to the dura, extensive dural resection or diathermic treatment of the dural attachment is usually performed to prevent tumor recurrence. The authors present the case of lumbar spinal meningioma in 82-year-old woman. Successful resection with preservation of the dura mater using the technique of Saito et al. (Spine 26:1805-1808, 2001) is described: After lumbar laminectomy a small incision was made in the surface of the spinal dura. The dura mater was separated into its inner and outer layers, and the tumor was resected with inner layer alone, preserving the outer layer. The outer layer is simply closed to achieve a watertight seal. The pathologic diagnosis was metaplastic (osseous) meningioma. Almost full recovery of the neurologic deficit was attained. Neither complication nor tumor recurrence has occurred in the 5 years since surgery. Dural preservation during surgical resection of spinal meningioma obviates the need for dural reconstruction and should reduce surgical morbidity. However, the patient should be followed long-term to watch for recurrence. PMID:19219468

  6. Immunolocalization of lactoferrin in surgically resected pigmented skin lesions

    Directory of Open Access Journals (Sweden)

    G Tuccari

    2009-06-01

    Full Text Available Lactoferrin (Lf expression was determined immunohistochemically in 57 formalin-fixed paraffin-embedded bioptic samples obtained from an equal number of patients treated by surgery to remove pigmented skin lesions (nevi = 23; melanoma = 12; vulgaris and seborrhoeic warts = 12; basal cell carcinoma = 10; in addition, 10 specimens of normal skin were studied as control. On 3 ?m thick sections, depigmentation and antigen retrieval procedures were performed. The Lf immunoreactivity was revealed by a rabbit anti-human Lf. Quantification of Lf immunoreactivity was performed using an intensity-distribution (ID score. Melanocytic cells, regardless of their benign or malignant nature, were consistently stained, with no significant differences in the Lf IDscore between melanomas or nevi. A different intensity of Lf immunoreactivity was encountered in superficial portions of warts, exclusively inside squamous epithelial cells arranged in sheets or whorls of keratin. On the contrary, basal cell carcinomas were always unstained, while a slight Lf positivity was found in focal keratinized areas present in two tumours showing baso-squamous differentiation. The Lf immunoreactivity was localized in the cytoplasm and only occasionally in the nucleus. The biological meaning of Lf in these cases of human skin specimens remains unexplained, although it cannot be ruled out that Lf might be involved in the defense system against tumours, or alternatively, may be used by cells requiring iron availability for their turnover. Moreover, the immunohistochemical expression of Lf in melanocytic lesions might be also related to a Lf-melanin interaction. Finally, the involvement of Lf in skin squamous non-neoplastic elements could be related to its role as one of the molecules modulating an unspecific inflammatory or anti-oxidant response.

  7. Surgical resection and reconstruction for primary malignant sternal tumor.

    Science.gov (United States)

    Hirai, Shinji; Nobuto, Hiroaki; Yokota, Kazunori; Matsuura, Yosuke; Uegami, Shinnosuke; Sato, Katsutoshi; Mitsui, Norimasa; Sugita, Takashi; Hamanaka, Yoshiharu

    2009-06-01

    We report a very rare and successful surgery for primary malignant tumor of the sternum. A 73-year-old male, previously healthy, was admitted to our hospital because a chest computed tomography scan detected an abnormal shadow that suggested a sternal tumor destroying part of the sternum body. Aspiration needle biopsy demonstrated a primary sternal chondrosarcoma measuring 3 x 4 cm in diameter. The sternum below the second intercostal space was resected along with a 1-cm width of cartilage below the third rib on each side. Sternal reconstruction was performed with Composix mesh, titanium mesh, and Marlex mesh, using a right pectoralis major muscle flap translation. The patient was extubated just after surgery, and the postoperative course was uneventful. This procedure may be useful for repairing the detect after wide sternotomy.

  8. Comparison of osteoarticular allograft reconstruction with and without the Sauvé-Kapandji procedure following tumour resection in distal radius.

    Science.gov (United States)

    Li, J; Jiao, Y; Guo, Z; Ji, Ch; Wang, Z

    2015-07-01

    The purpose of this study was to compare the midterm functional and oncological outcomes of patients with distal radial tumours treated with en bloc tumour excision and osteoarticular allograft reconstruction with or without a Sauvé-Kapandji (S-K) procedure. All cases of osteoarticular allograft reconstruction with or without the S-K procedure following resection of distal radial tumours (giant-cell tumour in 13, desmoplastic fibroma in two, osteosarcoma in one and malignant fibrous histiocytoma in one) performed from 2000 to 2009 were evaluated by clinical and radiologic examinations; the complications, functional outcomes and Musculoskeletal Tumor Society (MSTS) score were recorded. Seventeen patients (seven with the S-K procedure and 10 without the S-K procedure) with an average age of 31.8 years formed the study population. The follow-up time averaged 84.7 months. All patients continued to be disease-free except one with a local relapse. The reconstructive complications included non-union of radio allograft in one, allograft fracture in five, rupture of tendon in two and degenerative joint disease in all cases. Patients with the S-K procedure had better range of rotation (P = 0.040), greater grip power (P = 0.028) and less degenerative changes (P = 0.014) than those without the S-K procedure. Patients with additional S-K procedure tended to have a higher MSTS score (P = 0.073). En bloc resection of tumour in the distal radius followed by reconstruction with an osteoarticular allograft results in satisfactory oncologic and functional outcomes. Addition of the S-K procedure could improve functional outcomes with regard to allograft reconstruction. Evidence Rating Scale for Therapeutic Studies: Level III. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Pseudo-tumoral hepatic tuberculosis discovered after surgical resection

    Directory of Open Access Journals (Sweden)

    Miloudi Nizar

    2012-02-01

    Full Text Available Pseudo-tumoral hepatic tuberculosis is rare. It is characterized by non-specific symptoms and radiological polymorphism. Diagnosis is problematic. This article presents three cases, each clinically different from each other, that illustrate how difficult diagnosis can be. The definitive diagnosis of pseudo-tumoral hepatic tuberculosis was reached on the basis of histological examination of surgical samples. Treatment of the disease based on appropriate anti-tubercular therapy generally gives a positive outcome.

  10. Radiofrequency Ablation for 110 Malignant Liver Tumours: Preliminary Results on Percutaneous and Surgical Approaches

    Directory of Open Access Journals (Sweden)

    J. Wong

    2009-01-01

    Conclusion: RFA is a safe and effective procedure for treating patients with malignant liver tumours. No difference in short term outcomes was observed between percutaneous and surgical approaches. A more prolonged follow-up study is required to assess longer-term outcomes.

  11. Skin tumour surgery in primary care: do general practitioners need to improve their surgical skills?

    NARCIS (Netherlands)

    Rijsingen, M.C.J. van; Vossen, R.; Huystee, B.E.W.L. van; Gorgels, W.J.; Gerritsen, M.J.P.

    2015-01-01

    BACKGROUND: Due to a rapid increase in the incidence of skin cancer, it seems inevitable that general practitioners (GPs) will play a larger role in skin cancer care. OBJECTIVES: To assess surgical procedures used by GPs in skin tumour management. METHODS: We performed a retrospective study of 1,898

  12. Clinicopathological Features of Cervical Esophageal Cancer: Retrospective Analysis of 63 Consecutive Patients Who Underwent Surgical Resection.

    Science.gov (United States)

    Saeki, Hiroshi; Tsutsumi, Satoshi; Yukaya, Takafumi; Tajiri, Hirotada; Tsutsumi, Ryosuke; Nishimura, Sho; Nakaji, Yu; Kudou, Kensuke; Akiyama, Shingo; Kasagi, Yuta; Nakashima, Yuichiro; Sugiyama, Masahiko; Sonoda, Hideto; Ohgaki, Kippei; Oki, Eiji; Yasumatsu, Ryuji; Nakashima, Torahiko; Morita, Masaru; Maehara, Yoshihiko

    2017-01-01

    The objectives of this retrospective study were to elucidate the clinicopathological features and recent surgical results of cervical esophageal cancer. Cervical esophageal cancer has been reported to have a dismal prognosis. Accurate knowledge of the clinical characteristics of cervical esophageal cancer is warranted to establish appropriate therapeutic strategies. The clinicopathological features and treatment results of 63 consecutive patients with cervical esophageal cancer (Ce group) who underwent surgical resection from 1980 to 2013 were analyzed and compared with 977 patients with thoracic or abdominal esophageal cancer (T/A group) who underwent surgical resection during that time. Among the patients who received curative resection, the 5-year overall and disease-specific survival rates of the Ce patients were significantly better than those of the T/A patients (overall: 77.3% vs 46.5%, respectively, P = 0.0067; disease-specific: 81.9% vs 55.8%, respectively, P = 0.0135). Although total pharyngo-laryngo-esophagectomy procedures were less frequently performed in the recent period, the rate of curative surgical procedures was markedly higher in the recent period (2000-1013) than that in the early period (1980-1999) (44.4% vs 88.9%, P = 0.0001). The 5-year overall survival rate in the recent period (71.5%) was significantly better than that in the early period (40.7%, P = 0.0342). Curative resection for cervical esophageal cancer contributes to favorable outcomes compared with other esophageal cancers. Recent surgical results for cervical esophageal cancer have improved, and include an increased rate of curative resection and decreased rate of extensive surgery.

  13. Extent of surgical resection predicts seizure freedom in low-grade temporal lobe brain tumors.

    Science.gov (United States)

    Englot, Dario J; Han, Seunggu J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-04-01

    Achieving seizure control in patients with low-grade temporal lobe gliomas or glioneuronal tumors remains highly underappreciated, because seizures are the most frequent presenting symptom and significantly impact patient quality-of-life. To assess how the extent of temporal lobe resection influences seizure outcome. We performed a quantitative, comprehensive systematic literature review of seizure control outcomes in 1181 patients with epilepsy across 41 studies after surgical resection of low-grade temporal lobe gliomas and glioneuronal tumors. We measured seizure-freedom rates after subtotal resection vs gross-total lesionectomy alone vs tailored resection, including gross-total lesionectomy with hippocampectomy and/or anterior temporal lobe corticectomy. Included studies were observational case series, and no randomized, controlled trials were identified. Although only 43% of patients were seizure-free after subtotal tumor resection, 79% of individuals were seizure-free after gross-total lesionectomy (OR = 5.00, 95% confidence interval [CI]: 3.33-7.14). Furthermore, tailored resection with hippocampectomy plus corticectomy conferred additional benefit over gross-total lesionectomy alone, with 87% of patients achieving seizure freedom (OR = 1.82, 95% CI: 1.23-2.70). Overall, extended resection with hippocampectomy and/or corticectomy over gross-total lesionectomy alone significantly predicted seizure freedom (OR = 1.18, 95% CI: 1.11-1.26). Age seizure outcome. Gross-total lesionectomy of low-grade temporal lobe tumors results in significantly improved seizure control over subtotal resection. Additional tailored resection including the hippocampus and/or adjacent cortex may further improve seizure control, suggesting dual pathology may sometimes allow continued seizures after lesional excision.

  14. The Surgical Management of Klatskin Tumours: Has Anything Changed in the Last Decade?

    Science.gov (United States)

    Bhardwaj, Neil; Garcea, Giuseppe; Dennison, Ashley R; Maddern, Guy J

    2015-11-01

    Surgical treatment of hilar cholangiocarcinomas requires complex pre-, intra- and post-operative decision-making. Despite the significant progress in liver surgery over the years, several issues such as the role of pre-operative biliary drainage, portal vein embolisation, staging laparoscopy and neo-adjuvant chemotherapy remain unresolved. Operative strategies such as vascular resection, caudate lobe resection and liver transplant have also been practiced in order to improve R0 resectability and improved survival. The review aims to consolidate evidence from major studies in the last 11 years. Survival data were only included from studies that reported the results in at least 30 patients with 1-year follow-up. A significant number of patients may be prevented an unnecessary laparotomy if they underwent a staging laparoscopy. There remain no guidelines as to when portal vein embolisation or pre-operative biliary drainage should be employed but most studies agree with pre-operative biliary drainage being an absolute indication if portal vein embolisation is performed. Concomitant hepatectomy and caudate lobectomy increases R0 resection but vascular resection cannot be routinely recommended. Liver transplant at specialised centres in selective patients has had impressive results. Guidelines are required for pre-operative biliary drainage and portal vein embolisation and randomised trials are required in order to define the role of vascular resection in achieving a R0 resection and increasing survival.

  15. Tissue expander placement and adjuvant radiotherapy after surgical resection of retroperitoneal liposarcoma offers improved local control.

    Science.gov (United States)

    Park, Hyojun; Lee, Sanghoon; Kim, BoKyong; Lim, Do Hoon; Choi, Yoon-La; Choi, Gyu Seong; Kim, Jong Man; Park, Jae Berm; Kwon, Choon Hyuck David; Joh, Jae-Won; Kim, Sung Joo

    2016-08-01

    Given that retroperitoneal liposarcoma (LPS) is extremely difficult to completely resect, and has a relatively high rate of recurrence, radiotherapy (RT) is the treatment of choice after surgical resection. However, it is difficult to obtain a sufficient radiation field because of the close proximity of surrounding organs. We introduce the use of tissue expanders (TEs) after LPS resection in an attempt to secure a sufficient radiation field and to improve recurrence-free survival.This study is a retrospective review of 53 patients who underwent surgical resection of LPS at Samsung Medical Center between January 1, 2005, and December 31, 2012, and had no residual tumor detected 2 months postoperatively. The median follow-up period was 38.9 months.Patients were divided into 3 groups. Those in group 1 (n = 17) had TE inserted and received postoperative RT. The patients in group 2 (n = 9) did not have TE inserted and received postoperative RT. Finally, those in group 3 (n = 27) did not receive postoperative RT. Multivariate analysis was performed to identify the risk factors associated with recurrence-free survival within 3 years. Younger age, history of LPS treatment, and RT after TE insertion (group 1 vs group 2 or 3) were significantly favorable factors influencing 3-year recurrence-free survival.TE insertion after LPS resection is associated with increased 3-year recurrence-free survival, most likely because it allows effective delivery of postoperative RT.

  16. Sphincter sparing resection of a large obstructive distal rectal gastrointestinal stromal tumour after neoadjuvant therapy with imatinib (Glivec).

    Science.gov (United States)

    Kramp, Kelvin Harvey; Omer, Mohab Galal; Schoffski, Patrick; d'Hoore, Andre

    2015-01-08

    Gastrointestinal stromal tumours (GISTs) are generally rare but are known to be the most common mesenchymal tumours of the gastrointestinal tract. We present a case of a patient who presented with persistent obstructive gastrointestinal and urological symptoms, a sense of incomplete evacuation and bleeding per rectum. A colonoscopy was performed and a biopsy was taken of a submucosal mass in the distal rectum that revealed a GIST with positive KIT immunostaining. A positron emission tomography (PET)/CT scan showed a large metabolically active distal rectal tumour of 8 cm with macroscopic invasion of surrounding structures. Neoadjuvant therapy with receptor tyrosine kinase inhibitor imatinib (400 mg orally daily) was initiated and an excellent partial response consisting of a significant decrease in the size of the tumour with complete metabolic resolution was observed within 3 months. Six months after initiation of the neoadjuvant therapy a rectum resection with manual side-to-end coloanal anastomosis was performed. Pathology showed a GIST of 5 cm located 0.1 cm from the distal section plane. Our case shows that in patients with a large invasive distal rectal GIST, neoadjuvant imatinib therapy can facilitate anal sphincter sparing surgery.

  17. Management approach and surgical strategies for retrorectal tumours: a systematic review.

    Science.gov (United States)

    Toh, J W T; Morgan, M

    2016-04-01

    The management strategy for retrorectal tumours is complex. Due to their rarity, few surgeons have expertise in management. A systematic literature review was conducted using the PubMed database. English language publications in the years 2011-2015 that assessed preoperative management, surgical strategies and chemoradiotherapy for presacral tumours were included. Two hundred and fifty-one abstracts were screened of which 88 met the inclusion criteria. After review of the full text, this resulted in a final list of 42 studies eligible for review. In all, 932 patients (63.2% female, 36.8% male; P < 0.01) with a retrorectal tumour were identified. Most were benign (65.9% vs. 33.7%, P < 0.01). Imaging distinguished benign from malignant lesions in 88.1% of cases; preoperative biopsy was superior to imaging in providing an accurate definitive diagnosis (91.3% vs. 61.4%, P < 0.05) with negligible seeding risk. Biopsy should be performed in solid tumours. It is useful in guiding neoadjuvant therapy for gastrointestinal stromal tumours, sarcomas and desmoid type fibromatosis and may alter the management strategy in cases of diffuse large B-cell lymphoma and metastases. Biopsies for cystic lesions are not recommended. The gold standard in imaging is MRI. The posterior Kraske procedure is the most common surgical approach. Overall, the reported recurrence rate was 19.7%. This review evaluated the management strategies for retrorectal tumours. A preoperative biopsy should be performed for solid tumours. MRI is the most useful imaging modality. Surgery is the mainstay of treatment. There is limited information on robotic surgery, single-port surgery, transanal endoscopic microsurgery, chemoradiotherapy and reconstruction. Colorectal Disease © 2015 The Association of Coloproctology of Great Britain and Ireland.

  18. Parenteral corticosteroids followed by early surgical resection of large amblyogenic eyelid hemangiomas in infants

    Directory of Open Access Journals (Sweden)

    El Essawy R

    2013-05-01

    Full Text Available Rania El Essawy,1 Rasha Essameldin Galal21Department of Ophthalmology, 2Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, EgyptBackground: The purpose of this study was to evaluate the results and complications of early surgical resection of large amblyogenic subdermal eyelid hemangiomas in infants after prior short-term parenteral administration of corticosteroids.Methods: Sixteen infants were given dexamethasone 2 mg/kg/day in two divided doses for three consecutive days prior to scheduled surgical excision of large eyelid hemangiomas. The lesions were accessed via an upper eyelid crease, subeyebrow incision, or a lower eyelid subciliary incision.Results: In all cases, surgical excision of the entire lesion was possible with no significant intraoperative or postoperative complications. The levator muscle/aponeurosis complex was involved in 31.25% of cases and was managed by reinsertion or repositioning without resection. A satisfactory lid position and contour with immediate clearing of the visual axis was achieved in all but one case (93.8%.Conclusion: Parenteral corticosteroids helped in reducing volume and blood flow from the hemangiomas, allowing for very early total excision of large subdermal infantile hemangiomas without significant intraoperative hemorrhage. This resulted in immediate elimination of any reason for occlusion amblyopia. Long-term follow-up of visual development in these patients would help to demonstrate the effectiveness of this strategy compared with more conservative measures.Keywords: large eyelid hemangiomas, early surgical resection, parenteral corticosteroids

  19. Long-term follow-up of surgical resection of microcystic meningiomas.

    Science.gov (United States)

    Kalani, M Yashar S; Cavallo, Claudio; Coons, Stephen W; Lettieri, Salvatore C; Nakaji, Peter; Porter, Randall W; Spetzler, Robert F; Feiz-Erfan, Iman

    2015-04-01

    Microcystic meningioma is a rare tumor with myxoid and microcystic features. Our objective was to evaluate the efficacy of surgical resection of microcystic meningioma. Between December 1985 and October 2000 we treated 25 microcystic meningioma patients with surgical resection. We retrospectively analyzed the results including the long-term follow-up of this patient population. We identified 15 women and 10 men with a mean age of 53.8 years (24-76 years) who had microcystic meningiomas treated with surgery. Based on the Simpson grade, we found four Grade I (16%), 16 Grade II (64%), three Grade III (12%) and two Grade IV (8%) resections. The mean preoperative Karnofsky Performance Scale (KPS) score was 80.3 (range 60-100). The mean postoperative KPS score was 90.4 (range 60-100). At a mean follow-up of 101.7 months (range 16-221) the KPS score improved to a mean of 93.8. The recurrence/progression free survival (RFS/PFS) rates at 3 and 5 years were 96% and 88%, respectively. The 3 and 5 year RFS/PFS rates based on the Simpson grade were evaluated. The 3 year RFS/PFS rates for Grade I, II, III and IV were 100%, 100%, 66.6% and 100%, respectively. The 5 year RFS/PFS rates were 66.6%, 90%, 66.6% and 100%, respectively. Microcystic meningioma is a rare tumor, which is characterized by extracellular microcystic spaces filled by edematous fluid and peritumoral edema. Following surgical resection these tumors have a positive prognosis with a benign course. The surgical outcomes seem to be associated with the risks related to the surgical procedure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. Surgically cured hypoglycemia secondary to pleural solitary fibrous tumour: case report and update review on the Doege-Potter syndrome

    Directory of Open Access Journals (Sweden)

    Kalebi Ahmed Y

    2009-08-01

    Full Text Available Abstract The association of paraneoplastic hypoglycemia [Doege-Potter syndrome] and finger clubbing [Pierre-Marie-Bamberg syndrome] with pleural solitary fibrous tumour is rare. We present a previously unpublished but typical example of this rare occurrence together with a detailed updated literature review of previously published cases of pleural SFT discussing the histopathology of SFT; pathophysiology of the hypoglycemia and finger clubbing; treatment and outcome of pleural SFT. The patient, a 57-year-old African male was admitted at our hospital with recurrent episodes of hypoglycemia. He was found to have digital clubbing and decreased breath sounds in the right lower chest but no other significant clinical findings. His insulin level measured during an episode of hypoglycemia was undetectable. Chest radiograph and CT-scan revealed a lobulated mass in the right chest which was diagnosed to be SFT on histology. Surgical excision of the mass resulted in cure of the hypoglycemic episodes and rapid regression of the clubbing. Less than 65 cases of pleural SFT manifesting with hypoglycemia with or without finger-clubbing have been published in the English literature. The mean diameter of these tumours manifesting with hypoglycemia is 20 cm, 54% being benign while 42% were malignant. They predominantly present in the 6th-8th decade, average age of 64 years and a slight male preponderance at 58%. Complete surgical resection remains the most important predictor of clinical outcome in terms of recurrence and metastases, while providing instant cure for the hypoglycemia and rapid resolution of the finger clubbing.

  1. Surgical resection of adrenal metastasis from primary liver tumors:a report of two cases

    Institute of Scientific and Technical Information of China (English)

    Durgatosh Pandey; Kai-Chah Tan

    2008-01-01

    BACKGROUND: Although the treatment of extrahepatic metastases from primary liver tumors is essentially palliative, solitary metastasis from such tumors offers a possibility of cure by surgical resection. The adrenal gland is an uncommon site for metastasis from primary liver tumors. METHOD: We report two cases of adrenalectomy for solitary adrenal metastasis: one from intrahepatic cholangiocarcinoma and the other from hepatocellular carcinoma. RESULTS: The patient with intrahepatic cholangiocar-cinoma had a synchronous adrenal metastasis and underwent simultaneous liver resection and adrenalectomy. However, he developed recurrent disease 17 months following surgery for which he is presently on palliative chemotherapy. The other patient underwent adrenalectomy for adrenal metastasis 3 months following liver transplantation for hepatocellular carcinoma. He is presently alive and disease-free 27 months after adrenalectomy. CONCLUSION: Carefully selected patients with solitary metastasis from primary liver tumors may be considered for resection.

  2. Surgical team turnover and operative time: An evaluation of operating room efficiency during pulmonary resection.

    Science.gov (United States)

    Azzi, Alain Joe; Shah, Karan; Seely, Andrew; Villeneuve, James Patrick; Sundaresan, Sudhir R; Shamji, Farid M; Maziak, Donna E; Gilbert, Sebastien

    2016-05-01

    Health care resources are costly and should be used judiciously and efficiently. Predicting the duration of surgical procedures is key to optimizing operating room resources. Our objective was to identify factors influencing operative time, particularly surgical team turnover. We performed a single-institution, retrospective review of lobectomy operations. Univariate and multivariate analyses were performed to evaluate the impact of different factors on surgical time (skin-to-skin) and total procedure time. Staff turnover within the nursing component of the surgical team was defined as the number of instances any nurse had to leave the operating room over the total number of nurses involved in the operation. A total of 235 lobectomies were performed by 5 surgeons, most commonly for lung cancer (95%). On multivariate analysis, percent forced expiratory volume in 1 second, surgical approach, and lesion size had a significant effect on surgical time. Nursing turnover was associated with a significant increase in surgical time (53.7 minutes; 95% confidence interval, 6.4-101; P = .026) and total procedure time (83.2 minutes; 95% confidence interval, 30.1-136.2; P = .002). Active management of surgical team turnover may be an opportunity to improve operating room efficiency when the surgical team is engaged in a major pulmonary resection. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  3. Surgical resection of late solitary locoregional gastric cancer recurrence in stomach bed.

    Science.gov (United States)

    Watanabe, Masanori; Suzuki, Hideyuki; Maejima, Kentaro; Komine, Osamu; Mizutani, Satoshi; Yoshino, Masanori; Bo, Hideki; Kitayama, Yasuhiko; Uchida, Eiji

    2012-07-01

    Late-onset and solitary recurrence of gastric signet ring cell (SRC) carcinoma is rare. We report a successful surgical resection of late solitary locoregional recurrence after curative gastrectomy for gastric SRC carcinoma. The patient underwent total gastrectomy for advanced gastric carcinoma at age 52. Seven years after the primary operation, he visited us again with sudden onset of abdominal pain and vomiting. We finally decided to perform an operation, based on a diagnosis of colon obstruction due to the recurrence of gastric cancer by clinical findings and instrumental examinations. The laparotomic intra-abdominal findings showed that the recurrent tumor existed in the region surrounded by the left diaphragm, colon of splenic flexure, and pancreas tail. There was no evidence of peritoneal dissemination, and peritoneal lavage fluid cytology was negative. We performed complete resection of the recurrent tumor with partial colectomy, distal pancreatectomy, and partial diaphragmectomy. Histological examination of the resected specimen revealed SRC carcinoma, identical in appearance to the previously resected gastric cancer. We confirmed that the intra-abdominal tumor was a locoregional gastric cancer recurrence in the stomach bed. The patient showed a long-term survival of 27 months after the second operation. In the absence of effective alternative treatment for recurrent gastric carcinoma, surgical options should be pursued, especially for late and solitary recurrence.

  4. [A Case of Surgical Resection of Isolated Pulmonary Metastasis from Gastric Cancer].

    Science.gov (United States)

    Murata, Tomohiro; Koshiishi, Haruya; Imaizumi, Ken; Okuno, Keisuke; Nakata, Takuya; Hirano, Takayuki; Tokura, Michiyo; Matsuyama, Takatoshi; Hoshino, Mayumi; Kakimoto, Masaki; Goto, Hiroshi; Yoshimura, Tetsunori

    2015-11-01

    We report a rare case of surgical resection for pulmonary metastasis from gastric cancer. A 71-year-old man underwent total gastrectomy for gastric cancer in October 2012. After the operation, he received S-1 chemotherapy for 1 year. In January 2014, computed tomography of the chest showed a nodule shadow with a cavity at S3 in the right lung. Because it showed a tendency to gradually enlarge, we performed an operation in September 2014. The nodule was diagnosed as metastatic adenocarcinoma from gastric cancer on pathology. The patient is being treated with S-1 chemotherapy during follow-up. The pulmonary metastases of gastric cancer often develop along with carcinomatous lymphangiosis or carcinomatous pleurisy, and isolated pulmonary metastasis is rare. A consensus has not been reached about the usefulness of surgical resection, and the accumulation of further cases is required.

  5. Resection of ictal high-frequency oscillations leads to favorable surgical outcome in pediatric epilepsy

    Science.gov (United States)

    Fujiwara, Hisako; Greiner, Hansel M.; Lee, Ki Hyeong; Holland-Bouley, Katherine D.; Seo, Joo Hee; Arthur, Todd; Mangano, Francesco T.; Leach, James L.; Rose, Douglas F.

    2012-01-01

    Summary Purpose Intracranial electroencephalography (EEG) is performed as part of an epilepsy surgery evaluation when noninvasive tests are incongruent or the putative seizure-onset zone is near eloquent cortex. Determining the seizure-onset zone using intracranial EEG has been conventionally based on identification of specific ictal patterns with visual inspection. High-frequency oscillations (HFOs, >80 Hz) have been recognized recently as highly correlated with the epileptogenic zone. However, HFOs can be difficult to detect because of their low amplitude. Therefore, the prevalence of ictal HFOs and their role in localization of epileptogenic zone on intracranial EEG are unknown. Methods We identified 48 patients who underwent surgical treatment after the surgical evaluation with intracranial EEG, and 44 patients met criteria for this retrospective study. Results were not used in surgical decision making. Intracranial EEG recordings were collected with a sampling rate of 2,000 Hz. Recordings were first inspected visually to determine ictal onset and then analyzed further with time-frequency analysis. Forty-one (93%) of 44 patients had ictal HFOs determined with time-frequency analysis of intracranial EEG. Key Findings Twenty-two (54%) of the 41 patients with ictal HFOs had complete resection of HFO regions, regardless of frequency bands. Complete resection of HFOs (n = 22) resulted in a seizure-free outcome in 18 (82%) of 22 patients, significantly higher than the seizure-free outcome with incomplete HFO resection (4/19, 21%). Significance Our study shows that ictal HFOs are commonly found with intracranial EEG in our population largely of children with cortical dysplasia, and have localizing value. The use of ictal HFOs may add more promising information compared to interictal HFOs because of the evidence of ictal propagation and followed by clinical aspect of seizures. Complete resection of HFOs is a favorable prognostic indicator for surgical outcome. PMID

  6. Endovascular embolization prior to surgical resection of symptomatic intralobar pulmonary sequestration in an adult

    OpenAIRE

    Jernej Avsenik; Tomaž Štupnik; Peter Popovič

    2015-01-01

    Intralobar pulmonary sequestration is a rare congenital malformation, conventionally managed by surgical resection. Recently, the endovascular embolization has been proposed for the definite treatment of this disease. Additionally, preoperative embolization of aberrant arteries to minimize the risk of serious intraoperative haemorrhage has also been described. We report the case of 43-year old female patient who presented with cough and haemoptysis, and was successfully treated with endovascu...

  7. MR and CT diagnosis of carotid pseudoaneurysm in children following surgical resection of craniopharyngioma

    Energy Technology Data Exchange (ETDEWEB)

    Lakhanpal, S.K. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Glasier, C.M. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); James, C.A. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States); Angtuaco, E.J.C. [Dept. of Radiology, Univ. of Arkansas for Medical Sciences and Arkansas Children`s Hospital, Little Rock, AR (United States)

    1995-06-01

    We report the cases of two children who underwent CT, MR, MRA and angiography in the diagnosis of postoperative aneurysmal dilatation of the supraclinoid carotid arteries following surgical resection of craniopharyngioma. Craniopharyngiomas are relatively common lesions, accounting for 6-7 % of brain tumors in children. They are histologically benign, causing symptoms by their growth within the sella and suprasellar cistern with compression of adjacent structures, especially the pituitary gland, hypothalamus and optic nerves, chiasm, and tracts. (orig.)

  8. Reduction of Pulmonary Function After Surgical Lung Resections of Different Volume

    Science.gov (United States)

    Cukic, Vesna

    2014-01-01

    Introduction: In recent years an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused with common etiologic factor - smoking cigarettes. Objective: To determine how big the loss of lung function is after surgical resection of lung of different range. Methods: The study was done on 58 patients operated at the Clinic for thoracic surgery KCU Sarajevo, previously treated at the Clinic for pulmonary diseases “Podhrastovi” in the period from 01.06.2012. to 01.06.2014. The following resections were done: pulmectomy (left, right), lobectomy (upper, lower: left and right). The values of postoperative pulmonary function were compared with preoperative ones. As a parameter of lung function we used FEV1 (forced expiratory volume in one second), and changes in FEV1 are expressed in liters and in percentage of the recorded preoperative and normal values of FEV1. Measurements of lung function were performed seven days before and 2 months after surgery. Results: Postoperative FEV1 was decreased compared to preoperative values. After pulmectomy the maximum reduction of FEV1 was 44%, and after lobectomy it was 22% of the preoperative values. Conclusion: Patients with airway obstruction are limited in their daily life before the surgery, and an additional loss of lung tissue after resection contributes to their inability. Potential benefits of lung resection surgery should be balanced in relation to postoperative morbidity and mortality. PMID:25568542

  9. Rapid development of an osteosarcoma after surgical resection of an osteochondroma.

    Science.gov (United States)

    Gomez-Brouchet, Anne; Accadbled, Franck; Rubie, Herve; Janka, Dora; Castex, Marie-Pierre; Thuille, Benedicte; Delattre, Olivier; Laurell, Henrick; Baunin, Christiane; de Gauzy, Jérôme Sales

    2007-09-01

    The rapid development of an osteosarcoma, after surgical resection of an osteochondroma, has not been yet reported. We present here the case of a 12-year-old girl that had, in less than 2 months, an osteosarcoma at the initial site of a treated osteochondroma. Comparative Genomic Hybridization analyses showed that the 2 tumors were genetically distinct, suggesting a distant, if any, relationship. The possible implication of a deregulated tissue homeostasis caused by the surgical intervention is discussed. Proangiogenic factors involved in the tissue healing could be the triggering factor favoring tumor angiogenesis and explaining the very rapid progression of the tumor.

  10. Humoral hypercalcaemia of malignancy: metabolic and histomorphometric studies during surgical management of the primary tumour.

    Science.gov (United States)

    Ralston, S H; Boyce, B F; Cowan, R A; Gardner, M D; Dryburgh, F J; Boyle, I T

    1986-03-01

    Several aspects of calcium metabolism were studied in five patients during the surgical exploration of malignant tumours associated with humorally-mediated hypercalcaemia. Before operation in all patients the renal tubular threshold for calcium reabsorption was raised and the threshold for renal tubular phosphate reabsorption depressed. On removal of the primary tumour in three cases, serum calcium returned to normal, renal calcium threshold fell, renal phosphate threshold rose, but urinary hydroxyproline excretion did not change. In two patients where the tumour proved inoperable, serum calcium remained elevated and no changes in renal calcium threshold or phosphate threshold occurred. Histomorphometry carried out on biopsy specimens from four patients showed normal bone resorption in three, and slightly increased resorption in one, without depression of osteoblastic bone formation. It is suggested that hypercalcaemia in these patients resulted mainly from an alteration in renal calcium threshold caused by a humoral substance released by tumour cells. Correction of hypercalcaemia on removal of the primary tumour was achieved rapidly and could be explained principally by a reduction in renal calcium threshold with increased loss of calcium into the urine. These data contrast with those of many previous studies which have emphasised the predominant role of accelerated osteoclastic bone resorption as the principal cause of hypercalcaemia in malignancy and suggest that a renal effect of the putative humoral agent may predominate in some cases.

  11. Changes of Arterial Blood Gases After Different Ranges of Surgical Lung Resection

    Science.gov (United States)

    Cukic, Vesna; Lovre, Vladimir

    2012-01-01

    Introduction: In recent years there has been increase in the number of patients who need thoracic surgery – first of all different types of pulmonary resection because of primary bronchial cancer, and very often among patients whose lung function is impaired due to different degree of bronchial obstruction so it is necessary to assess functional status before and after lung surgery to avoid the development of respiratory insufficiency. Objective: To show the changes in the level of arterial blood gases after various ranges of lung resection. Material and methods: The study was done on 71 patients surgically treated at the Clinic for Thoracic Surgery KCU Sarajevo, who were previously treated at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 06. 2009. to 01. 09. 2011. Different types of lung resection were made. Patients whose percentage of ppoFEV1 was (prognosed postoperative FEV1) was less than 30% of normal values of FEV1 for that patients were not given a permission for lung resection. We monitored the changes in levels-partial pressures of blood gases (PaO2, PaCO2 and SaO2) one and two months after resection and compared them to preoperative values. As there were no significant differences between the values obtained one and two months after surgery, in the results we showed arterial blood gas analysis obtained two months after surgical resection. Results were statistically analyzed by SPSS and Microsoft Office Excel. Statistical significance was determined at an interval of 95%. Results: In 59 patients (83%) there was an increase, and in 12 patients (17%) there was a decrease of PaO2, compared to preoperative values. In 58 patients (82%) there was a decrease, and in 13 patients (18%) there was an increase in PaCO2, compared to preoperative values. For all subjects (group as whole): The value of the PaO2 was significantly increased after lung surgery compared to preoperative values (p <0.05) so is the value of the SaO2%. The value

  12. Video-assisted mediastinoscopy (VAM for surgical resection of ectopic parathyroid adenoma

    Directory of Open Access Journals (Sweden)

    Lansdown Mark

    2007-10-01

    Full Text Available Abstract Background Ectopic mediastinal parathyroid adenomas or hyperplasia account for up to 25% of primary hyperparathyroidism (HPT. Two percent of them are not accessible by standard cervical surgical approaches. Surgical resection has traditionally been performed via median sternotomy or thoracotomy and more recently, via video assisted thoracoscopic surgery (VATS. We present our experience with the novel use of Video-Assisted Mediastinoscopy (VAM for resection of ectopic mediastinal parathyroid glands. Case presentation 4 patients underwent VAM for removal of an ectopic intramediastinal parathyroid gland. All of them had at least one previous unsuccessful neck exploration. In all cases histology confirmed complete resection of ectopic parathyroid glands (3 parathyroid adenomas and one parathyroid hyperplasia. Two of the patients required a partial sternal split to facilitate exploration. Conclusion The cervical approach for resection of ectopic parathyroid adenomas is frequently unsuccessful. Previously, the standard surgical approach in such cases was sternotomy and exploration of the mediastinum. Recently, a number of less invasive modalities have been introduced. We found that VAM has several advantages. It has a short theatre time does not require a complex anaesthetic and is performed with the patient in classic supine position utilising often a previous cervical scar with good cosmetic results. It offers a short hospital stay; it is cost effective with minimal use of fancy and pricy consumables with a comfortable incision and no violation of the pleural space. Additionally the use of digital Video imaging has increased the sensitivity of the mediastinoscopy and has added safety and confidence in performing a detailed mediastinal exploration with an additional great training value as well.

  13. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome.

    Science.gov (United States)

    Ried, Michael; Potzger, Tobias; Sziklavari, Zsolt; Diez, Claudius; Neu, Reiner; Schalke, Berthold; Hofmann, Hans-Stefan

    2014-03-01

    Extended thymoma resections including adjacent structures and pleurectomy/decortication (P/D) with hyperthermic intrathoracic chemotherapy (HITHOC) perfusion were performed in a multidisciplinary treatment regime. Between July 2000 and February 2012, 22 patients with Masaoka stage III (n = 9; 41%) and Masaoka stage IVa (n = 13; 59%) thymic tumors were included. Mean age was 55 years (25-84 years) and 50% (11 out of 22) of patients were female. World Health Organization histological classification was as follows: B2 (n = 15), A (n = 1), B1 (n = 1), B3 (n = 2), and thymic carcinoma (C; n = 3). Radical thymectomy and partial resection of the mediastinal pleura and pericardium were performed. Of the 13, 9 patients with pleural involvement (stage IVa) received radical P/D followed by HITHOC (cisplatin). Macroscopic complete resection (R0/R1) was achieved in 19 (86%) patients. All patients received multimodality treatment depending on tumor stage, histology, and completeness of resection. Thirty-day mortality was 0% and three (13.6%) patients needed operative revision. Recurrence of thymoma was documented in five (22.7%) patients (stage III, n = 1; stage IVa, n = 4). Mean disease-free interval of patients with complete resection (n = 14 out of 22) was 30.2 months. After a mean follow-up of 29 months, 18 out of the 22 (82%) patients are alive. After P/D and HITHOC, 89% (8 out of 9 patients) are alive (current median survival is 25 months) without recurrence. Extended surgical resection of advanced thymic tumors infiltrating adjacent structures (stage III) or with pleural metastases (stage IVa) is safe and feasible. It provides a low recurrence rate and an acceptable survival. Additional HITHOC in patients with pleural thymoma spread seems to offer a better local tumor control. Georg Thieme Verlag KG Stuttgart · New York.

  14. Resection of the mesopancreas (RMP: a new surgical classification of a known anatomical space

    Directory of Open Access Journals (Sweden)

    Konerding Moritz A

    2007-04-01

    Full Text Available Abstract Background Prognosis after surgical therapy for pancreatic cancer is poor and has been attributed to early lymph node involvement as well as to a strong tendency of cancer cells to infiltrate into the retropancreatic tissue and to spread along the peripancreatic neural plexuses. The objective of our study was to classify the anatomical-surgical layer of the mesopancreas and to describe the surgical principles relevant for resection of the mesopancreas (RMP. Immunohistochemical investigation of the mesopancreatic-perineural lymphogenic structures was carried out with the purpose of identifying possible routes of metastatic spread. Methods Resection of the mesopancreas (RMP was performed in fresh corpses. Pancreas and mesopancreas were separated from each other and the mesopancreas was immunohistochemically investigated. Results The mesopancreas strains itself dorsally of the mesenteric vessels as a whitish-firm, fatty tissue-like layer. Macroscopically, in the dissected en-bloc specimens of pancreas and mesopancreas nerve plexuses were found running from the dorsal site of the pancreatic head to the mesopancreas to establish a perineural plane. Immunohistochemical examinations revealed the lymphatic vessels localized in direct vicinity of the neuronal plexuses between pancreas and mesopancreas. Conclusion The mesopancreas as a perineural lymphatic layer located dorsally to the pancreas and reaching beyond the mesenteric vessels has not been classified in the anatomical or surgical literature before. The aim to ensure the greatest possible distance from the retropancreatic lymphatic tissue which drains the carcinomatous focus can be achieved in patients with pancreatic cancer only by complete resection of the mesopancreas (RMP.

  15. Identifying the association between contrast enhancement pattern, surgical resection, and prognosis in anaplastic glioma patients

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Yinyan; Jiang, Tao [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Wang, Kai; Li, Shaowu; Ma, Jun [Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China); Wang, Jiangfei [Capital Medical University, Department of Neurosurgery, Beijing Tiantan Hospital, Beijing (China); Dai, Jianping [Capital Medical University, Beijing Neurosurgical Institute, Beijing (China); Capital Medical University, Department of Neuroradiology, Beijing Tiantan Hospital, Beijing (China)

    2016-04-15

    Contrast enhancement observable on magnetic resonance (MR) images reflects the destructive features of malignant gliomas. This study aimed to investigate the relationship between radiologic patterns of tumor enhancement, extent of resection, and prognosis in patients with anaplastic gliomas (AGs). Clinical data from 268 patients with histologically confirmed AGs were retrospectively analyzed. Contrast enhancement patterns were classified based on preoperative T1-contrast MR images. Univariate and multivariate analyses were performed to evaluate the prognostic value of MR enhancement patterns on progression-free survival (PFS) and overall survival (OS). The pattern of tumor contrast enhancement was associated with the extent of surgical resection in AGs. A gross total resection was more likely to be achieved for AGs with focal enhancement than those with diffuse (p = 0.001) or ring-like (p = 0.024) enhancement. Additionally, patients with focal-enhanced AGs had a significantly longer PFS and OS than those with diffuse (log-rank, p = 0.025 and p = 0.031, respectively) or ring-like (log-rank, p = 0.008 and p = 0.011, respectively) enhanced AGs. Furthermore, multivariate analysis identified the pattern of tumor enhancement as a significant predictor of PFS (p = 0.016, hazard ratio [HR] = 1.485) and OS (p = 0.030, HR = 1.446). Our results suggested that the contrast enhancement pattern on preoperative MR images was associated with the extent of resection and predictive of survival outcomes in AG patients. (orig.)

  16. Immediate reconstruction of the mandible after resection for aggressive odontogenic tumours: a cohort study

    NARCIS (Netherlands)

    Simon, E.N.; Merkx, M.A.W.; Kalyanyama, B.M.; Shubi, F.M.; Stoelinga, P.J.W.

    2013-01-01

    The results are reported of a clinical follow-up study on 32 selected but consecutive patients with mandibular ameloblastoma. They were all treated by a segmental resection and reconstructed, using two 2.3 mm reconstruction plates and an autogenous particulate bone graft, taken from the anterior

  17. Hospitalization for transurethral bladder resection reduces quality of life in Danish patients with non-muscle-invasive bladder tumour

    DEFF Research Database (Denmark)

    Mogensen, Karin; Christensen, Karl B.; Vrang, Marie-Louise;

    2016-01-01

    Objective The aim of the study was to evaluate the impact of transurethral resection of bladder tumour (TURBT) on patients' quality of life (QoL) and to validate a tool to quantify problems associated with TURBT in a Danish population. Materials and methods A prospective study was carried out using...... a combination of questionnaires and interviews. The study included 165 consecutive patients undergoing a TURBT owing to non-muscle-invasive bladder cancer (NMIBC) from 1 May 2011 to 30 April 2012. Seven patients were selected for interviews. The Danish translation of the QLQ-NMIBC24 Quality of Life...... Questionnaire for NMIBC, from the European Organisation for Research and Treatment of Cancer (EORTC), was used. The interviews were semi-structured. The reliability of the subscales quantifying QoL as defined by the EORTC was tested by computing Cronbach's coefficient alpha and confirmatory factor analysis...

  18. Metabolic tumour burden assessed by {sup 18}F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection

    Energy Technology Data Exchange (ETDEWEB)

    Xu, Hua-Xiang; Chen, Tao; Wang, Wen-Quan; Wu, Chun-Tao; Liu, Chen; Long, Jiang; Xu, Jin; Liu, Liang; Yu, Xian-Jun [Fudan University, Shanghai Cancer Center, Pancreatic Cancer Institute and Department of Pancreatic and Hepatobiliary Surgery, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Zhang, Ying-Jian [Fudan University, Shanghai Cancer Center, Department of Nuclear Medicine, Shanghai (China); Fudan University, Department of Oncology, Shanghai Medical College, Shanghai (China); Chen, Run-Hao [Fudan University, Department of General Surgery, Jinshan Hospital, Shanghai (China)

    2014-06-15

    Tumour burden is one of the most important prognosticators for pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate the predictive significance of metabolic tumour burden measured by {sup 18}F-FDG PET/CT in patients with resectable PDAC. Included in the study were 122 PDAC patients who received preoperative {sup 18}F-FDG PET/CT examination and radical pancreatectomy. Metabolic tumour burden in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), pathological tumour burden (tumour size), serum tumour burden (baseline serum CA19-9 level), and metabolic activity (maximum standard uptake value, SUVmax) were determined, and compared for their performance in predicting overall survival (OS) and recurrence-free survival (RFS). MTV and TLG were significantly associated with baseline serum CA19-9 level (P = 0.001 for MTV, P < 0.001 for TLG) and tumour size (P < 0.001 for MTV, P = 0.001 for TLG). Multivariate analysis showed that MTV, TLG and baseline serum CA19-9 level as either categorical or continuous variables, but not tumour size or SUVmax, were independent risk predictors for both OS and RFS. Time-dependent receiving operating characteristics analysis further indicated that better predictive performances for OS and RFS were achieved by MTV and TLG compared to baseline serum CA19-9 level, SUVmax and tumour size (P < 0.001 for all). MTV and TLG showed strong consistency with baseline serum CA19-9 level in better predicting OS and RFS, and might serve as surrogate markers for prediction of outcome in patients with resectable PDAC. (orig.)

  19. Accuracy of magnetic resonance imaging in planning the osseous resection margins of bony tumours in the proximal femur: based on coronal T1-weighted versus STIR images

    Energy Technology Data Exchange (ETDEWEB)

    Ahmad, Sarfraz; Stevenson, Jonathan; Mangham, Charles; Cribb, Gillian; Cool, Paul [Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Musculoskeletal Oncology, Oswestry, Shropshire (United Kingdom)

    2014-12-15

    Assessment of the extent of tumours using magnetic resonance imaging (MRI) is the basis for bone resection in limb-salvage surgery. We aimed to compare the accuracy of T1-weighted MRI and STIR sequences in measuring the extent of proximal femoral tumours, using the macroscopic specimens as the gold standard for comparison. We compared single coronal T1-weighted with STIR sequences in 34 proximal femoral tumours, using bivalved resected macroscopic tumours for comparison. After randomisation, four observers measured longitudinal osseous tumour extent using MRI and specimen photographs on two separate occasions, 3 weeks apart. There were 25 metastatic tumours, 8 chondrosarcomas and 1 myeloma. Eight patients presented with pathological fractures. The Pearson's correlation coefficient for comparison of T1 with macroscopic tumours was 0.91 (95 % confidence interval [CI]: 0.83 to 0.96) for all observers and 0.90 (95 % CI: 0.81 to 0.95) for STIR images. This difference was not statistically significant, and T1 and STIR sequence measurements had similar precision and accuracy. Bland-Altman plots showed T1-weighted imaging to be unbiased, whereas STIR sequences were biased and had systematic error. Moreover, STIR measurements overestimated tumour size by 6.4 mm (95 % CI: -26.9 to 39.7 mm) and 2 patients were outliers. T1 measurements were closer to the macroscopic measurements with a mean difference of 1.3 mm (95 % CI: -28.9 mm to 31.5 mm), with 3 patients falling outside of this. The variance was greater for STIR measurements. This difference between T1 and STIR measurements was statistically significant (p = 0.000003). The intra-observer reliability between separate measurements for MRI and specimen photographs achieved interclass correlation coefficients of 0.97, 0.96 and 0.95 (T1, STIR and macroscopic tumour respectively). T1 had greater interobserver correlation than for STIR and macroscopic tumour measurements (0.88 vs 0.85 and 0.85 respectively). These

  20. Paediatric intracranial anaplastic ependymoma: the role of multiple surgical resections for disease relapse in maintaining quality of life and prolonged survival.

    Science.gov (United States)

    Kitchen, William John; Pizer, Barry; Pettorini, Benedetta; Husband, David; Mallucci, Conor; Jenkinson, Michael D

    2015-01-01

    Ependymoma is the third most common intracranial glioma in children. The treatment of choice for these tumours remains gross total resection followed by radiotherapy. There are two principal histological subtypes, namely classic (∼70%) and anaplastic (∼30%) ependymoma. We present the case of a 12-year-old girl with an anaplastic ependymoma of the left temporal lobe. She underwent initial image-guided resection following biopsy. A postoperative MRI showed a macroscopic resection. She subsequently relapsed and indeed had 11 local and distant relapses managed by 12 separate craniotomies and tumour resection, 4 courses of radiotherapy and chemotherapy. For patients with multiple relapses, surgery should be considered primarily to re-resect any symptomatic lesion. This case demonstrates that multiple tumour resections can be undertaken with limited morbidity for the patient and with maintenance of quality of life. Repeated focal irradiation can also be used to control the disease with limited morbidity. © 2015 S. Karger AG, Basel.

  1. Surgical resection of a solitary liver metastasis from nasopharyngeal carcinoma:a case report

    Institute of Scientific and Technical Information of China (English)

    Spiros Delis; Ioannis Biliatis; Antonia Bourli; Nikolaos Kapranos; Christos Dervenis

    2006-01-01

    BACKGROUND: Nasopharyngeal carcinoma (NPC) has a propensity to develop distant metastases at a high rate and with poor prognosis. Metastatic sites are usually multifocal and involve bones, lungs, liver and distant lymph nodes. Management of metastatic disease is essentially palliative and is based on chemotherapy. METHODS:A 50-year-old man with a solitary liver metastasis from a newly diagnosed NPC was treated by segmentectomy. Prior to surgery, neoadjuvant chemo-therapy followed by concurrent chemoradiotherapy was administered. RESULTS:Complete remission of the primary disease was achieved, although the size of the hepatic lesion was increased. After resection of the liver metastasis, no signs of local or distant recurrence was noted during the 6-month follow up. CONCLUSION:Although surgical treatment has a limited role in metastatic NPC, there are rare cases of localized disease with a reasonable outcome after resection.

  2. Radiologic Evaluation of Small Lepidic Adenocarcinomas to Guide Decision Making in Surgical Resection.

    Science.gov (United States)

    Wilshire, Candice L; Louie, Brian E; Manning, Kristin A; Horton, Matthew P; Castiglioni, Massimo; Gorden, Jed A; Aye, Ralph W; Farivar, Alexander S; Vallières, Eric

    2015-09-01

    The International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification of pulmonary adenocarcinomas identifies indolent lesions associated with low recurrence, superior survival, and the potential for sublobar resection. The distinction, however, is determined on the pathologic evaluation, limiting preoperative surgical planning. We sought to determine whether preoperative computed tomography (CT) characteristics could guide decisions about the extent of the pulmonary resection. We reviewed the preoperative CT scans for 136 patients identified to have adenocarcinomas with lepidic features on the final pathologic evaluation. The solid component on CT was substituted for the invasive component, and patients were radiologically classified as adenocarcinoma in situ, 3 cm or less with no solid component; minimally invasive adenocarcinoma, 3 cm or less with a solid component of 5 mm or less; or invasive adenocarcinoma, exceeding 3 cm or solid component exceeding 5 mm, or both. Analysis of variance, t test, χ(2) test, and Kaplan-Meier methods were used for analysis. The radiologic classification identified 35 adenocarcinomas in situ (26%) and 12 minimally invasive (9%) and 89 invasive adenocarcinoma (65%) lesions. At a 32-month median follow-up, patient outcomes associated with the radiologic classification were similar to the pathologic-based classification: the radiologic classification identified 14 of 16 patients with recurrent disease and all 6 who died of lung cancer. In addition, patients with radiologic adenocarcinoma in situ and minimally invasive adenocarcinoma who underwent sublobar resections had no recurrence and 100% disease-free and overall survival at 5 years. The radiologic classification of patients with lepidic adenocarcinomas is associated with similar oncologic and survival outcomes compared with the pathologic classification and may guide decision making in the approach to surgical resection

  3. Different surgical approaches for mesial temporal epilepsy: resection extent, seizure, and neuropsychological outcomes.

    Science.gov (United States)

    Malikova, Hana; Kramska, Lenka; Vojtech, Zdenek; Liscak, Roman; Sroubek, Jan; Lukavsky, Jiri; Druga, Rastislav

    2014-01-01

    Surgical therapy of intractable mesial temporal lobe epilepsy (MTLE) is an effective and well-established treatment. We compared two different surgical approaches, standard microsurgical anterior temporal resection (ATL) and stereotactic radiofrequency amygdalohippocampectomy (SAHE) for MTLE, with respect to the extent of resection or destruction, clinical outcomes, and complications. 75 MTLE patients were included: 41 treated by SAHE (11 right sided, 30 left sided) and 34 treated by ATL (21 right sided, 13 left sided). SAHE and ATL seizure control were comparable (Engel I in 75.6 and 76.5% 2 years after surgery and 79.3 and 76.5% 5 years after procedures, respectively). The neuropsychological results of SAHE patients were better than in ATL. In SAHE patients, no memory deficit was found. Hippocampal (60.6 ± 18.7%) and amygdalar (50.3 ± 21.9%) volume reduction by SAHE was significantly lower than by ATL (86.0 ± 12.7% and 80.2 ± 20.9%, respectively). The overall rate of surgical nonsilent complications without permanent neurological deficit after ATL was 11.8%, and another 8.8% silent infarctions were found on MRI. The rate of clinically manifest complications after SAHE was 4.9%. The rate of visual field defects after SAHE was expectably less frequent than after ATL. Seizure control by SAHE was comparable to ATL. However, SAHE was safer with better neuropsychological results. © 2014 S. Karger AG, Basel.

  4. Role of {sup 18}F-FDG PET/CT in the prediction of gastric cancer recurrence after curative surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won [Jeju National University Hospital, Department of Nuclear Medicine, Jeju (Korea, Republic of); Lee, Sang Mi [Soonchunhyang University Hospital, Department of Nuclear Medicine, Cheonan, Chungcheongnam-do (Korea, Republic of); Lee, Moon-Soo [Soonchunhyang University Hospital, Department of Surgery, Cheonan (Korea, Republic of); Shin, Hyeong Cheol [Soonchunhyang University Hospital, Department of Radiology, Cheonan (Korea, Republic of)

    2012-09-15

    The study evaluated the role of preoperative {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT in the prediction of recurrent gastric cancer after curative surgical resection. A total of 271 patients with gastric cancer who underwent {sup 18}F-FDG PET/CT and subsequent curative surgical resection were enrolled. All patients underwent follow-up for cancer recurrence with a mean duration of 24 {+-} 12 months. {sup 18}F-FDG PET/CT images were visually assessed and, in patients with positive {sup 18}F-FDG cancer uptake, the maximum standardized uptake value (SUV{sub max}) of cancer lesions was measured. {sup 18}F-FDG PET/CT findings were tested as prognostic factors for cancer recurrence and compared with conventional prognostic factors. Furthermore, {sup 18}F-FDG PET/CT findings were assessed as prognostic factors according to histopathological subtypes. Of 271 patients, 47 (17 %) had a recurrent event. Positive {sup 18}F-FDG cancer uptake was shown in 149 patients (55 %). Tumour size, depth of invasion, presence of lymph node metastasis, positive {sup 18}F-FDG uptake and SUV{sub max} were significantly associated with tumour recurrence in univariate analysis, while only depth of invasion, positive {sup 18}F-FDG uptake and SUV{sub max} had significance in multivariate analysis. The 24-month recurrence-free survival rate was significantly higher in patients with negative {sup 18}F-FDG uptake (95 %) than in those with positive {sup 18}F-FDG uptake (74 %; p < 0.0001). In subgroup analysis, {sup 18}F-FDG uptake was a significant prognostic factor in patients with tubular adenocarcinoma (p = 0.003) or poorly differentiated adenocarcinoma (p = 0.0001). However, only marginal significance was shown in patients with signet-ring cell carcinoma and mucinous carcinoma (p = 0.05). {sup 18}F-FDG uptake of gastric cancer is an independent and significant prognostic factor for tumour recurrence. {sup 18}F-FDG PET/CT could provide effective information on the

  5. Abdominoperineal Resection, Pelvic Exenteration, and Additional Organ Resection Increase the Risk of Surgical Site Infection after Elective Colorectal Surgery: An American College of Surgeons National Surgical Quality Improvement Program Analysis.

    Science.gov (United States)

    Kwaan, Mary R; Melton, Genevieve B; Madoff, Robert D; Chipman, Jeffrey G

    2015-12-01

    Determining predictors of surgical site infection (SSI) in a large cohort is important for the design of accurate SSI surveillance programs. We hypothesized that additional organ resection and pelvic exenterative procedures are associated independently with a higher risk of SSI. Patients in the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®; American College of Surgeons, Chicago, IL) database (2005-2012) were identified (n=112,282). Surgical site infection (superficial or deep SSI) at 30 d was the primary outcome. Using primary and secondary CPT® codes (American Medical Association, Chicago, IL) pelvic exenteration was defined and additional organ resection was defined as: bladder resection/repair, hysterectomy, partial vaginectomy, additional segmental colectomy, small bowel, gastric, or diaphragm resection. Univariable analysis of patient and procedure factors identified significant (p40 (OR: 2.51), pulmonary comorbidities (OR: 1.22), smoking (OR: 1.24), bowel obstruction (OR: 1.40), wound classification 3 or 4 (OR: 1.18), and abdominoperineal resection (OR: 1.58). Laparoscopic or laparoscopically assisted procedures offered a protective effect against incision infection (OR: 0.55). Additional organ resection (OR: 1.08) was also associated independently with SSI, but the magnitude of the effect was decreased after accounting for operative duration. In the analysis that excludes operative duration, pelvic exenteration is associated with SSI (OR: 1.38), but incorporating operative duration into the model results in this variable becoming non-significant. In addition to other factors, obesity, surgery for bowel obstruction, abdominoperineal resection, and additional organ resection are independently associated with a higher risk of SSI. Surgical site infection risk in pelvic exenteration and multiple organ resection cases appears to be mediated by prolonged operative duration. In these established high-risk sub-groups of

  6. Surgical resection of synchronous and metachronous lung and liver metastases of colorectal cancers

    Science.gov (United States)

    Jeong, Shinseok; Park, Jin Young; Choi, Dong Wook; Choi, Seong Ho

    2017-01-01

    Purpose Surgical resection of isolated hepatic or pulmonary metastases of colorectal cancer is an established procedure, with a 5-year survival rate of about 50%. However, the role of surgical resections in patients with both hepatic and pulmonary metastases is not well established. We aimed to analyze overall survival of these patients and associated factors. Methods Data retrospectively collected from 66 patients who underwent both hepatic and pulmonary metastasectomy after colorectal cancer surgery from August 2002 through August 2013 were analyzed. In univariate analysis, the log-rank test compared patient survival between groups. P < 0.1 was considered indicative of significance. Multivariate analysis of the significance data using a Cox proportional hazard model identified factors associated with overall survival. The synchronous group (n = 57) was defined as patients who had metastasectomy within 3 months from primary colorectal cancer surgery. The remaining nine patients constituted the metachronous group. Results Median follow-up was 126 months from the primary colorectal cancer surgery. The 5-year survival was 73.4%. There was no difference in overall survival between the synchronous and metachronous groups, consistent with previous studies. Distribution (involving one hemiliver or both, P = 0.010 in multivariate analysis) of liver metastases and multiplicity of the pulmonary metastasis (P = 0.039) were predictors of poor prognosis. Conclusion Sequential or simultaneous resection of both hepatic and pulmonary metastasis of colorectal cancer resulted in good long-term survival in selected patients. Thus, an aggressive surgical approach and multidisciplinary decision making with surgeons seems to be justified. PMID:28203555

  7. Imaging of limb salvage surgery and pelvic reconstruction following resection of malignant bone tumours

    Energy Technology Data Exchange (ETDEWEB)

    Tan, Tien Jin, E-mail: tien_jin_tan@cgh.com.sg [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada); Aljefri, Ahmad M. [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada); Clarkson, Paul W.; Masri, Bassam A. [Department of Orthopaedics, University of British Columbia, Vancouver, BC (Canada); Ouellette, Hugue A.; Munk, Peter L.; Mallinson, Paul I. [Department of Radiology, Vancouver General Hospital, Vancouver, BC (Canada)

    2015-09-15

    Highlights: • Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. • The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. • This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases. • By being aware of the various types of reconstructive techniques used in limb salvage surgery as well as the potential complications, the reporting radiologist should possess greater confidence in making an accurate assessment of the expected post-operative imaging findings in the management of such cases. - Abstract: Advances in reconstructive orthopaedic techniques now allow for limb salvage and prosthetic reconstruction procedures to be performed on patients who would otherwise be required to undergo debilitating limb amputations for malignant bone tumours. The resulting post-operative imaging of such cases can be daunting for the radiologist to interpret, particularly in the presence of distorted anatomy and unfamiliar hardware. This article reviews the indications for limb salvage surgery, prosthetic reconstruction devices involved, expected post-operative imaging findings, as well as the potential hardware related complications that may be encountered in the management of such cases.

  8. Surgical resection of a solitary para-aortic lymph node metastasis from hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Junji Ueda; Hiroshi Yoshida; Yasuhiro Mamada; Nobuhiko Taniai; Sho Mineta; Masato Yoshioka; Youichi Kawano

    2012-01-01

    Lymph node (LN) metastases from hepatocellular carcinoma (HCC) are considered uncommon.We describe the surgical resection of a solitary para-aortic LN metastasis from HCC.A 65-year-old Japanese man with B-type liver cirrhosis was admitted for the evaluation of a liver tumor.He had already undergone radiofrequency ablation,transcatheter arterial chemoemboliza tion,and percutaneous ethanol injection therapy for HCC.Despite treatment,viable regions remained in segments 4 and 8.We performed a right paramedian sectionectomy with partial resection of the left paramedian section of the liver.Six months later,serum concentrations of alpha-fetoprotein (189 ng/mL) and PIVKA-2 (507 mAU/mL) increased.Enhanced computed tomography of the abdomen revealed a tumor (20 mm in diameter) on the right side of the abdominal aorta.Fluorine-18 fluorodeoxyglucose positron emission tomography revealed an increased standard uptake value.There was no evidence of recurrence in other regions.Esophagogastroduodenoscopy and colonoscopy revealed no malignant tumor in the gastrointestinal tract.Para-aortic LN metastasis from HCC was thus diagnosed.We performed lymphadenectomy.Histopathological examination revealed that the tumor was largely necrotic,with poorly differentiated HCC on its surface,which confirmed the suspected diagnosis.After 6 mo tumor marker levels were normal,with no evidence of recurrence.Our experience suggests that a solitary para-aortic LN metastasis from HCC can be treated surgically.

  9. Efficacy of surgical resection in management of isolated extrahepatic metastases of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Kun-Ming Chan; Ming-Chin Yu; Ting-Jung Wu; Chen-Fang Lee; Tse-Ching Chen; Wei-Chen Lee; Miin-Fu Chen

    2009-01-01

    AIM: To clarify the benefit of surgical excision for patients with extrahepatic metastases of hepatocellular carcinoma (HCC).METHODS: We retrospectively reviewed the medical records of 140 patients with pathologically proven extrahepatic metastases of HCC and evaluated the outcomes of those who had undergone surgical resection (SR) for extrahepatic metastatic lesions.Prognoses made on the basis of extrahepatic metastatic sites were also examined.RESULTS: The survival rates of patients who underwent SR of extrahepatic metastases were significantly better than those of patients who did not receive SR.For the SR group, 1- and 3-year survival rates were 24% and 7%, respectively, while for the non-resection group, the survival rates were 8% and 0%, respectively ( P < 0.0001).Survival rates related to metastatic sites were also significantly superior after SR of extrahepatic metastases: median survivals were 32 mo with lung metastasis, 10 mo with bone metastasis, 6.1 mo with brain metastasis.CONCLUSION: SR can provide survival benefits for patients with 1 or 2 isolated extrahepatic metastases and who concurrently exhibit good hepatic functional reserve and general performance status as well as successful treatment of intrahepatic HCC.

  10. Complications of resection and reconstruction in giant cell tumour of distal end of radius - An analysis

    Directory of Open Access Journals (Sweden)

    Saraf S

    2005-01-01

    Full Text Available Background: The bulk of literature on the subject focuses on the resection of the tumor followed by reconstruction using autologous fibula, however, papers analyzing the failures of this procedure are scanty. The aim is to analyze the various factors responsible for the failures. Methods: Study included 42 patients of aggressive GCT of distal radius, resected and reconstructed using nonvascularised autologous fibula. Host graft junction was fixed using screws (6, intramedullary nail (21 and plate (15. The minimum follow-up was 2 years or till a complication occurred requiring second surgery. Result: The major complications were recurrence in 6 cases (spillage of tumor tissue in 3, poor biopsy site 2, recurrence along the nail tract one case; failure of host graft union in 8 cases due to inadequate contact at host graft junction, poor implant selection, inadequate immobilization and infection; significant instability at wrist in 6 cases due to poor stabilization at carpo fibular junction in addition to inherent instability due to poor congruity between fibulocarpal articulations. Conclusion: Reconstruction of distal end of radius using auto fibula has much higher complication rates than usually believed. A meticulous planning and its execution is must to minimize the problems. Use of dynamic plate for host graft junction and fixation of fibular head to adjacent ulna/carpal bones improves the results.

  11. Factors associated with seizure freedom in the surgical resection of glioneuronal tumors.

    Science.gov (United States)

    Englot, Dario J; Berger, Mitchel S; Barbaro, Nicholas M; Chang, Edward F

    2012-01-01

    Gangliogliomas (GGs) and dysembryoplastic neuroepithelial tumors (DNETs) are low-grade brain tumors of glioneuronal origin that commonly present with seizures. Achieving seizure control in patients with glioneuronal tumors remains underappreciated, as tumor-related epilepsy significantly affects patients' quality-of-life. We performed a quantitative and comprehensive systematic literature review of seizure outcomes after surgical resection of GGs and DNETs associated with seizures. We evaluated 910 patients from 39 studies, and stratified outcomes according to several potential prognostic variables. Overall, 80% of patients were seizure-free after surgery (Engel class I), whereas 20% continued to have seizures (Engel class II-IV). We observed significantly higher rates of seizure-freedom in patients with ≤1 year duration of epilepsy compared to those with >1 year of seizures [odds ratio (OR) 9.48; 95% confidence interval (CI) 2.26-39.66], and with gross-total resection over subtotal lesionectomy (OR 5.34; 95% CI 3.61-7.89). In addition, the presence of secondarily generalized seizures preoperatively predicted a lower rate of seizure-freedom after surgery (OR 0.40; 95% CI 0.24-0.66). Outcomes did not differ significantly between adults and children, patients with temporal lobe versus extratemporal tumors, pathologic diagnosis of GG versus DNET, medically controlled versus refractory seizures, or with the use of electrocorticography (ECoG). Extended resection of temporal lobe tumors, with hippocampectomy and/or corticectomy, conferred additional benefit. These results suggest that early operative intervention and gross-total resection are critically important factors in achieving seizure-freedom, and thus improving quality-of-life, in patients with glioneuronal tumors causing epilepsy. Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.

  12. GPU-based RFA simulation for minimally invasive cancer treatment of liver tumours

    NARCIS (Netherlands)

    Mariappan, P.; Weir, P.; Flanagan, R.; Voglreiter, P.; Alhonnoro, T.; Pollari, M.; Moche, M.; Busse, H.; Futterer, J.J.; Portugaller, H.R.; Sequeiros, R.B.; Kolesnik, M.

    2017-01-01

    PURPOSE: Radiofrequency ablation (RFA) is one of the most popular and well-standardized minimally invasive cancer treatments (MICT) for liver tumours, employed where surgical resection has been contraindicated. Less-experienced interventional radiologists (IRs) require an appropriate planning tool

  13. Recurrent rhinosporidiosis: coblation assisted surgical resection-a novel approach in management.

    Science.gov (United States)

    Khan, Iram; Gogia, Shweta; Agarwal, Alok; Swaroop, Ajay

    2014-01-01

    Recurrent rhinosporidiosis is a chronic granulomatous disease with a known tendency to reoccur. Coblation EVAC 70 is a novel surgical tool which seems to provide excellent option in management of this notorious disease. We present an interesting case and the innovative approach in its management, using Coblation system. Introduction. Rhinosporidiosis seeberi causes a chronic granulomatous disease of upper airway, usually involving the nose and nasopharynx, and has a notorious tendency to reoccur. The current line of management is surgical excision of the lesion along with cauterization of the base, which does not prevent reoccurrence of the disease. Case Presentation. A 65-year-old male resident of rural India reported a history of breathing difficulty and change in voice. Patient is a Hindu priest by profession, who according to their rituals has to take bath in local pond or river. Conclusion. Rhinosporidiosis is a difficult to treat pathology due to its tendency to reoccur. Till date the management of the disease is far from satisfactory. Coblation system which has already found its roots in otorhinolaryngology can be used as a novel tool in surgical resection of recurrent rhinosporidiosis and has added advantage of low temperature dissection along with clear surgical field due to constant suctioning.

  14. Impact of medical therapy on patients with Crohn’s disease requiring surgical resection

    Science.gov (United States)

    Fu, YT Nancy; Hong, Thomas; Round, Andrew; Bressler, Brian

    2014-01-01

    AIM: To evaluate the impact of medical therapy on Crohn’s disease patients undergoing their first surgical resection. METHODS: We retrospectively evaluated all patients with Crohn’s disease undergoing their first surgical resection between years 1995 to 2000 and 2005 to 2010 at a tertiary academic hospital (St. Paul’s Hospital, Vancouver, Canada). Patients were identified from hospital administrative database using the International Classification of Diseases 9 codes. Patients’ hospital and available outpatient clinic records were independently reviewed and pertinent data were extracted. We explored relationships among time from disease diagnosis to surgery, patient phenotypes, medication usage, length of small bowel resected, surgical complications, and duration of hospital stay. RESULTS: Total of 199 patients were included; 85 from years 1995 to 2000 (cohort A) and 114 from years 2005 to 2010 (cohort B). Compared to cohort A, cohort B had more patients on immunomodulators (cohort A vs cohort B: 21.4% vs 56.1%, P < 0.0001) and less patients on 5-aminosalysilic acid (53.6% vs 29.8%, P = 0.001). There was a shift from inflammatory to stricturing and penetrating phenotypes (B1/B2/B3 38.8% vs 12.3%, 31.8% vs 45.6%, 29.4% vs 42.1%, P < 0.0001). Both groups had similar median time to surgery. Within cohort B, 38 patients (33.3%) received anti-tumor necrosis factor (TNF) agent. No patient in cohort A was exposed to anti-TNF agent. Compared to patients not on anti-TNF agent, ones exposed were younger at diagnosis (anti-TNF vs without anti-TNF: A1/A2/A3 39.5% vs 11.8%, 50% vs 73.7%, 10.5% vs 14.5%, P = 0.003) and had longer median time to surgery (90 mo vs 48 mo, P = 0.02). Combination therapy further extended median time to surgery. Using time-dependent multivariate Cox proportional hazard model, patients who were treated with anti-TNF agents had a significantly higher risk to surgery (adjusted hazard ratio 3.57, 95%CI: 1.98-6.44, P < 0.0001) compared to those

  15. Relationship of coagulation test abnormalities to tumour burden and postoperative DVT in resected colorectal cancer.

    Science.gov (United States)

    Iversen, L H; Thorlacius-Ussing, O

    2002-03-01

    In a prospective study, coagulation test results were compared in 137 patients with colorectal cancer (CRC) and 39 subjects with benign colorectal diseases. Prothrombin fragment 1+2 (F1+2), thrombin-antithrombin complex (TAT), and soluble fibrin (SF) were measured in plasma before and after surgery. CRC patients presented with significantly higher values of F1+2 and TAT than controls. Patients with localised CRC had elevated values of F1+2 and TAT, whereas patients with advanced CRC also had elevated SF values. TAT and SF levels correlated with tumour spread, and normal values virtually excluded advanced cancer. Postoperative deep venous thrombosis (DVT) was diagnosed by phlebography in 20% of the CRC patients. Preoperative values of the markers did not predict postoperative DVT, but postoperative values did.

  16. Intraoperative 3-tesla MRI in the management of paediatric cranial tumours - initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Avula, Shivaram; Garlick, Deborah; Abernethy, Laurence J. [Alder Hey Children' s NHS Foundation Trust, Department of Radiology, Liverpool (United Kingdom); Mallucci, Connor L. [Alder Hey Children' s Hospital, Department of Neurosurgery, Liverpool (United Kingdom); Pizer, Barry [Alder Hey Children' s Hospital, Department of Oncology, Liverpool (United Kingdom); Crooks, Daniel [Walton Centre for Neurology and Neurosurgery, Department of Pathology, Liverpool (United Kingdom)

    2012-02-15

    Intraoperative MRI (ioMRI) has been gaining recognition because of its value in the neurosurgical management of cranial tumours. There is limited documentation of its value in children. To review the initial experience of a paediatric 3-Tesla ioMRI unit in the management of cranial tumours. Thirty-eight children underwent ioMRI during 40 cranial tumour resections using a 3-Tesla MR scanner co-located with the neurosurgical operating theatre. IoMRI was performed to assess the extent of tumour resection and/or to update neuronavigation. The intraoperative and follow-up scans, and the clinical records were reviewed. In 27/40 operations, complete resection was intended. IoMRI confirmed complete resection in 15/27 (56%). As a consequence, surgical resection was extended in 5/27 (19%). In 6/27 (22%), ioMRI was equivocal for residual tumour. In 13/40 (33%) operations, the surgical aim was to partially resect the tumour. In 7 of the 13 (54%), surgical resection was extended following ioMRI. In our initial experience, ioMRI has increased the rate of complete resection, with intraoperative surgical strategy being modified in 30% of procedures. Collaborative analysis of ioMRI by the radiologist and neurosurgeon is vital to avoid errors in interpretation. (orig.)

  17. Complete Resection of Ampullary Paragangliomas Confined to the Submucosa on Endoscopic Ultrasound May Be Best Achieved by Radical Surgical Resection

    Directory of Open Access Journals (Sweden)

    Kevin A. Ghassemi

    2009-06-01

    Full Text Available Paragangliomas of the gastrointestinal tract generally are benign tumors usually found in the second portion of the duodenum. We present a case of paraganglioma of the ampulla of Vater confined to the submucosa on endoscopic ultrasound examination. This was initially treated by endoscopic resection, followed by pancreaticoduodenectomy after local resection margins were positive. Histopathology showed a well-differentiated ampullary paraganglioma confined to the submucosa, but with involvement of one regional lymph node. Only 25 prior cases of paraganglioma at the ampulla of Vater have been reported, and nine of these have demonstrated local or distant metastases. Because of their malignant potential, ampullary paragangliomas should be treated with radical resection if the goal is to achieve complete resection, even if preoperative imaging shows local confinement.

  18. Myofibroblastic tumor causing severe neonatal distress. Successful surgical resection after embolization.

    Science.gov (United States)

    Castañón, Montserrat; Saura, Laura; Weller, Santiago; Prat, Jordi; Thio, Marta; Sorolla, Juan P; Albert, Asteria; Morales, Lluís

    2005-06-01

    This report describes a case of a term male 3.1 kg, normal delivery, 38 weeks of gestation with a record of hydramnios by prenatal sonography. He had fetal acute suffering and respiratory distress. The first radiographic study showed a mass filling the whole left thorax cage causing erosion of the inferior edge of the third rib. The mediastinum was displaced to the right. Computed tomography scan confirmed a homogeneous tumor that filled the left thorax and displaced the mediastinum to the right without invasion. Surgical biopsy informed of a highly vascularized mesenchymal tumor. The tumor was embolized with Ivalon microparticles obtaining a nearly avascular mass. Complete surgical excision was made, including the whole mass and costal segments. Microscopically, it was an inflammatory myofibroblastic tumor. It was composed mainly of spindle-shaped cells without malignant features. On immunohistochemistry, the tumor showed positive staining for vimentin, whereas antidesmin antibodies and S-100 protein were negative. The aim of this article is to present an extremely uncommon case of neonatal distress caused by an intrathoracic, extrapulmonary myofibroblastic tumor. Complete surgical resection was possible after embolization.

  19. Android application for determining surgical variables in brain-tumor resection procedures.

    Science.gov (United States)

    Vijayan, Rohan C; Thompson, Reid C; Chambless, Lola B; Morone, Peter J; He, Le; Clements, Logan W; Griesenauer, Rebekah H; Kang, Hakmook; Miga, Michael I

    2017-01-01

    The fidelity of image-guided neurosurgical procedures is often compromised due to the mechanical deformations that occur during surgery. In recent work, a framework was developed to predict the extent of this brain shift in brain-tumor resection procedures. The approach uses preoperatively determined surgical variables to predict brain shift and then subsequently corrects the patient's preoperative image volume to more closely match the intraoperative state of the patient's brain. However, a clinical workflow difficulty with the execution of this framework is the preoperative acquisition of surgical variables. To simplify and expedite this process, an Android, Java-based application was developed for tablets to provide neurosurgeons with the ability to manipulate three-dimensional models of the patient's neuroanatomy and determine an expected head orientation, craniotomy size and location, and trajectory to be taken into the tumor. These variables can then be exported for use as inputs to the biomechanical model associated with the correction framework. A multisurgeon, multicase mock trial was conducted to compare the accuracy of the virtual plan to that of a mock physical surgery. It was concluded that the Android application was an accurate, efficient, and timely method for planning surgical variables.

  20. Indications for surgical resection of benign pancreatic tumors; Indikationen zur chirurgischen Therapie benigner Pankreastumoren

    Energy Technology Data Exchange (ETDEWEB)

    Isenmann, R.; Henne-Bruns, D. [Chirurgische Universitaetsklinik, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Ulm (Germany)

    2008-08-15

    Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification. Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential. (orig.) [German] Die Indikationsstellung zur Resektion benigner Pankreastumoren ist gegeben, wenn es sich um einen symptomatischen Tumor handelt oder - bei einem Zufallsbefund - um einen Tumor mit Potenzial zur malignen Entartung. Dies besteht bei der Mehrzahl der benignen Pankreastumoren, insbesondere bei der intraduktalen papillaeren muzinoesen Neoplasie (IPMN) oder muzinoesen Zystadenomen. Operativer Abklaerung beduerfen auch Tumoren, die unter Ausschoepfung aller diagnostischer Moeglichkeiten nicht eindeutig klassifizierbar sind. An chirurgischen Therapieverfahren stehen verschiedene Techniken zur Verfuegung. Die Wahl des Verfahren haengt von der Groesse und Lokalisation des Tumors ab und von der Frage, ob eine maligne Entartung bereits stattgefunden hat. Das onkologisch korrekte Standardresektionsverfahren bei Tumoren des Pankreaskopfes ist die partielle Duodenopankreatektomie, bei Tumoren des Pankreasschwanzes die Pankreaslinksresektion. Eine segmentale Resektion des

  1. Predictors of Wound Complications following Radiation and Surgical Resection of Soft Tissue Sarcomas

    Directory of Open Access Journals (Sweden)

    Drake G. LeBrun

    2017-01-01

    Full Text Available Wound complications represent a major source of morbidity in patients undergoing radiation therapy (RT and surgical resection of soft tissue sarcomas (STS. We investigated whether factors related to RT, surgery, patient comorbidities, and tumor histopathology predict the development of wound complications. An observational study of patients who underwent STS resection and RT was performed. The primary outcome was the occurrence of any wound complication up to four months postoperatively. Significant predictors of wound complications were identified using multivariable logistic regression. Sixty-five patients representing 67 cases of STS were identified. Median age was 59 years (range 22–90 and 34 (52% patients were female. The rates of major wound complications and any wound complications were 21% and 33%, respectively. After adjusting for radiation timing, diabetes (OR 9.6; 95% CI 1.4–64.8; P=0.02, grade ≥2 radiation dermatitis (OR 4.8; 95% CI 1.2–19.2; P=0.03, and the use of 3D conformal RT (OR 4.6; 95% CI 1.1–20.0; P=0.04 were associated with an increased risk of any wound complication on multivariable analysis. These data suggest that radiation dermatitis and radiation modality are predictors of wound complications in patients with STS.

  2. Prevalence of the CTNNB1 mutation genotype in surgically resected fibromatosis of the breast.

    Science.gov (United States)

    Kim, Taeeun; Jung, Eun Ah; Song, Ji Young; Roh, Ji Hyeon; Choi, Jong Sun; Kwon, Jee Eun; Kang, So Young; Cho, Eun Yoon; Shin, Jung Hee; Nam, Suk-Jin; Yang, Jung Hyun; Choi, Yoon-La

    2012-01-01

    To investigate CTNNB1 mutation and β-catenin expression in resected breast fibromatosis and to identify potential molecular markers of fibromatosis of the breast. We selected 12 patients with fibromatosis of the breast who underwent surgical resection and were confirmed by histological examination. Ultrasonography findings for 10 patients were reviewed and only two cases were suspicious for fibromatosis on imaging. On core needle biopsy for pre-operative diagnoses, only three cases were histologically suspicious for fibromatosis. Mutations in exon 3 of CTNNB1 were detected by direct DNA sequencing in nine (75.0%) cases: all were c.121G>A (p.T41A), which was much more frequent in breast fibromatoses than in other soft tissue lesions. Nuclear β-catenin expression was observed in all cases and the level of expression was higher in cases with mutation. In eight of nine cases, the matched biopsy specimen showed the same CTNNB1 mutation status as the pre-operative specimen. In the majority of cases, clinical presentation and breast imaging are highly suspicious for carcinoma. Definitive pre-operative pathological diagnosis by core needle biopsy is difficult. CTNNB1 mutation and nuclear β-catenin expression are frequently detected in sporadic breast fibromatoses, suggesting their potential as a useful tool to distinguish breast fibromatoses from other neoplasms. © 2011 Blackwell Publishing Limited.

  3. Raman microscopy in the diagnosis and prognosis of surgically resected nonsmall cell lung cancer

    Science.gov (United States)

    Magee, Nicholas David; Beattie, James Renwick; Carland, Chris; Davis, Richard; McManus, Kieran; Bradbury, Ian; Fennell, Dean Andrew; Hamilton, Peter William; Ennis, Madeleine; McGarvey, John Joseph; Elborn, Joseph Stuart

    2010-03-01

    The main curative therapy for patients with nonsmall cell lung cancer is surgery. Despite this, the survival rate is only 50%, therefore it is important to more efficiently diagnose and predict prognosis for lung cancer patients. Raman spectroscopy is useful in the diagnosis of malignant and premalignant lesions. The aim of this study is to investigate the ability of Raman microscopy to diagnose lung cancer from surgically resected tissue sections, and predict the prognosis of these patients. Tumor tissue sections from curative resections are mapped by Raman microscopy and the spectra analzsed using multivariate techniques. Spectra from the tumor samples are also compared with their outcome data to define their prognostic significance. Using principal component analysis and random forest classification, Raman microscopy differentiates malignant from normal lung tissue. Principal component analysis of 34 tumor spectra predicts early postoperative cancer recurrence with a sensitivity of 73% and specificity of 74%. Spectral analysis reveals elevated porphyrin levels in the normal samples and more DNA in the tumor samples. Raman microscopy can be a useful technique for the diagnosis and prognosis of lung cancer patients receiving surgery, and for elucidating the biochemical properties of lung tumors.

  4. Primary malignant pericardial mesothelioma with increased serum mesothelin diagnosed by surgical pericardial resection: A case report.

    Science.gov (United States)

    Kurosawa, Takeyuki; Sugino, Keishi; Isobe, Kazutoshi; Hata, Yoshinobu; Fukasawa, Yuri; Homma, Sakae

    2016-11-01

    A 37-year-old female smoker without a history of exposure to asbestos was referred to our hospital with persistent pericardial effusion. Chest computed tomography imaging examination revealed an irregular thickened pericardium with large amounts of pericardial effusion and a small pleural effusion. Fluorodeoxyglucose (FDG) positron emission tomography imaging demonstrated intrapericardial FDG accumulation. Blood tests revealed an increase in serum mesothelin levels. Examination of a surgically resected specimen revealed a grayish-white thickening of the pericardium, with a straw-colored mucinous pericardial effusion. Histopathological examination confirmed the diagnosis of epithelioid malignant mesothelioma. Although the patient's condition temporarily improved, with decreased levels of serum mesothelin during chemotherapy with carboplatin and pemetrexed, she succumbed to cardiac tamponade 18 months after the initial onset of the symptoms. Primary malignant pericardial mesothelioma (PMPM) is an extremely rare and refractory disorder. Thus, an early definitive diagnosis and timely treatment are crucial for the management of PMPM.

  5. Concurrent chemoradiotherapy for patients with postoperative recurrence of surgically resected non-small-cell lung cancer.

    Science.gov (United States)

    Takenaka, Tomoyoshi; Takenoyama, Mitsuhiro; Toyozawa, Ryo; Inamasu, Eiko; Yoshida, Tsukihisa; Toyokawa, Gouji; Shiraishi, Yoshimasa; Hirai, Fumihiko; Yamaguchi, Masafumi; Seto, Takashi; Ichinose, Yukito

    2015-01-01

    A few reports have evaluated the outcomes of concurrent chemoradiotherapy (CRT) for patients with postoperative recurrence of non-small cell lung cancer (NSCLC). From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of those, 280 patients had experienced postoperative recurrence by the end of 2012. Thirty-five patients received concurrent CRT as initial treatment of the recurrent disease. We retrospectively reviewed these cases, analyzed the outcomes of concurrent CRT after surgical resection, and examined the factors that predict long-term postrecurrence survival. The most common sites of recurrence in this cohort were the lymph nodes in 24 patients, followed by the lung in 5 patients and bone in 6 patients. The median radiation dose given as the initial treatment of recurrence was 60 Gy (range, 30-60 Gy). Chemotherapy included a platinum agent in all cases; cisplatin-based chemotherapy was administered in 23 cases, and a carboplatin-based chemotherapy regimen was administered in 12. The median progression-free and postrecurrence survival after CRT was 13 months (range, 4-127 months) and 31 months (range, 5-127 months), respectively. Seven patients were still alive without evidence of disease for > 3 years after the recurrence diagnosis. The ECOG performance status (PS), surgical procedure, and types of platinum agents used were independent prognostic factors for postrecurrence survival. Concurrent CRT for recurrent NSCLC is a promising therapy for selected patients. A poor PS and postpneumonectomy state were poor prognostic factors for patients who received concurrent CRT. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. A Phase 2 Trial of Stereotactic Radiosurgery Boost After Surgical Resection for Brain Metastases

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    Brennan, Cameron [Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yang, T. Jonathan [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hilden, Patrick; Zhang, Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Kelvin; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Chan, Timothy A. [Human Oncology and Pathogenesis Program, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lymberis, Stella C. [Department of Radiation Oncology, New York University Langone Medical Center, New York, New York (United States); Narayana, Ashwatha [Department of Radiation Oncology, Greenwich Hospital, Greenwich, Connecticut (United States); Tabar, Viviane; Gutin, Philip H. [Department of Neurosurgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Ballangrud, Åse [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Lis, Eric [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Beal, Kathryn, E-mail: BealK@MSKCC.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-01-01

    Purpose: To evaluate local control after surgical resection and postoperative stereotactic radiosurgery (SRS) for brain metastases. Methods and Materials: A total of 49 patients (50 lesions) were enrolled and available for analysis. Eligibility criteria included histologically confirmed malignancy with 1 or 2 intraparenchymal brain metastases, age ≥18 years, and Karnofsky performance status (KPS) ≥70. A Cox proportional hazard regression model was used to test for significant associations between clinical factors and overall survival (OS). Competing risks regression models, as well as cumulative incidence functions, were fit using the method of Fine and Gray to assess the association between clinical factors and both local failure (LF; recurrence within surgical cavity or SRS target), and regional failure (RF; intracranial metastasis outside of treated volume). Results: The median follow-up was 12.0 months (range, 1.0-94.1 months). After surgical resection, 39 patients with 40 lesions were treated a median of 31 days (range, 7-56 days) later with SRS to the surgical bed to a median dose of 1800 cGy (range, 1500-2200 cGy). Of the 50 lesions, 15 (30%) demonstrated LF after surgery. The cumulative LF and RF rates were 22% and 44% at 12 months. Patients who went on to receive SRS had a significantly lower incidence of LF (P=.008). Other factors associated with improved local control include non-small cell lung cancer histology (P=.048), tumor diameter <3 cm (P=.010), and deep parenchymal tumors (P=.036). Large tumors (≥3 cm) with superficial dural/pial involvement showed the highest risk for LF (53.3% at 12 months). Large superficial lesions treated with SRS had a 54.5% LF. Infratentorial lesions were associated with a higher risk of developing RF compared to supratentorial lesions (P<.001). Conclusions: Postoperative SRS is associated with high rates of local control, especially for deep brain metastases <3 cm. Tumors ≥3 cm with superficial dural

  7. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease.

    Science.gov (United States)

    Rosenbaum, Daniel G; Conrad, Maire A; Biko, David M; Ruchelli, Eduardo D; Kelsen, Judith R; Anupindi, Sudha A

    2017-01-01

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the

  8. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease

    Energy Technology Data Exchange (ETDEWEB)

    Rosenbaum, Daniel G. [NewYork-Presbyterian Hospital/Weill Cornell Medicine, Division of Pediatric Radiology, New York, NY (United States); Conrad, Maire A.; Kelsen, Judith R. [The Children' s Hospital of Philadelphia, Division of Gastroenterology, Hepatology and Nutrition, Philadelphia, PA (United States); Biko, David M.; Anupindi, Sudha A. [The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Ruchelli, Eduardo D. [The Children' s Hospital of Philadelphia, Division of Anatomic Pathology, Philadelphia, PA (United States)

    2017-01-15

    Imaging predictors for surgery in children with Crohn disease are lacking. To identify imaging features of the terminal ileum on short-interval bowel ultrasound (US) and MR enterography (MRE) in children with Crohn disease requiring surgical bowel resection and those managed by medical therapy alone. This retrospective study evaluated patients 18 years and younger with Crohn disease undergoing short-interval bowel US and MRE (within 2 months of one another), as well as subsequent ileocecectomy or endoscopy within 3 months of imaging. Appearance of the terminal ileum on both modalities was compared between surgical patients and those managed with medical therapy, with the following parameters assessed: bowel wall thickness, mural stratification, vascularity, fibrofatty proliferation, abscess, fistula and stricture on bowel US; bowel wall thickness, T2 ratio, enhancement pattern, mesenteric edema, fibrofatty proliferation, abscess, fistula and stricture on MRE. A two-sided t-test was used to compare means, a Mann-Whitney U analysis was used for non-parametric parameter scores, and a chi-square or two-sided Fisher exact test compared categorical variables. Imaging findings in surgical patients were correlated with location-matched histopathological scores of inflammation and fibrosis using a scoring system adapted from the Simple Endoscopic Score for Crohn Disease, and a Spearman rank correlation coefficient was used to compare inflammation and fibrosis on histopathology. Twenty-two surgical patients (mean age: 16.5 years; male/female: 13/9) and 20 nonsurgical patients (mean age: 14.8; M/F: 8/12) were included in the final analysis. On US, the surgical group demonstrated significantly increased mean bowel wall thickness (6.1 mm vs. 4.7 mm for the nonsurgical group; P = 0.01), loss of mural stratification (odds ratio [OR] = 6.3; 95% confidence interval [CI]: 1.4-28.4; P = 0.02) and increased fibrofatty proliferation (P = 0.04). On MRE, the surgical group showed

  9. [Surgical treatment of ptosis by resection of the superior tarsal muscle employing a cutaneous approach (author's transl)].

    Science.gov (United States)

    Morax, S

    1982-01-01

    A simple technique for resection of the superior tarsal muscle through a cutaneous approach, for the surgical treatment of ptosis, was employed in severe or moderate, congenital and acquired forms of the affection. Muller's muscle and the aponeurotic fascia are removed in a single piece, while conserving the tarsus.

  10. Multidisciplinary Management of a Giant Plexiform Neurofibroma by Double Sequential Preoperative Embolization and Surgical Resection

    Directory of Open Access Journals (Sweden)

    Roberto Vélez

    2013-01-01

    Full Text Available Plexiform neurofibromas are benign tumors originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. Giant neurofibromas are very difficult to manage surgically as they are extensively infiltrative and highly vascularized. These types of lesions require complex preoperative and postoperative management strategies. This case report describes a 22-year-old female with a giant plexiform neurofibroma of the lower back and buttock who underwent pre-operative embolization and intraoperative use of a linear cutting stapler system to assist with haemostasis during the surgical resection. Minimal blood transfusion was required and the patient made a good recovery. This case describes how a multidisciplinary management of these large and challenging lesions is technically feasible and appears to be beneficial in reducing perioperative blood loss and morbidity. Giant neurofibroma is a poorly defined term used to describe a neurofibroma that has grown to a significant but undefined size. Through a literature review, we propose that the term “giant neurofibroma” be used for referring to those neurofibromas weighing 20% or more of the patient's total corporal weight.

  11. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    Science.gov (United States)

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach.

  12. Surgical resection and vascularized bone reconstruction in advanced stage medication-related osteonecrosis of the jaw.

    Science.gov (United States)

    Caldroney, S; Ghazali, N; Dyalram, D; Lubek, J E

    2017-07-01

    A retrospective review of all patients with stage 3 medication-related osteonecrosis of the jaw (MRONJ), treated by surgical resection and immediate vascularized bone reconstruction at a tertiary care medical center, was performed. Eleven patients were included, seven female and four male; their mean age was 65.8 years (range 56-73 years). Mean follow-up was 25 months. Ten patients had received intravenous bisphosphonates. The most common pathology was breast cancer (4/11). Pain (n=8) and pathological fracture (n=7) were the most common presenting symptoms. Microvascular free flaps consisted of seven fibula osteocutaneous flaps and four scapula osteocutaneous free flaps. All patients reported resolution of symptoms, with complete bone union identified radiographically (100%). Complications occurred in three patients (27%). One patient required removal of hardware at 8 months postoperative. Dental implant rehabilitation was completed in two patients. Ten patients are tolerating an oral diet. Ten patients are alive without evidence of MRONJ at any of the surgical sites. One patient died 28 months after surgery from progression of metastatic disease. Advanced MRONJ can be successfully treated in patients using vascularized tissue transfer, including those patients with significant peripheral vascular disease. Dental rehabilitation is a viable option for advanced MRONJ patients treated by vascularized flap reconstruction. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Anaesthetic management in thoracoscopic distal tracheal resection.

    Science.gov (United States)

    Acosta Martínez, J; Beato López, J; Domínguez Blanco, A; López Romero, J L; López Villalobos, J L

    2017-03-01

    Surgical resection of tracheal tumours, especially distal tracheal tumours, is a challenge for the anaesthesiologists involved, mainly due to difficulties in ensuring adequate control of the airway and ventilation. We report the case of a patient undergoing tracheal resection and anastomosis by VATS, emphasizing the anaesthetic management. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Root resection under the surgical field employed for extraction of impacted tooth and management of external resorption

    Directory of Open Access Journals (Sweden)

    A R Vivekananda Pai

    2012-01-01

    Full Text Available This case report illustrates determination of prognosis and immediate resection carried out, before completing the endodontic therapy, during the surgery employed for managing a nonperiodontal problem. This case showed external pressure resorption in the distobuccal root of maxillary second molar caused by the impingement of impacted third molar. Extraction of third molar was decided when healing was not seen, despite initiating endodontic therapy in second molar. Following elevation of flap and extraction of third molar, the poor prognosis due to severe bone loss around the resorbed root was evident. But due to strategic value of second molar, it was found beneficial to employ resection. Therefore, immediate resection was carried out in the same surgical field before the completion of endodontic therapy. This prevented the need for another surgical entry with its associated trauma to carry out resection separately later. Resection followed by the completion of endodontic therapy and full crown assisted in salvaging the remaining functional portion of the tooth and prevented the occurrence of distal extension with its potential drawbacks.

  15. CT-guided localization of small pulmonary nodules using adjacent microcoil implantation prior to video-assisted thoracoscopic surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Su, Tian-Hao; Jin, Long; He, Wen [Capital Medical University, Department of Radiology, Beijing Friendship Hospital, Beijing (China); Fan, Yue-Feng [Xiamen University, Department of Interventional Therapy, The First Affiliated Hospital, Xiamen, Fujian (China); Hu, Li-Bao [Peking University People' s Hospital, Department of Radiology, Beijing (China)

    2015-09-15

    To describe and assess the localization of small peripheral pulmonary nodules prior to video-assisted thoracoscopic surgical (VATS) resection using the implantation of microcoils. Ninety-two patients with 101 pulmonary nodules underwent computed tomography (CT)-guided implantation of microcoils proximal to each nodule. Patients were randomly assigned to undergo entire microcoil or leaving-microcoil-end implantations. The complications and efficacy of the two implantation methods were evaluated. VATS resection of lung tissue containing each pulmonary lesion and microcoil were performed in the direction of the microcoil marker. Histopathological analysis was performed for the resected pulmonary lesions. CT-guided microcoil implantation was successful in 99/101 cases, and the placement of microcoils within 1 cm of the nodules was not disruptive. There was no difference in the complications and efficacy associated with the entire implantation method (performed for 51/99 nodules) versus the leaving-microcoil-end implantation method (performed for 48/99 nodules). All nodules were successfully removed using VATS resection. Asymptomatic pneumothorax occurred in 16 patients and mild pulmonary haemorrhage occurred in nine patients. However, none of these patients required further surgical treatment. Preoperative localization of small pulmonary nodules using a refined percutaneous microcoil implantation method was found to be safe and useful prior to VATS resection. (orig.)

  16. [Surgical treatment of rectal prolapse with transanal resection according to Altemeier. Experience and results].

    Science.gov (United States)

    Carditello, Antonio; Milone, Antonino; Stilo, Francesco; Mollo, Francesco; Basile, Maurizio

    2003-01-01

    In recent years the number of patients with partial or total rectal prolapse has increased. Numerous techniques and surgical approaches have been described for its treatment. In this study we examine the main ones and stress the advantages of the transanal-perineal resection technique according to Altemeier and modified by Prasad, which we have used to treat the condition in the last 15 years. From 1988 to 2002, 269 patients with "haemorrhoidal prolapse" were referred to our department; 146 were females (54%), and the mean age was 58 years. Clinical examination and proctosigmoidoscopy revealed the presence of total rectal prolapse in 41 patients (15%, 32 F, 9 M), complicated in 4 cases by moderate incontinence and associated in 3 cases with post-haemorrhoidectomy stenosis. These 41 patients underwent transanal resection according to Altemeier. Thirty-four of them (83%) were operated on under local anaesthesia with sedation, 5 patients (12%) under peridural anaesthesia and 2 patients (5%) under narcosis. The mean hospital stay was 5 days and depended on the time of the first spontaneous evacuation. Check-ups were performed after 7 days, 1 months and every 3 months for 1 year. There was no postoperative mortality, and only 1 case of postoperative haemorrhage, which did not require reoperation, in a patient with a previous myocardial infarct who spontaneously continued to take salicylates up to 24 h before surgery. Thirty-three patients (80%) had their first postoperative evacuation within 48 h of surgery after taking sorbitol orally in the evening, 6 patients (15%) within 72 h, and 2 patients (5%) on postoperative day 4. No evacuative enemas were performed. We observed clinical healing in all patients 1 month after the operation, and regular, spontaneous evacuations without the use of oral laxatives. Stool or gas incontinence were never observed or reported. During the follow-up, only in 2% of cases did we observe partial recurrence of the prolapse. The choice

  17. Effect of pre-operative neoadjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer: a Meta-analysis

    Directory of Open Access Journals (Sweden)

    Wei ZHU

    2011-08-01

    Full Text Available Objective To explore the effect of pre-operative adjuvant chemo-radiotherapy and surgical treatment on resectable esophageal cancer.Methods By searching Medline,CENTRAL(the Cochrane Central Register of Controlled trials,EMBASE,CBM(China Biology Medicine and CNKI(China National Knowledge Infrastructure by computer,the data of randomized controlled trials(RCTs of neoadjuvant chemoradiotherapy and surgical treatment for resectable esophageal cancer were selected and analyzed using Stata 11.0 statistical software.The study population was patients with resectable early or medium stage esophageal cancer,the intervention was neoadjuvant chemoradiotherapy(include sequential chemoradiotherapy and concurrent chemoradiotherapy followed with surgical resection,the outcome indices were 1-and 3-year survival rates and local recurrence rate.The combined odds ratio(OR,relative risk(RR and their 95% confidence interval(CI were calculated to estimate the results.Results Nine articles including a total of 1156 patients were finally analyzed in the Meta-analysis.Among all the patients,579 received neoadjuvant chemoradiotherapy(study group and 577 received surgical treatment only(control group.Compared the study group and control group,the OR of 1-and 3-year survival rate was 1.06(95%CI=0.94-1.19,Z=0.97,P=0.33 and 1.30(95%CI=1.07.-1.57,Z=2.67,P=0.008,respectively,and the RR of local recurrence rate was 0.75(95%CI=0.50-1.12,Z=1.40,P=0.162.Conclusions Neoadjuvant chemoradiotherapy could improve the 3-year survival rate of patients with resectable esophageal cancer,but could not decrease the local recurrence rate.

  18. Trends in surgical mortality following colorectal resection between 2002 and 2012: A single-centre, retrospective analysis.

    LENUS (Irish Health Repository)

    Stephens, I

    2017-06-01

    Surgical mortality is a commonly-used measurement of surgical risk. It is imperative that patients receive accurate, up-to-date information regarding operative risk. To date, studies investigating temporal changes in surgical mortality following colorectal resection in Ireland have been limited. This retrospective study investigates such trends in one of the eight centres for symptomatic and screen-detected colorectal cancers in Ireland, across an 11-year period. A steady decline in surgical mortality was found across this time, showing a significant difference in rates before and after centralisation of rectal cancer care and the advent of colorectal surgery as a surgical specialisation (5.2%, 1.52%). This has important implications for the organisation of colorectal cancer care in Ireland.

  19. A Histomorphological Pattern Analysis of Pulmonary Tuberculosis in Lung Autopsy and Surgically Resected Specimens

    Directory of Open Access Journals (Sweden)

    Mamta Gupta

    2016-01-01

    Full Text Available Background. Tuberculosis (TB is a major cause of morbidity and mortality globally. Many cases are diagnosed on autopsy and a subset of patients may require surgical intervention either due to the complication or sequelae of TB. Materials and Methods. 40 cases of resected lung specimens following surgery or autopsy in which a diagnosis of pulmonary tuberculosis was made were included. Histopathological pattern analysis of pulmonary tuberculosis along with associated nonneoplastic changes and identification of Mycobacterium tuberculosis bacilli was done. Results. The mean age of diagnosis was 41 years with male predominance (92.5%. Tuberculosis was suspected in only 12.1% of cases before death. Seven cases were operated upon due to associated complications or suspicion of malignancy. Tubercular consolidation was the most frequent pattern followed by miliary tuberculosis. The presence of necrotizing granulomas was seen in 33 cases (82.5%. Acid fast bacilli were seen in 57.5% cases on Ziehl-Neelsen stain. Conclusion. Histopathology remains one of the most important methods for diagnosing tuberculosis, especially in TB prevalent areas. It should be considered in the differential diagnosis of all respiratory diseases because of its varied clinical presentations and manifestations.

  20. [Resection margins in conservative breast cancer surgery].

    Science.gov (United States)

    Medina Fernández, Francisco Javier; Ayllón Terán, María Dolores; Lombardo Galera, María Sagrario; Rioja Torres, Pilar; Bascuñana Estudillo, Guillermo; Rufián Peña, Sebastián

    2013-01-01

    Conservative breast cancer surgery is facing a new problem: the potential tumour involvement of resection margins. This eventuality has been closely and negatively associated with disease-free survival. Various factors may influence the likelihood of margins being affected, mostly related to the characteristics of the tumour, patient or surgical technique. In the last decade, many studies have attempted to find predictive factors for margin involvement. However, it is currently the new techniques used in the study of margins and tumour localisation that are significantly reducing reoperations in conservative breast cancer surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  1. Surgical outcomes of the endoscopic transsphenoidal route to pituitary tumours in paediatric patients >10 years of age: 5 years of experience at a single institute

    Science.gov (United States)

    Zhan, Rucai; Xu, Guangming; Wiebe, Timothy M; Li, Xingang

    2015-01-01

    Objective To evaluate the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for the management of pituitary adenomas in paediatric patients >10 years of age. Methods A retrospective chart review was performed to identify 56 paediatric patients between 10 and 18 years of age who underwent an endonasal endoscopic transsphenoidal approach for the resection of a pituitary adenoma during the last 5 years. The age, sex, symptoms, tumour size, extent of tumour resection, clinical outcome and surgical complications of patients were reviewed. Results Total resection was achieved in 49 (87.5%) cases, subtotal resection was achieved in 7 (12.5%) cases and no patient had a partial or insufficient resection. Of the 35 patients who experienced preoperative deterioration of vision, 33 (94.2%) achieved visual remission with rates of 34.2% and 60% for normalisation and improvement, respectively. Endocrinological normalisation was achieved in 13 (31.7%) of 41 patients who had preoperative hyperhormonal levels; hormone levels decreased in 25 (61.0%) patients, and 3 (7.3%) patients had no change in hormone level. Two (3.5%) patients incurred postoperative cerebrospinal fluid leakage, which was resolved after lumbar drainage. Four (7.1%) patients developed hypopituitarism, which required hormone therapy. Post-surgery, five (8.9%) patients incurred transient diabetes insipidus (DI), of which one (1.7%) patient developed persistent DI and was administered Minirin. Meningitis occurred in one (1.7%) patient who was cured by the administration of a third-generation antibiotic. There were no cases of intracranial haematoma, reoperation or death. Conclusions EETA allows neurosurgeons to safely and effectively remove paediatric pituitary adenomas with low morbidity and mortality. PMID:26006173

  2. Anaesthetics modulate tumour necrosis factor α: effects of L-carnitine supplementation in surgical patients. Preliminary results.

    Directory of Open Access Journals (Sweden)

    Giovanna Delogu

    1993-01-01

    Full Text Available Both anaesthetics and surgical trauma could strongly affect the production of tumour necrosis factor α (TNFα. During in vitro experiments the authors found that anaesthetics modulate the production of TNFα by peripheral blood mononuclear cells. Notably, Pentothal strongly increased the production of the cytokine as compared to both lipopolysacchride treated and control mononuclear cells, whereas in supernatants from Leptofen driven mononuclear cells TNFα was strongly reduced. On the other hand, Pavulon did not significantly affect the cytokine production. In the in vivo study, in an attempt to ameliorate the metabolic response to surgical trauma, L-carnitine was administered to 20 surgical patients, then the circulating TNFα was measured. The results indicate that the levels of circulating TNFα were strongly increased following surgery and that L-carnitine administration resulted in a strong reduction of TNFα. Thus, the data suggest that L-carnitine could be helpful in protecting surgical patients against dysmetabolism dependent on dysregulated production of TNFα.

  3. MRI characteristics of midbrain tumours

    Energy Technology Data Exchange (ETDEWEB)

    Sun, B. [Chinese Academy of Medical Science, Beijing (China). Neurosurgical Inst.]|[Department of Neuroradiology, Beijing Tiantan Hospital (China); Wang, C.C.; Wang, J. [Chinese Academy of Medical Science, Beijing (China). Neurosurgical Inst.

    1999-03-01

    We diagnosed 60 cases of midbrain tumours by MRI between 1993 to 1997. There were 39 males and 21 females, aged 2-64 years, mean 25.6 years. We found 38 patients with true intramedullary midbrain tumours, 11 predominantly in the tectum, 20 in the tegmentum and 7 with a downward extension to the pons; there were 7 within the cerebral aqueduct. There were 22 patients with infiltrating midbrain tumours extending from adjacent structures, 11 cases each from the thalamus and pineal region. All patients received surgical treatment. Gross total resection was achieved in 42 cases, subtotal (> 75 %) resection in 18. Pathological diagnoses included 16 low-grade and 15 high-grade astrocytomas; 5 oligodendroastrocytomas; 2 ependymomas; 11 glioblastomas; and 11 pineal parenchymal or germ-cell tumours. Midbrain tumours are a heterogeneous group of neoplasms, with wide variation in clinical and MRI features, related to the site and type of tumour. MRI not only allows precise analysis of their growth pattern, but also can lead to a correct preoperative diagnosis in the majority of cases. (orig.) (orig.) With 3 figs., 3 tabs., 19 refs.

  4. Locally recurrent non-small-cell lung cancer after complete surgical resection.

    Science.gov (United States)

    Shaw, E G; Brindle, J S; Creagan, E T; Foote, R L; Trastek, V F; Buskirk, S J

    1992-12-01

    Between Jan. 1, 1976, and Dec. 31, 1985, at our institution, 37 patients who had undergone prior complete surgical resection of non-small-cell lung cancer received definitive thoracic radiation therapy (TRT) for locally recurrent disease. Of the 37 recurrences, 33 were in the pulmonary parenchyma or the hilar, mediastinal, or supraclavicular lymph nodes; the other 4 were in the chest wall. The initial stage of disease was I in 43%, II in 35%, and IIIA in 19%, whereas at the time of local recurrence, the stage was I in 8%, II in 11%, IIIA in 57%, IIIB in 22%, and IV in 3% (this patient had multiple pulmonary nodules encompassible within a single TRT field). The locally recurrent lesions were squamous cell carcinoma in 30%, adenocarcinoma or large-cell carcinoma in 46%, mixed types in 5%, and unknown type in 19%. All patients received megavoltage TRT, most often 4,000 cGy in 10 fractions administered in a split-course schedule. In addition, 15 patients received multiagent chemotherapy, usually a combination of cyclophosphamide, doxorubicin hydrochloride, and cisplatin or a regimen that included these drugs. The 2-year and 5-year survivals were 30% and 4%, respectively, and the median duration of survival was 13.7 months. Survival was not improved by the addition of chemotherapy. Approximately half of the patients had radiographic and symptomatic responses after TRT. Of 33 patients assessable for post-TRT patterns of failure, 46% had local failure only, 18% had local plus systemic failure, and 32% had systemic failure only. Two-thirds of the patients died as a direct consequence of progressive chest disease, despite receiving TRT.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Meta-analysis of surgical resection and radiofrequency ablation for early hepatocellular carcinoma

    Directory of Open Access Journals (Sweden)

    Xu Gang

    2012-08-01

    Full Text Available Abstract Background There is no definite agreement on the better therapy (radiofrequency ablation (RFA versus surgical resection (SR for early hepatocellular carcinoma (HCC eligible for surgical treatments. The purpose of this study is to evaluate the evidence using meta-analytical techniques. Methods A literature search was undertaken until December 2011 to identify comparative studies evaluating survival rates, recurrence rates, and complications. Pooled odds ratios (OR and 95% confidence intervals (95% CI were calculated with either the fixed or random effect model. Results Thirteen articles, comprising two randomized controlled trials(RCTs, were included in the review, with a total of 2,535 patients (1,233 treated with SR and 1,302 with RFA. The overall survival rates were significantly higher in patients treated with SR than RFA after1, 3, and 5 years (respectively: OR, 0.60 (95% CI, 0.42 to 0.86; OR, 0.49 (95% CI, 0.36 to 0.65; OR, 0.60 (95% CI, 0.43 to 0.84. In the SR group, the 1, 3, and 5 years recurrence rates were significantly lower than the RFA group (respectively: OR, 1.48 (95% CI, 1.05 to 2.08; OR, 1.76 (95% CI, 1.49 to 2.08; OR, 1.68 (95% CI, 1.21 to 2.34. However, local recurrence between two groups did not exhibit significant difference. For HCC ≤ 3 cm in diameter, SR was better than RFA at the 1, 3, and 5 years overall survival rates (respectively: OR, 0.34 (95% CI, 0.13 to 0.89; OR, 0.56 (95% CI, 0.37 to 0.84; OR, 0.44 (95% CI, 0.31 to 0.62. This meta-analysis indicated that the complication of SR was higher than RFA (OR, 6.25 (95%CI, 3.12 to 12.52; P = 0.000. Conclusion Although local recurrence between two groups did not exhibit significant difference, SR demonstrated significantly improved survival benefits and lower complications for patients with early HCC, especially for HCC ≤ 3 cm in diameter. These findings should be interpreted carefully, owing to the lower level of evidence.

  6. HER2 testing on core needle biopsy specimens from primary breast cancers: interobserver reproducibility and concordance with surgically resected specimens

    Directory of Open Access Journals (Sweden)

    Yamamoto Sohei

    2010-10-01

    Full Text Available Abstract Background Accurate evaluation of human epidermal growth factor receptor type-2 (HER2 status based on core needle biopsy (CNB specimens is mandatory for identification of patients with primary breast cancer who will benefit from primary systemic therapy with trastuzumab. The aim of the present study was to validate the application of HER2 testing with CNB specimens from primary breast cancers in terms of interobserver reproducibility and comparison with surgically resected specimens. Methods A total of 100 pairs of archival formalin-fixed paraffin-embedded CNB and surgically resected specimens of invasive breast carcinomas were cut into sections. All 100 paired sections were subjected to HER2 testing by immunohistochemistry (IHC and 27 paired sections were subjected to that by fluorescence in situ hybridization (FISH, the results being evaluated by three and two observers, respectively. Interobserver agreement levels in terms of judgment and the concordance of consensus scores between CNB samples and the corresponding surgically resected specimens were estimated as the percentage agreement and κ statistic. Results In CNB specimens, the percentage interobserver agreement of HER2 scoring by IHC was 76% (κ = 0.71 for 3 × 3 categories (0-1+ versus 2+ versus 3+ and 90% (κ = 0.80 for 2 × 2 categories (0-2+ versus 3+. These levels were close to the corresponding ones for the surgically resected specimens: 80% (κ = 0.77 for 3 × 3 categories and 92% (κ = 0.88 for 2 × 2 categories. Concordance of consensus for HER2 scores determined by IHC between CNB and the corresponding surgical specimens was 87% (κ = 0.77 for 3 × 3 categories, and 94% (κ = 0.83 for 2 × 2 categories. Among the 13 tumors showing discordance in the mean IHC scores between the CNB and surgical specimens, the results of consensus for FISH results were concordant in 11. The rate of successful FISH analysis and the FISH positivity rate in cases with a HER2 IHC score of

  7. Prognostic significance of cyclooxygenase-2 (COX-2 expression in patients with surgically resectable adenocarcinoma of the oesophagus

    Directory of Open Access Journals (Sweden)

    Cree Ian A

    2006-05-01

    Full Text Available Abstract Background COX-2 expression in tumour cells has been associated with poor prognosis in gastrointestinal and non-gastrointestinal cancers. The aim of our study was to test the hypothesis that higher levels of COX-2 expression are prognostically related to poor clinico-pathologic features in adenocarcinoma of the oesophagus. Methods We reviewed the records of 100 consecutive patients undergoing resection for adenocarcinoma of the oesophagus to collect data on T-stage, N-stage, tumour recurrence and survival. T & N-stage was further confirmed by histological examination. COX-2 protein expression was assessed by immunohistochemistry in all patients and COX-2 m-RNA expression was measured by quantitative RT-PCR in a small group of patients. Results Higher levels of COX-2 expression were associated with higher T stage (p = 0.008, higher N stage (p = 0.049, increased risk of tumour recurrence (p = 0.01 and poor survival (p = 200 was associated with a median survival of 10 months compared to 26 months with a score of Conclusion Higher levels of COX-2 expression are associated with poor clinico-pathologic features and poor survival in patients with oesophageal adenocarcinoma.

  8. Surgical treatment of hepatoblastoma in children

    Energy Technology Data Exchange (ETDEWEB)

    Czauderna, Piotr [Medical University of Gdansk, Department of Paediatric Surgery, Gdansk (Poland); Otte, Jean-Bernard [Catholic University of Louvain, Department of Paediatric Surgery and Liver Transplantation, Brussels (Belgium); Roebuck, Derek J. [Great Ormond Street Hospital, Department of Radiology, London (United Kingdom); Schweinitz, Dietrich von [Dr. von Hauner Children' s Hospital, Department of Paediatric Surgery, Munich (Germany); Plaschkes, Jack [Inselspital, Department of Paediatric Surgery, Bern (Switzerland)

    2006-03-15

    Hepatoblastoma is the most common liver malignancy in children. With rare exceptions, complete tumour resection is required to cure the patient. Radical tumour resection can be obtained either with standard partial hepatectomy or orthotopic liver transplantation. At present, the surgical approach to hepatoblastoma differs significantly between treatment groups in different parts of the world. Our aim was to review current surgical policy in hepatoblastoma. All aspects of surgery in hepatoblastoma are discussed, including biopsy, tumour resection principles, modern achievements in the field of liver surgery, and the indications and potential contraindications for liver transplantation. Every effort should be made to resect hepatoblastoma completely either by standard partial hepatectomy or by the use of liver transplantation in difficult or clearly unresectable cases. (orig.)

  9. Combined endoscopic and laparoscopic approach for palliative resection of metastatic melanoma of the stomach

    Directory of Open Access Journals (Sweden)

    Pritchard SA

    2006-03-01

    Full Text Available Abstract Background Metastatic tumours of the stomach present a clinical dilemma for the surgeon. Palliative surgical resection can alleviate symptoms and prolong survival in selected patients. However, previous studies have used open methods of surgical resection with potentially high morbidity and mortality. We describe the use of laparoscopic wedge resection of the stomach for palliative resection of metastatic melanoma to highlight the benefits of this technique. Case presentation A 58 year old male was investigated for iron deficiency anaemia while under treatment for pulmonary metastatic malignant melanoma. An upper gastrointestinal endoscopy revealed a 5 cm diameter ulcer on the anterior wall of the stomach, biopsies from the ulcer confirmed metastatic melanoma. Laparoscopic wedge resection of the stomach lesion was performed without complication. Conclusion Laparoscopic approach has many benefits and is useful for the palliative resection of rare tumours of the stomach in order to preserve the quality of life. Its use should be considered in selected patients.

  10. Plexiform malignant peripheral nerve sheath tumour of infancy and childhood of the index finger : Surgical treatment

    NARCIS (Netherlands)

    Meek, Marcel F.; Wolf, Rinze; Coert, J. Henk; Hoekstra, Harald J.; Nicolai, Jean-Philippe A.

    2009-01-01

    We describe a rare case of plexiform malignant peripheral nerve sheath tumour (MPNST) of infancy and childhood in a 3.5-year-old girl. The tumour was located in the proximal phalanx of the left index finger. After initial excisions and a ray amputation, exarticulation of the third and fourth rays wa

  11. Rapid and non-enzymatic in vitro retrieval of tumour cells from surgical specimens.

    Directory of Open Access Journals (Sweden)

    Brigitte Mack

    Full Text Available The study of tumourigenesis commonly involves the use of established cell lines or single cell suspensions of primary tumours. Standard methods for the generation of short-term tumour cell cultures include the disintegration of tissue based on enzymatic and mechanical stress. Here, we describe a simple and rapid method for the preparation of single cells from primary carcinomas, which is independent of enzymatic treatment and feeder cells. Tumour biopsies are processed to 1 mm(3 cubes termed explants, which are cultured 1-3 days on agarose-coated well plates in specified medium. Through incisions generated in the explants, single cells are retrieved and collected from the culture supernatant and can be used for further analysis including in vitro and in vivo studies. Collected cells retain tumour-forming capacity in xenotransplantation assays, mimic the phenotype of the primary tumour, and facilitate the generation of cell lines.

  12. [Long-term survival after surgical resection of a cancer of unknown primary site-a case report].

    Science.gov (United States)

    Tsukao, Yukiko; Moon, Jeong Ho; Kobayashi, Kenji; Hyuga, Satoshi; Chono, Teruhiro; Watanabe, Risa; Matsumoto, Takashi; Takemoto, Hiroyoshi; Takachi, Ko; Nishioka, Kiyonori; Aoki, Taro; Uemura, Yoshio

    2013-11-01

    We report a case of long-term survival after combination chemotherapy and surgical resection of a cancer of unknown primary site[ CUPs]. A septuagenarian female was identified as having high blood levels of carcinoembryonic antigen (CEA) during follow-up monitoring of asthma. Endoscopy and imaging studies including computed tomography (CT) and positron emission tomography (PET)-CT revealed a malignant lymph node adjacent to the abdominal aorta; however, no other lesion was detected. Therefore, we performed CT-guided biopsy and diagnosed the lesion to be a lymph node metastasis of poorly differentiated adenocarcinoma. As we considered this as a systemic disease, the patient received 2 courses of combination chemotherapy with 5-fluorouracil( 5-FU)/cisplatin( CDDP) and achieved a partial response (PR). Later, the patient received S-1 therapy as second-line chemotherapy and S-1/irinotecan( CPT-11) as third-line chemotherapy in an outpatient clinic. However, the tumor continued to grow, and therefore, we decided to perform surgical resection. Histopathological examination of the resected specimen yielded a diagnosis of metastatic adenocarcinoma of the lymph node. The patient has been well without any signs of recurrence for more than 9 years since surgery. As CUPs is generally associated with poor prognosis, this case raises the possibility that combination therapy might improve convalescence.

  13. Tips and tricks of the surgical technique for borderline resectable pancreatic cancer: mesenteric approach and modified distal pancreatectomy with en-bloc celiac axis resection.

    Science.gov (United States)

    Hirono, Seiko; Yamaue, Hiroki

    2015-02-01

    Borderline resectable (BR) pancreatic cancer involves the portal vein and/or superior mesenteric vein (PV/SMV), major arteries including the superior mesenteric artery (SMA) or common hepatic artery (CHA), and sometimes includes the involvement of the celiac axis. We herein describe tips and tricks for a surgical technique with video assistance, which may increase the R0 rates and decrease the mortality and morbidity for BR pancreatic cancer patients. First, we describe the techniques used for the "artery-first" approach for BR pancreatic cancer with involvement of the PV/SMV and/or SMA. Next, we describe the techniques used for distal pancreatectomy with en-bloc celiac axis resection (DP-CAR) and tips for decreasing the delayed gastric emptying (DGE) rates for advanced pancreatic body cancer. The mesenteric approach, followed by the dissection of posterior tissues of the SMV and SMA, is a feasible procedure to obtain R0 rates and decrease the mortality and morbidity, and the combination of this aggressive procedure and adjuvant chemo(radiation) therapy may improve the survival of BR pancreatic cancer patients. The DP-CAR procedure may increase the R0 rates for pancreatic cancer patients with involvement within 10 mm from the root of the splenic artery, as well as the CHA or celiac axis, and preserving the left gastric artery may lead to a decrease in the DGE rates in cases where there is more than 10 mm between the tumor edge and the root of the left gastric artery. The development of safer surgical procedures is necessary to improve the survival of BR pancreatic cancer patients. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  14. [Primary pulmonary artery sarcoma in 36-year-old women: 3-years follow-up after partial resection and radiotherapy].

    Science.gov (United States)

    Drożdż, Jarosław; Warchoł, Ewa; Fijuth, Jacek; Filipiak, Krzysztof; Spych, Michał; Maciejewski, Marek; Piestrzeniewicz, Katarzyna; Ludomir, Stafańczyk; Janaszek-Sitkowska, Hanna; Januszewicz, Andrzej; Zembala, Marian

    2013-01-01

    Intimal sarcoma of the heart and pulmonary artery is a very rare, malignant, primary tumour. The prognosis in patients with primary sarcoma of the pulmonary artery, including intimal sarcoma, is poor. We present the case and 3-years follow-up of 36-year-old woman who was successfully treated with surgical, partial resection of the tumour followed by radiotherapy.

  15. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    NARCIS (Netherlands)

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de

    2015-01-01

    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  16. Preoperative Platelet Count Associates with Survival and Distant Metastasis in Surgically Resected Colorectal Cancer Patients

    Science.gov (United States)

    Wan, Shaogui; Lai, Yinzhi; Myers, Ronald E.; Li, Bingshan; Hyslop, Terry; London, Jack; Chatterjee, Devjani; Palazzo, Juan P.; Burkart, Ashlie L.; Zhang, Kejin; Xing, Jinliang

    2013-01-01

    Objective Platelets have been implicated in cancer metastasis and prognosis. No population-based study has been reported as to whether preoperative platelet count directly predicts metastatic recurrence of colorectal cancer (CRC) patients. Design Using a well-characterized cohort of 1,513 surgically resected CRC patients, we assessed the predictive roles of preoperative platelet count in overall survival, overall recurrence, as well as locoregional and distant metastatic recurrences. Results Patients with clinically high platelet count (≥400× 109/L) measured within 1 month before surgery had a significantly unfavorable survival (hazard ratio [HR]=1.66, 95 % confidence interval [CI] 1.34–2.05, P=2.6×10−6, Plog rank= 1.1×10−11) and recurrence (HR=1.90, 1.24–2.93, P=0.003, Plog rank=0.003). The association of platelet count with recurrence was evident only in patients with metastatic (HR=2.81, 1.67–4.74, P=1.1×10−4, Plog rank =2.6×10−6) but not locoregional recurrence (HR=0.59, 95 % CI 0.21–1.68, P= 0.325, Plog rank=0.152). The findings were internally validated through bootstrap resampling (P<0.01 at 98.6 % of resampling). Consistently, platelet count was significantly higher in deceased than living patients (P<0.0001) and in patients with metastatic recurrence than locoregional (P= 0.004) or nonrecurrent patients (P<0.0001). Time-dependent modeling indicated that the increased risks for death and metastasis associated with elevated preoperative platelet counts persisted up to 5 years after surgery. Conclusion Our data demonstrated that clinically high level of preoperative platelets was an independent predictor of CRC survival and metastasis. As an important component of the routinely tested complete blood count panel, platelet count may be a cost-effective and noninvasive marker for CRC prognosis and a potential intervention target to prevent metastatic recurrence. PMID:23549858

  17. 5-Fluorouracil and cisplatin therapy after palliative surgical resection of squamous cell carcinoma of the esophagus. A multicenter randomized trial. French Associations for Surgical Research.

    Science.gov (United States)

    Pouliquen, X; Levard, H; Hay, J M; McGee, K; Fingerhut, A; Langlois-Zantin, O

    1996-01-01

    BACKGROUND: The curative rate of surgical resection of squamous cell carcinoma of the esophagus is low. Reports on the efficacy of preoperative and postoperative chemotherapy are conflicting or have included limited disease or radical surgery alone. OBJECTIVE: The authors' objective was to study the results of chemotherapy on the duration and quality of survival in patients who have undergone palliative surgical resection for esophageal squamous cell carcinoma. PATIENTS AND METHODS: Of 124 patients with histologically proven esophageal squamous cell carcinoma situated more than 5 cm from the upper end of the esophagus, 4 patients were withdrawn for failure to comply with the protocol. The remaining 120 patients, 116 males and 4 females (mean age, 57 +/- 9 years), were randomly assigned to either a control group who were to receive no chemotherapy (68 patients) or to a group who were to be treated with chemotherapy (52 patients). Patients were subdivided into two strata as follows: (1) stratum I, complete resection of the tumor with lymph node involvement (62 patients) and (2) stratum ii, incomplete resection leaving macroscopic tumor tissue in situ or with metastases. Noninclusion criteria were histologically proven tracheobronchial involvement, esotracheal fistula, major alteration of general health status (Karnofsky score 30% of parenchyma) hepatic metastasis, peritoneal carcinomatosis, associated or previously treated upper airway cancer, or, conversely, complete resection of tumor without lymph node involvement. Chemotherapy was given in 5-day courses, every 28 days, with a maximum of 8 courses. Cisplatin was administered either as a single dose of 100 mg/m2 at the beginning of the course or as 20 mg/m2/day for 5 days given over 3 hours. 5- Fluorouracil (5-FU) (100 mg/m2/day) was infused over 24 hours for 5 days. The duration of treatment ranged from 6 to 8 months. The main aim was to establish median survival and actuarial survival curves. The subsidiary aim

  18. Surgical planning for resection of an ameloblastoma and reconstruction of the mandible using a selective laser sintering 3D biomodel.

    Science.gov (United States)

    Sannomiya, Eduardo Kazuo; Silva, Jorge Vicente L; Brito, Antonio Albuquerque; Saez, Daniel Martinez; Angelieri, Fernanda; Dalben, Gisele da Silva

    2008-07-01

    Ameloblastoma is a benign locally aggressive infiltrative odontogenic lesion. It is characterized by slow growth and painless swelling. The treatment for ameloblastoma varies from curettage to en bloc resection, and the reported recurrence rates after treatment are high; the safety margin of resection is important to avoid recurrence. Advances in technology brought about great benefits in dentistry; a new generation of computed tomography scanners and 3-dimensional images enhance the surgical planning and management of maxillofacial tumors. The development of new prototyping systems provides accurate 3D biomodels on which surgery can be simulated, especially in cases of ameloblastoma, in which the safety margin is important for treatment success. A case of mandibular follicular ameloblastoma is reported where a 3D biomodel was used before and during surgery.

  19. Surgical strategy to avoid ischemic complications of the pyramidal tract in resective epilepsy surgery of the insula: technical case report.

    Science.gov (United States)

    Ikegaya, Naoki; Takahashi, Akio; Kaido, Takanobu; Kaneko, Yuu; Iwasaki, Masaki; Kawahara, Nobutaka; Otsuki, Taisuke

    2017-06-09

    Surgical treatment of the insula is notorious for its high probability of motor complications, particularly when resecting the superoposterior part. Ischemic damage to the pyramidal tract in the corona radiata has been regarded as the cause of these complications, resulting from occlusion of the perforating arteries to the pyramidal tract through the insular cortex. The authors describe a strategy in which a small piece of gray matter is spared at the bottom of the periinsular sulcus, where the perforating arteries pass en route to the pyramidal tract, in order to avoid these complications. This method was successfully applied in 3 patients harboring focal cortical dysplasia in the posterior insula and frontoparietal operculum surrounding the periinsular sulcus. None of the patients developed permanent postoperative motor deficits, and seizure control was achieved in all 3 cases. The method described in this paper can be adopted for functional preservation of the pyramidal tract in the corona radiata when resecting epileptogenic pathologies involving insular and opercular regions.

  20. Large benign retroperitoneal tumour in pregnancy.

    Science.gov (United States)

    Berczi, Csaba; Osvath, Peter; Flasko, Tibor

    2015-01-01

    A 31-year-old female was in the 13th week of pregnancy when an abdominal ultrasound examination revealed a large retroperitoneal tumour. Magnetic resonance imaging was carried out and the imaging described a 10-cm mass in diameter extending from the right kidney. Given that the patient was in her first trimester and that there was a suspicion of malignancy, further surgical exploration of the tumour was warranted. During the operation, the tumour was removed, but nephrectomy was not necessary. Histologic analysis of the resected tumour showed a mucinous cystic adenoma, and no signs of malignancy were present. Following the surgery, the pregnancy was otherwise uneventful and further complications did not occur. This case illustrates that surgery is recommended in patients with a retroperitoneal tumour early during a pregnancy, when a malignancy cannot be excluded.

  1. Laparoscopic Colorectal Cancer Resection in High-Volume Surgical Centers: Long-Term Outcomes from the LAPCOLON Group Trial.

    Science.gov (United States)

    Huscher, Cristiano G S; Bretagnol, Frederic; Corcione, Francesco

    2015-08-01

    Strong evidence has confirmed the benefit of laparoscopy in colorectal cancer resection but remains a challenging procedure. It is not clear that such promising results in selected patients translate into a favorable risk-benefit balance in real practice. We conducted a multicenter national observational registry to assess operative and oncologic long-term outcomes following laparoscopic colorectal cancer resection. All patients with laparoscopic colorectal cancer resection between 2001 and 2004 were included. Data were extracted from the prospective Italian national database of 10 high-volume centers (≥40 colorectal cancer laparoscopic resections per year). Surgical technique and follow-up were standardized. Survivals were analyzed by Kaplan-Meier method. We reported 1832 patients with colon (58.5%) and rectal cancer (41.5%). TNM stage was 0-I-II in 1044 patients (57%) and III-IV in 788 patients (43%). Surgery included a totally laparoscopic procedure in 1820 patients (99.3%). Conversion was 10.5%. Postoperative morbidity and 30-day mortality rates were 17 and 1.2%, respectively. Clinical anastomotic leakage rate was 8.3% (n=152). R0 resection was 95%. With a median follow-up of 54.2 months, cancer recurrence rate was 13.3%. At 5 years, cancer-free survival was 86.7%. Upon multivariate analysis, age (P=0.001) and TNM stage (Pcancer-free survival. Predictive factors of cancer recurrence were gender (P=0.029) and TNM stage (Pcancer achieves good operative results with satisfactory long-term oncologic results. Even in the laparoscopy era, age, gender, and TNM stage remain the most powerful predictor of oncologic outcomes.

  2. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical and Technical Considerations for Successful Outcomes

    Directory of Open Access Journals (Sweden)

    Sonia Tewani Orcutt

    2016-03-01

    Full Text Available Preoperative portal vein embolization (PVE is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other’s techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient’s anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications and how to avoid the complications in each step is of great importance for safe and successful PVE, and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  3. Portal Vein Embolization as an Oncosurgical Strategy Prior to Major Hepatic Resection: Anatomic, Surgical, and Technical Considerations.

    Science.gov (United States)

    Orcutt, Sonia T; Kobayashi, Katsuhiro; Sultenfuss, Mark; Hailey, Brian S; Sparks, Anthony; Satpathy, Bighnesh; Anaya, Daniel A

    2016-01-01

    Preoperative portal vein embolization (PVE) is used to extend the indications for major hepatic resection, and it has become the standard of care for selected patients with hepatic malignancies treated at major hepatobiliary centers. To date, various techniques with different embolic materials have been used with similar results in the degree of liver hypertrophy. Regardless of the specific strategy used, both surgeons and interventional radiologists must be familiar with each other's techniques to be able to create the optimal plan for each individual patient. Knowledge of the segmental anatomy of the liver is paramount to fully understand the liver segments that need to be embolized and resected. Understanding the portal vein anatomy and the branching variations, along with the techniques used to transect the portal vein during hepatic resection, is important because these variables can affect the PVE procedure and the eventual surgical resection. Comprehension of the advantages and disadvantages of approaches to the portal venous system and the various embolic materials used for PVE is essential to best tailor the procedures for each patient and to avoid complications. Before PVE, meticulous assessment of the portal vein branching anatomy is performed with cross-sectional imaging, and embolization strategies are developed based on the patient's anatomy. The PVE procedure consists of several technical steps, and knowledge of these technical tips, potential complications, and how to avoid the complications in each step is of great importance for safe and successful PVE and ultimately successful hepatectomy. Because PVE is used as an adjunct to planned hepatic resection, priority must always be placed on safety, without compromising the integrity of the future liver remnant, and close collaboration between interventional radiologists and hepatobiliary surgeons is essential to achieve successful outcomes.

  4. Surgical cytoreduction in recurrent ovarian carcinoma in patients with complete response to paclitaxel-platinum

    DEFF Research Database (Denmark)

    Gronlund, Bo; Lundvall, L; Christensen, Ib Jarle;

    2005-01-01

    tumour, was no longer significantly associated with survival. CONCLUSIONS: Complete tumour resection following secondary cytoreductive surgery is associated with improved survival in selected groups of patients with recurrent ovarian cancer. However, other clinical factors than surgical cytoreduction......AIM: The objective was to analyse the impact of secondary cytoreductive surgery in patients with recurrent ovarian carcinoma. METHODS: Retrospective review of 572 consecutive patients with primary ovarian carcinoma. Thirty-eight patients with intraabdominal/pelvic recurrence consisted the study...... group. Clinical variables affecting tumour resectability and survival were evaluated. RESULTS: Complete tumour resection was obtained in 42% of patients. A solitary tumour recurrence was independently associated with complete tumour resection (p=0.009). Median survival for patients with complete...

  5. Resident training in urology: Bipolar transurethral resection of the prostate - a safe method in learning endoscopic surgical procedure

    Directory of Open Access Journals (Sweden)

    Alessandro Del Rosso

    2013-06-01

    Full Text Available Introduction: Modern medicine uses increasingly innovative techniques that require more and more capabilities for acquisition. In the urological department is increasing the presence of patients with lower urinary tract symptoms (LUTS and transurethral resection of the prostate (TURP is the standard of care in their surgical treatment. We report our surgical experience and learning curve of using bipolar plasmakinetic devices in the training of urological residents to benign prostatic hyperplasia (BPH treatment. Materials and Methods: 80 patients with benign prostatic enlargement due to BPH were enrolled in the study. TURP has been performed by three urological residents and by an expe- rienced urologist. Patients were evaluated before and 6 months after the endoscopic bipolar plasmakinetic resection using the International Prostate Symptom Score (IPSS, maximum uri- nary flow rate (Qmax, postvoid residual urine (PVR and prostate specific antigen (PSA. Results: Overall 60 procedures were performed, 18 PlasmaKinetic (PK-TURP procedures were completed by the three residents. In the other 42 cases the procedures were completed by the experienced urologist. In eight cases there was a capsular perforation and the experienced urol- ogist replaced the resident to complete the resection. No complications have been reported in the procedures completed by the senior urologist. All complications caused by the residents were man- aged intraoperatively without changing the course of the procedure. Statistical differences were observed regarding IPSS, quality of life (QoL, and PVR at 6-month follow-up when procedures completed by urological residents were compared to those completed by the senior urologist. Conclusion: Bipolar device represents appropriate tools to acquire endoscopic skills. It is safe and it can be used at the first experience of BPH treatment by a resident who has not previ- ously approached this endoscopic surgical procedure.

  6. Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study.

    Science.gov (United States)

    Trillsch, F; Mahner, S; Vettorazzi, E; Woelber, L; Reuss, A; Baumann, K; Keyver-Paik, M-D; Canzler, U; Wollschlaeger, K; Forner, D; Pfisterer, J; Schroeder, W; Muenstedt, K; Richter, B; Fotopoulou, C; Schmalfeldt, B; Burges, A; Ewald-Riegler, N; de Gregorio, N; Hilpert, F; Fehm, T; Meier, W; Hillemanns, P; Hanker, L; Hasenburg, A; Strauss, H-G; Hellriegel, M; Wimberger, P; Kommoss, S; Kommoss, F; Hauptmann, S; du Bois, A

    2015-02-17

    Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.

  7. Predictive Value of Conventional Ultrasound and Contrast-Enhanced Ultrasound in Early Recurrence of Hepatocellular Carcinoma after Surgical Resection.

    Science.gov (United States)

    Wang, Yibin; Liao, Jintang; Qi, Wenjun; Xie, Lulu; Li, Yueyi

    2016-05-01

    The goals of the work described here were to study the pre-operative risk factors associated with early recurrence (ER) of hepatocellular carcinoma (HCC) after surgical resection and discuss the value of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in predicting ER of HCC, so as to provide more information for optimizing clinical treatment and improving prognosis. A retrospective analysis was conducted on 59 patients who underwent both US and CEUS examinations pre-operatively and surgical resection for HCC between December 2010 and January 2014 in our hospital. The patients' clinical data, laboratory examination data and ultrasonic imaging diagnostic data were collected. Univariate analysis and logistic regression analysis were performed to determine the independent risk factors for ER of HCC after surgical resection. Diagnostic values of independent risk factors in predicting ER were further evaluated. The 59 patients were divided into the ER group (27 cases) and ER-free group (32 cases). There were no significant differences in age and sex between the two groups (p > 0.05). Univariate analysis revealed that differences in pre-operative serum α-fetoprotein level ≥400 ng/mL (p = 0.008), tumor diameter ≥5 cm (p = 0.012), macroscopic vascular invasion (p = 0.040), "fast wash-out" enhancement pattern (p = 0.006) and inhomogeneous distribution of contrast agent (p = 0.031) statistically significantly differed between the two groups. Logistic regression analysis indicated that pre-operative serum AFP level ≥400 ng/mL (p = 0.024), tumor diameter ≥5 cm (p = 0.042) and "fast wash-out" enhancement pattern (p = 0.009) were independent risk factors for ER of HCC; macrovascular invasion (p = 0.095) and inhomogeneous distribution of contrast agent (p = 0.628) did not statistically significantly differ between two groups (p = 0.628). Predictive values of the independent risk factors were further evaluated. The sensitivity of a "fast wash

  8. Long-term survival after surgical resection for huge hepatocellular carcinoma: comparison with transarterial chemoembolization after propensity score matching.

    Science.gov (United States)

    Min, Yang Won; Lee, Jun Hee; Gwak, Geum-Youn; Paik, Yong Han; Lee, Joon Hyoek; Rhee, Poong-Lyul; Koh, Kwang Cheol; Paik, Seung Woon; Yoo, Byung Chul; Choi, Moon Seok

    2014-05-01

    Surgical resection (SR) and transarterial chemoembolization (TACE) have been commonly applied for patients with huge hepatocellular carcinoma (HCC). However, optimal treatment has not been established. Between 2000 and 2009, 267 patients with huge HCC (≥ 10 cm) underwent TACE and 84 underwent SR as the first treatment. Propensity score matching generated a matched cohort composed of 152 patients. We investigated overall survival and possible prognostic factors. At baseline, the surgery group showed a tendency to have solitary tumor (72.6% vs 39.3%, P huge HCC. © 2013 Journal of Gastroenterology and Hepatology Foundation and Wiley Publishing Asia Pty Ltd.

  9. Submental Artery Island Flap in Reconstruction of Harde Plate after wide Surgical Resection of Veruccous Carcinoma. Two case reports

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2013-06-01

    Full Text Available Introduction: Reconstruction of intraoral soft tissue defects is important in restoring function and esthetic. In large defects, there will be demand for regional pedicle flaps or free flaps. Hard palate separates nasal and oral cavities. Due to the small surface area between flap and remaining palate after surgical resections, optimal blood supply of the flaps for hard palate reconstructions are needed. This article demonstrates immediate reconstruction of two edentulous hemimaxillectomy patients with submental artery Island flap and brief review of this flap discussed. 

  10. Skull reconstruction after resection of bone tumors in a single surgical time by the association of the techniques of rapid prototyping and surgical navigation.

    Science.gov (United States)

    Anchieta, M V M; Salles, F A; Cassaro, B D; Quaresma, M M; Santos, B F O

    2016-10-01

    Presentation of a new cranioplasty technique employing a combination of two technologies: rapid prototyping and surgical navigation. This technique allows the reconstruction of the skull cap after the resection of a bone tumor in a single surgical time. The neurosurgeon plans the craniotomy previously on the EximiusMed software, compatible with the Eximius Surgical Navigator, both from the company Artis Tecnologia (Brazil). The navigator imports the planning and guides the surgeon during the craniotomy. The simulation of the bone fault allows the virtual reconstruction of the skull cap and the production of a personalized modelling mold using the Magics-Materialise (Belgium)-software. The mold and a replica of the bone fault are made by rapid prototyping by the company Artis Tecnologia (Brazil) and shipped under sterile conditions to the surgical center. The PMMA prosthesis is produced during the surgical act with the help of a hand press. The total time necessary for the planning and production of the modelling mold is four days. The precision of the mold is submillimetric and accurately reproduces the virtual reconstruction of the prosthesis. The production of the prosthesis during surgery takes until twenty minutes depending on the type of PMMA used. The modelling mold avoids contraction and dissipates the heat generated by the material's exothermic reaction in the polymerization phase. The craniectomy is performed with precision over the drawing made with the help of the Eximius Surgical Navigator, according to the planned measurements. The replica of the bone fault serves to evaluate the adaptation of the prosthesis as a support for the perforations and the placement of screws and fixation plates, as per the surgeon's discretion. This technique allows the adequate oncologic treatment associated with a satisfactory aesthetic result, with precision, in a single surgical time, reducing time and costs.

  11. Outcome of surgical resection for pathologic N0 and Nx non-small cell lung cancer.

    Science.gov (United States)

    Osarogiagbon, Raymond U; Allen, Jeffrey W; Farooq, Aamer; Berry, Allen; Spencer, David; O'Brien, Thomas

    2010-02-01

    Metastasis to lymph nodes (LNs) connotes poor prognosis in non-small cell lung cancer (NSCLC). Sufficient LNs must be examined to accurately determine LN negativity. Patients with no LNs examined (pNx) have an indeterminate stage, may have undetected disease and erroneous assignment to a low-risk group. To evaluate this possibility, we compared the survival of patients with node-negative disease and at least one LN examined (pN0) to those with pNx. Retrospective analysis of all resections for NSCLC from January 1, 2004 to December 31, 2007 at hospitals in the Memphis Metropolitan Area. Of 746 resections, 90 (12.1%) were Nx; 506 (67.8%) N0. Demographic and histologic characteristics were similar. A total of 54.4% Nx patients had sublobar resection, compared with 5.5% N0 (p Nx do significantly worse than those with pT2N0.

  12. Reconstructive options in pelvic tumours

    Directory of Open Access Journals (Sweden)

    Mayilvahanan N

    2005-01-01

    Full Text Available Background: Pelvic tumours present a complex problem. It is difficult to choose between limb salvage and hemipelvectomy. Method: Forty three patients of tumours of pelvis underwent limb salvage resection with reconstruction in 32 patients. The majority were chondrosarcomas (20 cases followed by Ewing sarcoma. Stage II B was the most common stage in malignant lesions and all the seven benign lesions were aggressive (B3. Surgical margins achieved were wide in 31 and marginal in 12 cases. Ilium was involved in 51% of cases and periacetabular involvement was seen in 12 patients. The resections done were mostly of types I &II of Enneking′s classification of pelvic resection. Arthrodesis was attempted in 24 patients. Customized Saddle prosthesis was used in seven patients and no reconstruction in 12 patients. Adjuvant chemotherapy was given to all high-grade malignant tumours, combined with radiotherapy in 7 patients. Results: With a mean follow up of 48.5 months and one patient lost to follow up, the recurrence rate among the evaluated cases was 16.6%. Oncologically, 30 patients were continuously disease free with 7 local recurrences and 4 deaths due to disseminated disease and 2 patients died of other causes. During the initial years, satisfactory functional results were achieved with prosthetic replacement. Long-term functional result of 36 patients who were alive at the time of latest follow up was satisfactory in 75% who underwent arthrodesis and in those where no reconstruction was used. We also describe a method of new classification of pelvic resections that clarifies certain shortcomings of the previous systems of classification. Conclusion: Selection of a procedure depends largely on the patient factors, the tumour grade, the resultant defect and the tissue factors. Resection with proper margins gives better functional and oncological results

  13. Primary tuberculous infection of breast: experiences of surgical resection for aged p.atients and review of literature

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Primary mammary tuberculosis is a rare entity that usually occurs in female of reproductive age. Herein three such patients including two males with ages over 80 years, who underwent surgical resection, are reported. Fine needle biopsy failed to achieve specific diagnosis before surgical operation. All of their conditions got satisfactory improvement and anti-tuberculosis chemotherapy was administered postoperatively. Previous literature related to the epidemiology, diagnosis and treatment for mammary tuberculosis will be also reviewed. Mammary tuberculosis is usually related to breast feeding women and is extremely rare in aged man. The possible mechanisms resulting in this disease in our three patients, including direct extension, reactivation,or transmitted by staffs or peers of the nursing home, would also be discussed.

  14. Successful surgical management of osteonecrosis of the jaw due to RANK-ligand inhibitor treatment using fluorescence guided bone resection.

    Science.gov (United States)

    Otto, Sven; Baumann, Sebastian; Ehrenfeld, Michael; Pautke, Christoph

    2013-10-01

    Osteonecrosis of the jaw has recently been described in patients receiving subcutaneous administration of RANKL-inhibitors (denosumab). However, due to promising study results, more patients will receive denosumab in order to avoid skeletal complications due to metastatic bone disease and osteoporosis. Therefore, this has the potential to become a comparable challenge to the bisphosphonate induced jaw necrosis in the area of Oral and Maxillofacial Surgery. Indeed, so far no convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANKL-inhibitor therapy. In this technical note, we report two successful cases of surgical treatment of jaw-bone necrosis under RANKL-inhibitor treatment using fluorescence guided bone resection. In conclusion, the technique is suggested as treatment option for this entity of osteonecrosis of the jaw.

  15. Three-dimensional endoscope-assisted surgical approach to the foramen magnum and craniovertebral junction: minimizing bone resection with the aid of the endoscope.

    Science.gov (United States)

    Anichini, Giulio; Evins, Alexander I; Boeris, Davide; Stieg, Philip E; Bernardo, Antonio

    2014-12-01

    To evaluate objectively the anatomic areas of the cranial base exposed by a three-dimensional (3D) endoscope-assisted far lateral approach. A series of far lateral approaches with only condyle resection, with only jugular tubercle resection, with both partial condyle and total jugular tubercle resection, and without occipital condyle and jugular tubercle resection were performed on 10 cadaveric heads (20 sides). To assess properly the exposure of major anatomic and neurovascular structures, the intradural anatomy of the exposed craniocervical junction was divided into 8 compartments, including 3 superior cranial compartments, 3 inferior cranial compartments, and 2 spinal compartments. The anteromedial compartments toward the midline were difficult to explore using the microscope and required the aid of the endoscope. The 3D endoscope provided general circumferential visualization of the anatomic structures, even without resection of the jugular tubercle, and afforded good visualization of the more lateral compartments. Safe and optimal surgical corridors for insertion of the endoscope were also identified. Use of a 3D endoscope allows for minimal resection of the condyle and jugular tubercle, better visualization of the surgical compartments toward the midline, and better in-depth surgical exploration of each intradural compartment. However, the 3D probe is still too large and restricts surgical maneuverability. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Intravenous leiomyomatosis : report of two cases and strategy for surgical resection

    NARCIS (Netherlands)

    Tielliu, I. F. J.; Otterman, M. L.; Meuzelaar, J. J.; Zeebregts, C. J.; Peeters, P. M. J. G.

    2010-01-01

    Intravenous leiomyomatosis is a rare smooth muscle tumour that arises from the myometrium and grows into the extrauterine venous system. It typically can extend into the vena cava inferior and even the cardiac chambers. This can lead to life threatening obstruction of cardiac valves. The only effect

  17. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas

    Energy Technology Data Exchange (ETDEWEB)

    Koenigkam Santos, Marcel, E-mail: marcelk46@yahoo.com.br [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP (Brazil); Muley, Thomas [Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Warth, Arne [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Paula, Wagner Diniz de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Radiology, University of Brasilia, Brasilia (Brazil); Lederlin, Mathieu [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Thoracic and Cardiovascular Imaging, University of Bordeaux, Bordeaux (France); Schnabel, Philipp Albert [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Schlemmer, Heinz-Peter [German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); and others

    2014-07-15

    Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients’ outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors’ size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients’ survival data and a previously studied population of ADC surgically resected at the same time period. Results: Cavitation correlated negatively with overall (hazard ratio = 3.04), disease-specific (HR = 3.67) and disease-free survival (HR = 2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors. Conclusions: Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients.

  18. Extended surgical resection for xanthogranulomatous cholecystitis mimicking advanced gallbladder carcinoma: A case report and review of literature

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Sven Jonas; Jan M Langrehr; Peter Neuhaus; Guido Schumacher; Andreas Pascher; Enrique Lopez-Hanninen; Hussain Al-Abadi; Christoph Benckert; Igor M Sauer; Johann Pratschke; Ulf P Neumann

    2006-01-01

    Xanthogranulomatous cholecystitis (XGC) is a destructive inflammatory disease of the gallbladder, rarely involving adjacent organs and mimicking an advanced gallbladder carcinoma. The diagnosis is usually possible only after pathological examination. A 46 year-old woman was referred to our center for suspected gallbladder cancer involving the liver hilum, right liver lobe, right colonic flexure, and duodenum. Brushing cytology obtained by endoscopic retrograde cholangiography (ERC) showed high-grade dysplasia. The patient underwent an en-bloc resection of the mass, consisting of right lobectomy,right hemicolectomy, and a partial duodenal resection.Pathological examination unexpectedly revealed an XGC.Only six cases of extended surgical resections for XGC with direct involvement of adjacent organs have been reported so far. In these cases, given the possible coexistence of XGC with carcinoma, malignancy cannot be excluded, even after cytology and intraoperative frozen section investigation. In conclusion, due to the poor prognosis of gallbladder carcinoma on one side and possible complications deriving from highly aggressive inflammatory invasion of surrounding organs on the other side, it seems these cases should be treated as malignant tumors until proven otherwise. Clinicians should include XGC among the possible differential diagnoses of masses in liver hilum.

  19. Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.

    Science.gov (United States)

    Flexman, Alana M; Gooderham, Peter A; Griesdale, Donald E; Argue, Ruth; Toyota, Brian

    2017-06-01

    Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared. Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P recruitment maneuver. The BRS did not change with either maneuver. Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

  20. Risk factors associated with recurrence of surgically resected node-positive non-small cell lung cancer.

    Science.gov (United States)

    Ohtaki, Yoichi; Shimizu, Kimihiro; Kaira, Kyoichi; Nagashima, Toshiteru; Obayashi, Kai; Nakazawa, Seshiru; Kakegawa, Seiichi; Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nishiyama, Masahiko; Takeyoshi, Izumi

    2016-10-01

    The aim of this study was to identify risk factors for recurrence in non-small cell lung cancer (NSCLC) patients with lymph node metastases after surgical resection. We reviewed 66 consecutive patients with surgically resected NSCLC who had pathologically proven positive lymph nodes (pN1 or pN2). All patients underwent a preoperative 2-[(18)F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) evaluation. We analyzed the recurrence-free survival (RFS) and recurrence-free proportion (RFP) according to the clinicopathological factors. A total of 27 patients were pathologically N1 and 39 were N2. The 5-year overall survival rate and the RFS rate were 47.2 and 27.7 %, respectively. The cut-off values for the SUVmax of the tumor and the lymph node ratio (LNR) were determined to be 6.5 and 0.12, respectively, using a receiver operating characteristics curve analysis. Both univariate and multivariate analyses revealed three significant independent factors for RFS: namely, the SUVmax of the tumor, the LNR, and the use of adjuvant chemotherapy. Only the SUVmax was an independent significant predictor of the RFP. Both the SUVmax and the LNR can serve as prognostic factors for patients with pN + NSCLC. Our study suggests that the LNR could be a stronger prognostic factor than the N classification of the TNM system and the SUVmax may predict recurrence in node-positive NSCLC patients.

  1. The Use of Multislice Spiral CT to Predict the Resectability of Central Lung Cancer: Correlation with Pathologic and Surgical Findings

    Institute of Scientific and Technical Information of China (English)

    Yang Liu; Yu'e Sun; Naikang Zhou; Qiming Xu

    2005-01-01

    OBJECTIVE To assess the accuracy of multi-slice spiral CT (MSCT) with imaging reconstruction in judging central pulmonary vascular involvement from central lung cancer, and to explore its ability to predict the resectability of lung cancer.METHODS MSCTs were conducted on 48 patients who were diagnosed preoperatively with central lung cancer. Images of pulmonary arteries and veins that might affect Iobectomy or pneumonectomy were reconstructed by means of imaging processing techniques. Then the relationship of the tumor to the vessels was assessed prospectively on both axial CT images and axial CT images plus reconstructed images(CT-RI) in comparison to subsequent pathologic and surgical findings.RESULTS MSCTs were obtained on all 48 patients whom 42 underwent thoracotomy, Iobectomy or pneumonectomy. Compared with the axial CT images,CT-RI was more accurate in judging the relationship of the central pulmonary vessels to the tumor based on subsequent pathologic 78 vessels studiedand surgical findings (186 vessels studied) (0.01 <P<0.05). The sensitivity and positive predictive value of unresectability of the vessels were all remarkably higher with CT-RI (P<0.01).CONCLUSION MSCT with imaging reconstruction can improve the recognition of neoplastic invasion of central pulmonary vessels. It can be used to predict preoperatively the resectability of central lung cancer and to plan surgery.

  2. Surgical treatment of synchronous colorectal liver and lung metastases:the usefulness of thoracophrenolaparotomy for single stage resection

    Institute of Scientific and Technical Information of China (English)

    Daniele Del Fabbro; Marco Alloisio; Fabio Procopio; Matteo Cimino; Matteo Donadon; Angela Palmisano; Luca Viganò; Guido Torzilli

    2016-01-01

    When suitable, surgery still remains the therapeu-tic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, si-multaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients (median age of 53 years) carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolapa-rotomy. The median number of liver metastases removed was 5 (range 2-30) and of lung metastases removed was 2 (range 1-3). Lung metastases were located in the upper lobe in 1 pa-tient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity: one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases: in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.

  3. Pre-operative embolization facilitating a posterior approach for the surgical resection of giant sacral neurogenic tumors.

    Science.gov (United States)

    Chen, Kangwu; Zhou, Ming; Yang, Huilin; Qian, Zhonglai; Wang, Genlin; Wu, Guizhong; Zhu, Xiaoyu; Sun, Zhiyong

    2013-07-01

    The present study aimed to assess a posterior approach for the surgical resection of giant sacral neurogenic tumors, and to evaluate the oncological and functional outcomes. A total of 16 patients with giant sacral neurogenic tumors underwent pre-operative embolization and subsequent posterior sacral resection between January 2000 and June 2010. Benign tumors were identified in 12 cases, while four cases exhibited malignant peripheral nerve sheath tumors (MPNSTs). An evaluation of the operative techniques used, the level of blood loss, any complications and the functional and oncological outcomes was performed. All tumor masses were removed completely without intra-operative shock or fatalities. The mean tumor size was 17.5 cm (range, 11.5-28 cm) at the greatest diameter. The average level of intra-operative blood loss was 1,293 ml (range, 400-4,500 ml). Wound complications occurred in four patients (25%), including three cases of cutaneous necrosis and one wound infection. The mean follow-up time was 59 months (range, 24-110 months). Tumor recurrence or patient mortality as a result of the disease did not occur in any of the patients with benign sacral neurogenic tumors. The survival rate of the patients with malignant lesions was 75% (3/4 patients) since 25 % (1/4 patients) had multiple local recurrences and succumbed to the disease. The patients with benign tumors scored an average of 92.8% on the Musculoskeletal Tumor Society (MSTS) score functional evaluation, while the patients with malignant tumors scored an average of 60.3%. A posterior approach for the surgical resection of giant sacral neurogenic tumors, combined with pre-operative embolization may be safely conducted with satisfactory oncological and functional outcomes.

  4. Adjuvant Radiation Therapy Improves Local Control After Surgical Resection in Patients With Localized Adrenocortical Carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Sabolch, Aaron [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Else, Tobias [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Griffith, Kent A. [Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Mchigan (United States); Ben-Josef, Edgar [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Williams, Andrew [University of Michigan Medical School, Ann Arbor, Mchigan (United States); Miller, Barbra S. [Division of Endocrine Surgery, Department of General Surgery, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Worden, Francis [Division of Hematology/Oncology, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Hammer, Gary D. [Division of Metabolism, Endocrinology, and Diabetes, Department of Internal Medicine, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States); Jolly, Shruti, E-mail: shrutij@med.umich.edu [Department of Radiation Oncology, University of Michigan Hospital and Health Systems, Ann Arbor, Mchigan (United States)

    2015-06-01

    Purpose: Adrenocortical carcinoma (ACC) is a rare malignancy known for high rates of local recurrence, though the benefit of postoperative radiation therapy (RT) has not been established. In this study of grossly resected ACC, we compare local control of patients treated with surgery followed by adjuvant RT to a matched cohort treated with surgery alone. Methods and Materials: We retrospectively identified patients with localized disease who underwent R0 or R1 resection followed by adjuvant RT. Only patients treated with RT at our institution were included. Matching to surgical controls was on the basis of stage, surgical margin status, tumor grade, and adjuvant mitotane. Results: From 1991 to 2011, 360 ACC patients were evaluated for ACC at the University of Michigan (Ann Arbor, MI). Twenty patients with localized disease received postoperative adjuvant RT. These were matched to 20 controls. There were no statistically significant differences between the groups with regard to stage, margins, grade, or mitotane. Median RT dose was 55 Gy (range, 45-60 Gy). Median follow-up was 34 months. Local recurrence occurred in 1 patient treated with RT, compared with 12 patients not treated with RT (P=.0005; hazard ratio [HR] 12.59; 95% confidence interval [CI] 1.62-97.88). However, recurrence-free survival was no different between the groups (P=.17; HR 1.52; 95% CI 0.67-3.45). Overall survival was also not significantly different (P=.13; HR 1.97; 95% CI 0.57-6.77), with 4 deaths in the RT group compared with 9 in the control group. Conclusions: Postoperative RT significantly improved local control compared with the use of surgery alone in this case-matched cohort analysis of grossly resected ACC patients. Although this retrospective series represents the largest study to date on adjuvant RT for ACC, its findings need to be prospectively confirmed.

  5. Surgical myectomy for hypertrophic cardiomyopathy in the 21st century, the evolution of the "RPR" repair: resection, plication, and release.

    Science.gov (United States)

    Swistel, Daniel G; Balaram, Sandhya K

    2012-01-01

    Since its first description in the 1950s, the pathophysiology of hypertrophic cardiomyopathy has been clarified by advanced echocardiographic technologies. Improved pharmacotherapy now successfully treats most afflicted individuals. Along with these advances, surgical management has also evolved, as the role of the mitral valve and the subvalvular structures in causing obstruction has been identified. Over the last 2 decades, a variety of options to surgically manage the complex patient with obstruction have been described. Successful surgical management is dependent on the complete evaluation of the causes of obstruction in the specific individual, as the heterogeneity of the anatomy may confound the direction of therapy. Mitral valve replacement may no longer be necessary in individuals who have a relatively thin septum and instead obstruct from an elongated mitral anterior leaflet or the presence of accessory papillary muscles and chords. Techniques for mitral valve plication have been successfully used with mid- to long-term success. A systematic strategy for the evaluation of obstruction in hypertrophic cardiomyopathy and the various surgical options are summarized in a procedure termed RPR for resection (extended myectomy), plication (mitral valve shortening), and release (papillary muscle manipulation).

  6. Dural Tail Sign in the Resection of Ventral Foramen Magnum Meningiomas via a Far Lateral Approach: Surgical Implications.

    Science.gov (United States)

    Wu, Bo; Shen, Shang-Hang; Chen, Long-Yi; Liu, Wei-Dong

    2015-11-01

    To investigate the implications of dural tail sign (DTS) in the tailored far lateral approach for resection of ventral foramen magnum meningiomas (FMMs). Clinical data for 16 patients treated surgically for ventral FMMs over 5 years were reviewed retrospectively. The DTS was positive in 11 cases (68.8%) and negative in 5 cases (31.2%). The most frequent form was a single cranial tail (7 of 11), followed by multiple tails consisting of a cranial tail and a caudal tail (3 of 11), and multiple tails composed of a cranial tail and a contralateral tail (1 of 11). The retrocondylar approach was carried out in 5 cases without DTS characterized by a narrow dural attachment and a partial transcondylar approach in 11 cases with DTS featuring a broad and hypervascular dural attachment. Drilling ranged from approximately one fifth to one third of the condyle with reference to the DTS form and tumor size. Total tumor removal was achieved in 16 patients. Postoperative complications were encountered in 25% of patients, predominantly associated with cranial nerve impairment. Follow-up ranging from 8 to 56 months (mean 24.4 months) showed no tumor recurrence. In addition to tumor dural attachment and tumor size, we propose that DTS should be considered as another factor in planning the surgical approach for ventral FMMs. Differentiation between a positive and negative DTS plays a role in the neurosurgical planning of ventral FMMs. Bone removal is warranted in tumors with DTS, particularly the multiple form with contralateral tails, to facilitate the surgical procedure and achieve a more radical resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Clinical and pathological characteristics of septum pellucidum tumor and choice of surgical approaches for its resection

    Institute of Scientific and Technical Information of China (English)

    WANG Lei; ZHANG Mao-zhi; ZHANG Wei; ZHAO Shang-feng; ZHAO Ji-zong; JIA Jin-xiu

    2005-01-01

    Background Tumor involving the septum pellucidum is uncommon. Surgery as the main therapeutic procedure for this lesion is a challenge to neurosurgeons. We analyzed the clinical characteristics and pathological features of septum pellucidum tumor in 41 patients and compared the curative effects of frontal transcortical, trans-sulcal and interhemispheric transcallosal approaches. Methods Clinical characteristics and the pathological features of septum pellucidum tumor were investigated retrospectively in 41 patients. The differences in postoperative residual rates, extents of tumors and resection of normal brain tissues after use of the three approaches in these patients were analyzed statistically. Results Septum pellucidum tumor is more likely to attack young or middle-aged persons. The tumor mainly presents itself as a central neurocytoma or cerebral low-grade glioma in pathology and manifests as intracranial hypertension clinically. No difference was found in the extent of tumor resection but significant difference in the extent of normal brain tissue resection and in postoperative disability rate among the three approaches. The transcortical approach brought about the most serious injury to brain tissue and the highest disability rate, Whereas the frontal transcallosal approach the lightest injury and the lowest disability rate. The injury to brain tissue and the disability rate brought about by the front trans-sulcus approach were between the above two approaches. Conclusions Operation is still regarded the major treatment for septum pellucidum tumor. Transcallosal and trans-sulcus approaches are fit with the concept of minimally invasive surgery, and transcallosal approach is the first choice for septum pellucidum tumor.

  8. Impact of Portal Vein Involvement from Pancreatic Cancer on Metastatic Pattern After Surgical Resection.

    Science.gov (United States)

    Mierke, Franz; Hempel, Sebastian; Distler, Marius; Aust, Daniela E; Saeger, Hans-Detlev; Weitz, Jürgen; Welsch, Thilo

    2016-12-01

    The present study aims to evaluate the long-term outcome and metastatic pattern of patients who underwent resection of a pancreatic ductal adenocarcinoma (PDAC) with portal or superior mesenteric vein (PV/SMV) resection. Patients who underwent a partial pancreatoduodenectomy or total pancreatectomy for PDAC between 2005 and 2015 were retrospectively analyzed. Three subgroups were generated, depending on PV/SMV resection (P(+)) and pathohistological PV/SMV tumor infiltration (I(+)): P(+)I(+), P(+)I(-), and P(-)I(-). Statistical analysis was performed using the R software package. The study cohort included 179 patients, 113 of whom underwent simultaneous PV/SMV resection. Thirty-six patients (31.9 %) had pathohistological tumor infiltration of the PV/SMV (P(+)I(+)), and were matched with 66 cases without PV/SMV infiltration (P(-)I(-)). The study revealed differences in overall median survival (11.9 [P(+)I(+)] vs. 16.1 [P(+)I(-)] vs. 20.1 [P(-)I(-)] months; p = 0.01). Multivariate survival analysis identified true invasion of the PV/SMV as the only significant, negative prognostic factor (p = 0.01). Whereas the incidence of local recurrence was comparable (p = 0.96), the proportion of patients with distant metastasis showed significant differences (75 % [P(+)I(+)] vs. 45.8 % [P(+)I(-)] vs. 54.7 % [P(-)I(-)], p = 0.01). Furthermore, the median time to progression was significantly shorter if the PV/SMV was involved (7.4 months [P(+)I(+)] vs. 10.9 months [P(+)I(-)] vs. 11.6 months [P(-)I(-)]). Initial liver metastases occurred in 33 % of the patients. True invasion of the PV/SMV is an independent risk factor for overall survival, and is associated with a higher incidence of distant metastasis and shorter progressive-free survival. Radical vascular resection cannot compensate for aggressive tumor biology.

  9. Pre-surgical integration of FMRI and DTI of the sensorimotor system in transcortical resection of a high-grade insular astrocytoma

    Directory of Open Access Journals (Sweden)

    Chelsea eEkstrand

    2016-03-01

    Full Text Available Herein we report on a patient with a WHO Grade III astrocytoma in the right insular region in close proximity to the internal capsule who underwent a right frontotemporal craniotomy. Total gross resection of insular gliomas remains surgically challenging based on the possibility of damage to the corticospinal tracts. However, maximizing the extent of resection has been shown to decrease future adverse outcomes. Thus, the goal of such surgeries should focus on maximizing extent of resection while minimizing possible adverse outcomes. In this case, pre-surgical planning included integration of functional magnetic resonance imaging (fMRI and diffusion tensor imaging (DTI, to localize motor and sensory pathways. Novel fMRI tasks were individually developed for the patient to maximize both somatosensory and motor activation simultaneously in areas in close proximity to the tumor. Information obtained was used to optimize resection trajectory and extent, facilitating gross total resection of the astrocytoma. Across all three motor-sensory tasks administered, fMRI revealed an area of interest just superior and lateral to the astrocytoma. Further, DTI analyses showed displacement of the corona radiata around the superior dorsal surface of the astrocytoma, extending in the direction of the activation found using fMRI. Taking into account these results, a transcortical superior temporal gyrus surgical approach was chosen in order to avoid the area of interest identified by fMRI and DTI. Total gross resection was achieved and minor post-surgical motor and sensory deficits were temporary. This case highlights the utility of comprehensive pre-surgical planning, including fMRI and DTI, to maximize surgical outcomes on a case-by-case basis.

  10. Immediate chest wall reconstruction during pregnancy: surgical management after extended surgical resection due to primary sarcoma of the breast.

    Science.gov (United States)

    Arruda, Eduardo Gustavo; Munhoz, Alexandre Mendonça; Montag, Eduardo; Filassi, José Roberto; Gemperli, Rolf

    2014-01-01

    Breast sarcoma during pregnancy is an extremely rare event and represents a complex problem because of a more advanced stage at presentation. This report presents the first case of a 24-year-old woman with a gestational age of 20 weeks with a fast growing tumour in her left breast (29 × 19 × 15 cm) and infiltrating the skin/pectoralis muscles. Radical mastectomy was performed with a gestational age of 22 weeks and a different design was planned for the latissimus dorsi musculocutaneous flap (LDMF) with primary closure in the V-Y pattern. Satisfactory chest wall coverage and contour were achieved. Final histopathological findings allowed a diagnosis of undifferentiated sarcoma. With a gestational age of 37 weeks, a healthy infant was delivered by means of a caesarean section. The patient is currently in the second postoperative year and no recurrence has been observed. Management of a large breast sarcoma in a pregnant patient presents unique challenges in consideration of the potential risks to the foetus and the possible maternal benefit. The results of this study demonstrate that the VY-LDMF is a reliable technique and should be considered in cases of immediate large thoracic wound reconstruction. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Postoperative irradiation of laryngeal carcinoma--the prognostic value of tumour-free surgical margins.

    Science.gov (United States)

    Naudé, J; Dobrowsky, W

    1997-01-01

    Between 1972 and 1987, two hundred and five carcinoma patients were treated with surgery and postoperative radiotherapy. The histological confirmation of tumour-free margins was only predictive of significant differences in locoregional control in locally advanced disease. In addition, macroscopically assessed margins in advanced cases were predictive of survival probability. We suggest that the adjuvant radiotherapy was able to reduce the incidence of locoregional recurrence in the early stage microscopic positive group, hence the lack of a significant difference in the control rates. The effect on survival is therefore indirect. The advanced cases showed significantly reduced locoregional control rates and disease-specific survival times after macroscopic assessment of positive margins, possibly a sign of tumour extension beyond the margins of the radiation field. We compare our results with published reports of cases not receiving adjuvant therapy.

  12. Malignant Pancreatic Polypeptide Secreting Tumour of Islet Cells: A Case for Aggressive Surgical Palliation

    Directory of Open Access Journals (Sweden)

    R. D. Pullan

    1993-01-01

    at presentation at which time it was excised. Pancreatic duct obstruction occurred 3 years after excision causing severe pain on eating. Major palliative surgery, in the form of a pancreatico-jejunostomy, cured the severe symptoms. The patient survives, largely symptom free, over six years after original excision. This case illustrates the need for aggressive management of symptoms in tumours in which long term survival is possible despite locally advanced or metastatic disease.

  13. Cardiac inflammatory myofibroblastic tumor: does it recur after complete surgical resection in an adult?

    Directory of Open Access Journals (Sweden)

    Yang Xuedong

    2012-05-01

    Full Text Available Abstract Inflammatory myofibroblastic tumor is currently considered to be a low-grade neoplasm, and it rarely involves the heart. We reported a rare case of a 59-year-old female who received cardiac surgery for complete resection of inflammatory myofibroblastic tumor in the left atrium. Five months after surgery, the patient presented with acute cardiogenic pulmonary edema and subsequent sudden death due to a left atrial tumor which protruded into the left ventricle through mitral annulus during diastole. The recurrence of inflammatory myofibroblastic tumor in the left atrium was strongly suggested clinically.

  14. A randomized controlled trial comparing primary tumour resection plus systemic therapy with systemic therapy alone in metastatic breast cancer (PRIM-BC): Japan Clinical Oncology Group Study JCOG1017.

    Science.gov (United States)

    Shien, Tadahiko; Nakamura, Kenichi; Shibata, Taro; Kinoshita, Takayuki; Aogi, Kenjiro; Fujisawa, Tomomi; Masuda, Norikazu; Inoue, Kenichi; Fukuda, Haruhiko; Iwata, Hiroji

    2012-10-01

    This trial is being conducted to confirm the superiority, in terms of overall survival, of primary tumour resection plus systemic therapy to systemic therapy alone in patients with Stage IV breast cancer who are not refractory to primary systemic therapy. The inclusion criteria for the study are as follows: untreated patients with histologically confirmed invasive breast cancer with one or more measurable metastatic lesions diagnosed by radiological examination. All patients receive primary systemic therapy according to the estrogen receptor and human epidermal growth factor receptor type-2 status of the primary breast cancer after the first registration. After 3 months, the patients without disease progression are randomized to the primary tumour resection plus systemic therapy arm or the systemic therapy alone arm. The primary endpoint is the overall survival, and the secondary endpoints are proportion of patients without tumour progression at the metastatic sites, yearly local recurrence-free survival, proportion of local ulcer/local bleeding, yearly primary tumour resection-free survival, adverse events of chemotherapy, operative morbidity and serious adverse events. The patient recruitment was commenced in May 2011. Enrolment of 410 patients for randomization is planned over a 5 year recruitment period. We hereby report the details of the study.

  15. Does obesity affect the outcomes of pulmonary resections for lung cancer? A National Surgical Quality Improvement Program analysis.

    Science.gov (United States)

    Mungo, Benedetto; Zogg, Cheryl K; Hooker, Craig M; Yang, Stephen C; Battafarano, Richard J; Brock, Malcolm V; Molena, Daniela

    2015-04-01

    Obesity has increased dramatically in the American population during the past 2 decades. Approximately 35% of adults are obese. Although obesity represents a major health issue, the association between obesity and operative outcomes has been a subject of controversy. We queried the National Surgical Quality Improvement Program (NSQIP) database to determine whether an increased body mass index (BMI) affects the outcomes of pulmonary resection for lung cancer. We identified 6,567 patients with a diagnosis of lung cancer who underwent pulmonary resection from 2005 to 2012 in the NSQIP database. We stratified this population into 6 BMI groups according to the World Health Organization classification. The primary outcome measured was 30-day mortality; secondary outcomes included length of stay (LOS), operative time, and NSQIP-measured postoperative complications. We performed both unadjusted analysis and adjusted multivariable analysis, controlling for statistically significant variables. Adjusted multivariable logistic regression showed no increase in 30-day mortality, overall morbidity, and serious morbidity among obese patients. Adjusted Poisson regression revealed greater operative times for both obese and underweight patients compared with normal weight patients. Overall, obese patients were younger and had a greater percentage of preoperative comorbidities, including diabetes, hypertension, dyspnea, renal disease, and history of previous cardiac surgery. The prevalence of active smokers was greater among patients with low and normal BMI. Underweight patients had a greater risk-adjusted LOS relative to normal weight patients, whereas overweight and mildly obese patients had lesser risk-adjusted LOS. The results of our analysis suggest that obesity does not confer greater mortality and morbidity after lung resection. Copyright © 2015 Elsevier Inc. All rights reserved.

  16. Real-time Video-Streaming to Surgical Loupe Mounted Head-Up Display for Navigated Meningioma Resection.

    Science.gov (United States)

    Diaz, Roberto; Yoon, Jang; Chen, Robert; Quinones-Hinojosa, Alfredo; Wharen, Robert; Komotar, Ricardo

    2017-04-30

    Wearable technology interfaces with normal human movement and function, thereby enabling more efficient and adaptable use.We developed a wearable display system for use with intra-operative neuronavigation for brain tumor surgery. The Google glass head-up display system was adapted to surgical loupes with a video-streaming integrated hardware and software device for display of the Stealth S7 navigation screen. Phantom trials of surface ventriculostomy were performed. The device was utilized as an alternative display screen during cranial surgery. Image-guided brain tumor resection was accomplished using Google Glass head-up display of Stealth S7 navigation images. Visual display consists of navigation video-streaming over a wireless network. The integrated system developed for video-streaming permits video data display to the operating surgeon without requiring movement of the head away from the operative field. Google Glass head-up display can be used for intra-operative neuronavigation in the setting of intracranial tumor resection.

  17. CT-guided brachytherapy as salvage therapy for intrahepatic recurrence of HCC after surgical resection.

    Science.gov (United States)

    Schnapauff, Dirk; Collettini, Federico; Hartwig, Kerstin; Wieners, Gero; Chopra, Sascha; Hamm, Bernd; Gebauer, Bernhard

    2015-01-01

    Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurrence of HCC who have few therapeutic options. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Diabetes mellitus increases the risk of intrahepatic recurrence of hepatocellular carcinoma after surgical resection.

    Science.gov (United States)

    Choi, Yunseon; Choi, YoungKil; Choi, Chang Soo; Lee, Yun-Han

    2017-05-12

    The relationship between cancer and metabolism has recently been receiving attention. We investigated the prognostic influence of type 2 diabetes mellitus in patients with hepatocellular carcinoma (HCC) treated with curative resection. The records of 58 patients who underwent curative resection for HCC pT1-2N0M0 between 2010 and 2014 were reviewed retrospectively. Fourteen patients (24.1%) had diabetes mellitus at diagnosis. Local control (LC) was defined as time to recurrence in the liver. The median follow-up was 23.3 months. Relapses occurred in 20 patients (34.5%) during the follow-up period; 17 of them developed intrahepatic recurrence, which was associated with diabetes mellitus (p = 0.013) and alpha fetoprotein (AFP) levels >500 ng/mL (p = 0.019). Overall relapses (n = 20) were related to T stage (p = 0.044), AFP level (p = 0.005), and diabetes (p = 0.044). The 3-year local control (intrahepatic control), disease-free survival, and overall survival rates were 56.7%, 50.5%, and 84.3%, respectively. LC was affected by diabetes mellitus (p = 0.046), Barcelona Clinic Liver Cancer staging (pDiabetes was also associated with reduced LC in the subgroup with hepatitis B-related HCC (n = 44, p = 0.028). Diabetes mellitus is correlated with intrahepatic HCC recurrence after surgery. Greater attention should be paid to managing patients with HCC and diabetes mellitus.

  19. Uncommon features of surgically resected ALK-positive cavitary lung adenocarcinoma: a case report.

    Science.gov (United States)

    Takamori, Shinkichi; Yamaguchi, Masafumi; Taguchi, Kenichi; Edagawa, Makoto; Shimamatsu, Shinichiro; Toyozawa, Ryo; Nosaki, Kaname; Hirai, Fumihiko; Seto, Takashi; Takenoyama, Mitsuhiro; Ichinose, Yukito

    2017-12-01

    Some features found on chest computed tomography (CT), such as central tumor location, large pleural effusion, and the absence of a pleural tail, and a patient age of less than 60 years, have been suggested to be useful in predicting anaplastic lymphoma kinase (ALK) rearrangement in patients with non-small cell lung cancer (NSCLC).A 68-year-old female patient with a history of gynecological treatment was found to have a cavitary mass in the right lower lobe on an annual chest roentgenogram. The tumor was located in the peripheral area with a pleural tail showing no pleural effusion. In addition, two pure ground-glass-opacity nodules (p-GGNs) in the right upper lobe of the lung were detected on consecutive chest CT scans. The patient underwent right lower lobectomy, partial resection of the right upper lobe, and hilar mediastinal lymph node dissection for complete resection of each tumor. The pathological diagnosis was invasive mucinous adenocarcinoma with signet-ring cells for the cavitary mass in the right lower lobe and invasive adenocarcinoma for the rest of the p-GGNs; subcarinal lymph node metastasis was also detected. The ALK rearrangement was detected by fluorescence in situ hybridization from the cavitary mass. The patient underwent four cycles of cisplatin and vinorelbine chemotherapy as standard adjuvant chemotherapy for pStage III NSCLC. The ALK fusion gene status of NSCLC with atypical CT features should also be investigated.

  20. The Consequences of Surgical Trauma on Intra-Peritoneal Tumour Recurrence and/or Adhesion Formation

    NARCIS (Netherlands)

    S. ten Raa

    2007-01-01

    textabstractPeritoneal carcinomatosis and postoperative intra-abdominal adhesion formation still are genuine problems after potentially curative intra-abdominal surgery. The inflammatory reaction triggered by surgical trauma to the peritoneum not only promotes adhesion formation but also stimulates

  1. Surgical treatment for lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida: A case report.

    Science.gov (United States)

    Sato, Tatsuya; Yonezawa, Ikuho; Onda, Shingo; Yoshikawa, Kei; Takano, Hiromitsu; Shimamura, Yukitoshi; Okuda, Takatoshi; Kaneko, Kazuo

    2017-09-01

    A hyperlordosis deformity of the lumbar spine is relatively rare, and surgical treatment has not been comprehensively addressed. In this case report, we describe the clinical presentation, surgical treatment, and medium-term follow-up of a patient presenting with a progressive lumbar hyperlordosis deformity after resection of a spinal lipoma associated with spina bifida. The patient was a 20-year-old woman presenting with a progressive hyperlordosis deformity of the lumbar spine associated with significant back pain (visual analog pain score of 89/100 mm), but with no neurological symptoms. The lumbar lordosis (LL), measured on standing lateral view radiographs, was 114°, with a sagittal vertical axis (SVA) of -100 mm. The patient had undergone excision of a lipoma, associated with spina bifida of the lumbar spine, at 7 months of age.She was first evaluated at our hospital at 18 years of age for progressive spinal deformity and lumbago. An in situ fusion, from T5 to S1, using pedicle screws with bone graft obtained from the iliac crest, was performed. Postoperatively, the LL decreased to 93°, and the SVA decreased to -50 mm. The decision to not correct the hyperlordosis deformity fully was intentional. Seven years and 1 month postsurgery, the patient had no limitations in standing and walking and reported a pain score of 8/100 mm; there was no evidence of a loss of correction. Lumbar hyperlordosis after resection of a spinal lipoma associated with spina bifida is rare. Posterior fixation provided an effective treatment in this case. As the lumbar hyperlordosis deformity is often high, correction can be difficult. In this case, although the correction and fusion were performed in situ, there was no progression of either the deformity or the lumbago. Early detection remains an essential component of effective treatment, allowing correction when the spinal deformity is easily reversible.

  2. Distance between the rectal wall and mesorectal fascia measured by MRI: Effect of rectal distension and implications for preoperative prediction of a tumour-free circumferential resection margin

    Energy Technology Data Exchange (ETDEWEB)

    Slater, A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Halligan, S. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Taylor, S.A. [Department of Specialist Radiology, University College Hospital, London (United Kingdom); Marshall, M. [Intestinal Imaging Centre, St Mark' s Hospital, Northwick Park, London (United Kingdom)

    2006-01-15

    Aim: To determine the effect of rectal distension, used by some workers to facilitate staging, on mesorectal tissues. Subjects and methods: Ninety-seven consecutive rectal cancer staging MRI examinations were identified of which 76 were analysable: 48 studies were performed using rectal insufflation of 100 ml room air and 28 were performed without distension. Median age was 69 and 72 years, respectively. In each patient a single experienced observer measured the distance from the outer rectal wall to the inner margin of the mesorectal fascia at four locations (12, 3, 6 and 9 o'clock), excluding sites of tumour involvement, from the T1-weighted axial image at the level of the sacro-coccygeal junction. The two groups of measurements were compared using Mann-Whitney test statistic, and frequencies then categorized into <5 mm or {>=}5 mm, and compared using Fisher's exact test. Results: The median distance between the rectal wall and mesorectal fascia in the distended group was approximately half that found in the non-distended group, and significantly lower at the 3, 6 and 9 o'clock positions (p<0.001). 68/167 (41%) of measurements were 5 mm or less, compared with 19/104 (18%) in the non-distended group (p<0.001). Conclusion: Rectal distension before MRI significantly reduces the distance between the rectal wall and mesorectal fascia. Although this is advocated to facilitate visualization of the primary tumour, it potentially affects the accuracy with which a clear circumferential resection margin can be predicted.

  3. Surgical resection of a giant primary liposarcoma of the anterior mediastinum

    Science.gov (United States)

    Mani, Vishnu R.; Ofikwu, Godwin; Safavi, Ali

    2015-01-01

    This case describes the incidental finding and surgical removal of an 1.8-kg liposarcoma in the anterior mediastinum. These tumors are very rare and would normally present with symptoms of intrathoracic compression; however, this patient was completely asymptomatic. The case presentation and treatment rationale are described along with a brief review of existing literature. PMID:26410831

  4. Surgical resection of a giant primary liposarcoma of the anterior mediastinum

    OpenAIRE

    Mani, Vishnu R.; Ofikwu, Godwin; Safavi, Ali

    2015-01-01

    This case describes the incidental finding and surgical removal of an 1.8-kg liposarcoma in the anterior mediastinum. These tumors are very rare and would normally present with symptoms of intrathoracic compression; however, this patient was completely asymptomatic. The case presentation and treatment rationale are described along with a brief review of existing literature.

  5. Evaluating lanreotide as maintenance therapy after first-line treatment in patients with non-resectable duodeno-pancreatic neuroendocrine tumours.

    Science.gov (United States)

    Lepage, Côme; Dahan, Laetitia; Bouarioua, Nadia; Toumpanakis, Christos; Legoux, Jean-Louis; Le Malicot, Karine; Guimbaud, Rosine; Smith, Denis; Tougeron, David; Lievre, Astrid; Cadiot, Guillaume; Di Fiore, Frédéric; Bouhier-Leporrier, Karine; Hentic, Olivia; Faroux, Roger; Pavel, Marianne; Borbath, Ivan; Valle, Juan W; Rinke, Anja; Scoazec, Jean-Yves; Ducreux, Michel; Walter, Thomas

    2017-05-01

    Patients with metastatic or locally advanced, non-resectable, grade 1 or 2 well-differentiated duodeno-pancreatic (WDDP) NETs are treated following European guidelines. Patients (Pts) with aggressive disease, i.e. progressive and/or symptomatic metastases and/or with significant hepatic invasion (>30-50%), and/or bone metastases, anti-tumour therapy should receive systemic combination of chemotherapy once disease control is obtained. The aim is to stop chemotherapy until progression. REMINET is an academic randomized, double-blind, placebo-controlled, phase II/III study designed to evaluate lanreotide (LAN) as maintenance treatment after L1 chemotherapy in G1-G2 WDDP NET. Main eligibility criteria: adults pts with a metastatic (synchronous or metachronous) or locally advanced, non-resectable, grade 1 or 2 WDDP NETs and documented control disease after L1 therapy at least 4 weeks prior to randomization. 222 patients will be randomly assigned in a 1:1 ratio to receive 120mg LAN or placebo, every 28 days, until disease progression or unacceptable toxicity. The aim of the phase II part is to demonstrate a 6-months PFS >45% in LAN arm. Secondary endpoints are PFS according to central review, overall survival, safety and quality of life. A bio-bank of frozen blood will be constituted. The study is currently open in France, Germany, Belgium, United Kingdom and Ireland. A total of 25 patients are randomized (NCT02288377). Copyright © 2017 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

  6. Nodal Stage of Surgically Resected Non-Small Cell Lung Cancer and Its Effect on Recurrence Patterns and Overall Survival

    Energy Technology Data Exchange (ETDEWEB)

    Varlotto, John M., E-mail: john.varlotto@umassmemorial.org [Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (United States); Yao, Aaron N. [Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia (United States); DeCamp, Malcolm M. [Division of Thoracic Surgery, Department of Surgery, Northwestern Memorial Hospital, Chicago, Illinois (United States); Northwestern University School of Medicine, Chicago, Illinois (United States); Ramakrishna, Satvik [Northwestern University School of Medicine, Chicago, Illinois (United States); Recht, Abe [Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (United States); Flickinger, John [Department of Radiation Oncology, Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania (United States); Andrei, Adin [Northwestern University, Chicago, Illinois (United States); Reed, Michael F. [Pennsylvania State University College of Medicine, Hershey, Pennsylvania (United States); Heart and Vascular Institute, Pennsylvania State University-Hershey, Hershey, Pennsylvania (United States); Toth, Jennifer W. [Pennsylvania State University College of Medicine, Hershey, Pennsylvania (United States); Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Pennsylvania State University-Hershey, Hershey, Pennsylvania (United States); Fizgerald, Thomas J. [Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, Massachusetts (United States); Higgins, Kristin [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Zheng, Xiao [Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, Virginia (United States); Shelkey, Julie [Department of Anesthesiology, Columbia University, New York, New York (United States); and others

    2015-03-15

    Purpose: Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy (PORT) for patients with resected non-small cell lung cancer (NSCLC) with N2 involvement. We investigated the relationship between nodal stage and local-regional recurrence (LR), distant recurrence (DR) and overall survival (OS) for patients having an R0 resection. Methods and Materials: A multi-institutional database of consecutive patients undergoing R0 resection for stage I-IIIA NSCLC from 1995 to 2008 was used. Patients receiving any radiation therapy before relapse were excluded. A total of 1241, 202, and 125 patients were identified with N0, N1, and N2 involvement, respectively; 161 patients received chemotherapy. Cumulative incidence rates were calculated for LR and DR as first sites of failure, and Kaplan-Meier estimates were made for OS. Competing risk analysis and proportional hazards models were used to examine LR, DR, and OS. Independent variables included age, sex, surgical procedure, extent of lymph node sampling, histology, lymphatic or vascular invasion, tumor size, tumor grade, chemotherapy, nodal stage, and visceral pleural invasion. Results: The median follow-up time was 28.7 months. Patients with N1 or N2 nodal stage had rates of LR similar to those of patients with N0 disease, but were at significantly increased risk for both DR (N1, hazard ratio [HR] = 1.84, 95% confidence interval [CI]: 1.30-2.59; P=.001; N2, HR = 2.32, 95% CI: 1.55-3.48; P<.001) and death (N1, HR = 1.46, 95% CI: 1.18-1.81; P<.001; N2, HR = 2.33, 95% CI: 1.78-3.04; P<.001). LR was associated with squamous histology, visceral pleural involvement, tumor size, age, wedge resection, and segmentectomy. The most frequent site of LR was the mediastinum. Conclusions: Our investigation demonstrated that nodal stage is directly associated with DR and OS but not with LR. Thus, even some patients with, N0-N1 disease are at relatively high risk of local recurrence. Prospective

  7. Desmoid Fibromatosis of the Abdominal Wall: Surgical Resection and Reconstruction with Biological Matrix Egis®

    Directory of Open Access Journals (Sweden)

    Saveria Tropea

    2017-02-01

    Full Text Available Desmoid tumor is a rare monoclonal fibroblast proliferation that is regarded as benign. The clinical management of desmoid tumors is very complex and requires a multidisciplinary approach because of the unpredictable disease course. For those cases localized in the anterior abdominal wall, symptomatic and unresponsive to medical treatment, radical resection and reconstruction with a prosthetic device are indicated. We present here a case of desmoid fibromatosis of the left anterolateral abdominal wall with a marked increase of the mass that required a large excision followed by reconstruction with biological matrix. The fact that it can be incorporated in patient tissue without a fibrotic response and that it can resist future infections, together with a very competetive price, made the new collagen matrix Egis® our first choice.

  8. Evaluation of intraoperative radiotherapy for gastric carcinoma with D2 and D3 surgical resection

    Institute of Scientific and Technical Information of China (English)

    Huan-Long Qin; Chao-Hong Lin; Xiu-Long Zhang

    2006-01-01

    AIM: To study the proper sites and doses of intraoperative radiotherapy (IORT) for gastric carcinoma and the effects of this treatment.METHODS: A total of 106 patients with stage Ⅰ -Ⅳ gastric carcinoma who Received D2 or D3 radical operation combined with IORT were analyzed. Sixty-seven patients with gastric cancer of the antrum and body underwent distal gastrectomy. The sites of irradiation were at the celiac artery and hepatoduodenal ligment area. Another 39 patients with carcinoma of the cardia and upper part of the gastric body and whole stomach underwent proximal gastrectomy or total gastrectomy. The sites of irradiation for this group were the upper margin of the pancreas and the regional para-aorta. The therapeutic effects (including survival and complications) of these 106 cases Received operation combined with IORT (IORT group) were compared with 441 cases treated during the same time period by a radical operation alone (operation group).RESULTS: The radiation dose below 30 Gy was safe.The therapeutic method of the operation combined with IORT did not prolong the survival of patients with stage Ⅰ and Ⅳ gastric cancer, but the 5-year survival rates of patients with stage Ⅱ and Ⅲ gastric cancers were significantly improved. The 5-year survival rates of the stages Ⅲ cancer patients receiving D2 resection combined with IORT were markedly improved, while for those receiving D3 radical resection, only the postoperative 3- or 4-year survival rates were improved (P < 0.005-0.001). The 5-year survival rate for those patients was raised only by 4.7% (P > 0.05).CONCLUSION: The 5-year survival rates of patients lymphadenectomy combined with IORT were improved,and there was no influence on the postoperative complications and mortality.

  9. Isolated metastasis of colon cancer to the scapula: is surgical resection warranted?

    Directory of Open Access Journals (Sweden)

    Onesti Jill K

    2011-10-01

    Full Text Available Abstract Background Distant metastases from colon cancer spread most frequently to the liver and the lung. Risk factors include positive lymph nodes and high grade tumors. Isolated metastases to the appendicular skeleton are very rare, particularly in the absence of identifiable risk factors. Case report The patient was a 55 year old male with no previous personal or family history of colon cancer. Routine screening revealed a sigmoid adenocarcinoma. He underwent resection with primary anastomosis and was found to have Stage IIA colon cancer. He declined chemotherapy as part of a clinical trial, and eight months later was found to have an isolated metastasis in his right scapula. This was treated medically, but grew to 12 × 15 cm. The patient underwent a curative forequarter amputation and is now more than four years from his original colon surgery. Discussion Stage IIA colon cancers are associated with a high five year survival rate, and chemotherapy is not automatically given. If metastases occur, they are likely to arise from local recurrence or follow lymphatic dissemination to the liver or lungs. Isolated skeletal metastases are quite rare and are usually confined to the axial skeleton. To our knowledge, this is the first reported case of an isolated scapular metastasis in a patient with node negative disease. The decision to treat the recurrence with radiation and chemotherapy did not reduce the tumor, and a forequarter amputation was eventually required. Conclusion This case highlights the importance of adequately analyzing the stage of colon cancer and offering appropriate treatment. Equally important is the early involvement of a surgeon in discussing the timing of the treatment for recurrence. Perhaps if the patient had received chemotherapy or earlier resection, he could have been spared the forequarter amputation. The physician must also be aware of the remote possibility of an unusual presentation of metastasis in order to pursue

  10. {sup 18}F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Peungjesada, Silanath [University New Mexico, Department of Radiology, Albuquerque, NM (United States); Aloia, Thomas A. [University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Unit 444, Houston, TX (United States); Fox, Patricia [University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1411, Houston, TX (United States); Chasen, Beth [University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Unit 1483, Houston, TX (United States); Shin, Sooyoung; Loyer, Evelyne M. [University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States); Baiomy, Ali [Cairo University, National Cancer Center, Cairo (Egypt)

    2015-08-15

    To evaluate the patterns of {sup 18}F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUV{sub max} was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  11. Surgical resection of a renal cell carcinoma involving the inferior vena cava: the role of the cardiothoracic surgeon

    LENUS (Irish Health Repository)

    Parissis, Haralabos

    2010-11-05

    Abstract Background The techniques for the resection of renal tumors with IVC extension are based on the experience of individual units. We attempt to provide a logical approach of the surgical strategies in a stepwise fashion. Methods Over 6-years 9 patients with renal cell carcinoma invading the IVC, underwent surgery. There were 6 males. The extension was at level IV in 4 and III in 5 cases. CPB used in 8 and hypothermia and circulatory arrest in all patients with level IV disease. The results and an algorithm of the plan of action, as per level of extension are presented. Results Plan of action: For level I-II disease: No Cardiothoracic involvement, For level III: Cardiopulmonary Bypass (CPB) & control of the cavo-atrial junction. For level IV: use of brief periods of Circulatory Arrest & repair of the Cavotomy with a pericardial patch. Postoperative morbidity: prolonged ICU stay, 3 patients (33.3%); tracheostomy, 1 (11.1%); Sepsis, 2 (22.2%); CVA 1, (11.1%). Mortality: 2 patients (22.2%) Conclusions Total clearance of the IVC from an adherent tumor is important, therefore extensive level IV disease presents a surgical challenge. We recommend CPB for level III and brief periods of Total Circulatory Arrest (TCA) for level IV disease.

  12. Impact of obesity on the surgical outcome following repeat hepatic resection in Japanese patients with recurrent hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Tohru Utsunomiya; Masahiro Okamoto; Toshihumi Kameyama; Ayumi Matsuyama; Manabu Yamamoto; Megumu Fujiwara; Masaki Mori; Shiomi Aimitsu; Teruyoshi Ishida

    2008-01-01

    AIM:To evaluate the impact of obesity on the postoperative outcome after hepatic resection in patients with hepatocellular carcinoma (HCC).METHODS:Data from 328 consecutive patients with primary HCC and 60 patients with recurrent HCC were studied.We compared the surgical outcomes between the non-obese group (body mass index:BHI<25 kg/m2)and the obese group(BHI≥25 kg/m2).RESULTS:Following curative hepatectomy in patients with primary HCC,the incidence of postoperative complications and the long-term prognosis in the nonobese group(n=240) were comparable to those in the obese group(n=88).Among patients with recurrent HCC,the incidence of postoperative complications after repeat hepatectomy was not significantly different between the non-obese group(n=44) and the obese group(n=16).However,patients in the obese group showed a significantly poorer long-term prognosis than those in the non-obese group(P<0.05,five-year survival rate;51.9% and 92.0%,respectively).CONCLUSION:Obesity alone may not have an adverse effect on the surgical outcomes of patients with primary HCC.However,greater caution seems to be required when planning a repeat hepatectomy for obese patients with recurrent HCC.

  13. Surgical resection of a huge cemento-ossifying fibroma in skull base by intraoral approach.

    Science.gov (United States)

    Cheng, Xiao-Bing; Li, Yun-Peng; Lei, De-Lin; Li, Xiao-Dong; Tian, Lei

    2011-03-01

    Cemento-ossifying fibroma, also known as ossifying fibroma, usually occurs in the mandible and less commonly in the maxilla. The huge example in the skull base is even rare. We present a case of a huge cemento-ossifying fibroma arising below the skull base of a 30-year-old woman patient. Radiologic investigations showed a giant, lobulated, heterogeneous calcified hard tissue mass, which is well circumscribed and is a mixture of radiolucent and radiopaque, situated at the rear of the right maxilla to the middle skull base. The tumor expands into the right maxillary sinus and the orbital cavity, fusing with the right maxilla at the maxillary tuberosity and blocking the bilateral choanas, which caused marked proptosis and blurred vision. The tumor was resected successfully by intraoral approach, and pathologic examination confirmed the lesion to be a cemento-ossifying fibroma. This case demonstrates that cemento-ossifying fibroma in the maxilla, not like in the mandible, may appear more aggressive because the extensive growth is unimpeded by anatomic obstacles and that the intraoral approach can be used to excise the tumor in the skull base.

  14. [A surgically resected case of AFP and PIVKA-II producing gastric cancer with hepatic metastasis].

    Science.gov (United States)

    Tomono, Ayako; Wakahara, Tomoyuki; Kanemitsu, Kiyonori; Toyokawa, Akihiro; Teramura, Kazuhiro; Iwasaki, Takeshi

    2013-05-01

    A 78-year-old man was admitted for workup for a liver tumor. Both serum AFP and PIVKA-II levels were high (2260ng/ml and 806mAU/ml, respectively). Contrast-enhanced CT scan and MRI using Gd-EOB-DTPA demonstrated a liver tumor in segment 6 resembling the imaging patterns of hepatocellular carcinoma (HCC), while the upper gastrointestinal endoscopy revealed a type 2 gastric cancer in the gastric antrum. Although the liver metastasis of the gastric cancer was undeniable, we performed partial resection of segment 6 of the liver and distal gastrectomy under a preoperative diagnosis of double cancer. Histopathologically, gastric tumor consisted of two components, such as well differentiated adenocarcinoma and hepatoid adenocarcinoma. The histology of the liver tumor was similar to that of the hepatoid component in the stomach lesion. Immunohistochemical staining revealed both the gastric and the liver tumors to be positive for AFP and PIVKA-II, yielding a definite diagnosis of AFP and PIVKA-II producing gastric cancer with liver metastasis. Because many cases of this disease have liver metastases at presentation with confusing images with HCC, the diagnosis of liver tumors should be carefully differentiated in the gastric cancer patients with liver tumors, high serum AFP and PIVKA-II levels.

  15. Prognostic significance of CpG island methylator phenotype in surgically resected small cell lung carcinoma.

    Science.gov (United States)

    Saito, Yuichi; Nagae, Genta; Motoi, Noriko; Miyauchi, Eisaku; Ninomiya, Hironori; Uehara, Hirofumi; Mun, Mingyon; Okumura, Sakae; Ohyanagi, Fumiyoshi; Nishio, Makoto; Satoh, Yukitoshi; Aburatani, Hiroyuki; Ishikawa, Yuichi

    2016-03-01

    Methylation is closely involved in the development of various carcinomas. However, few datasets are available for small cell lung cancer (SCLC) due to the scarcity of fresh tumor samples. The aim of the present study is to clarify relationships between clinicopathological features and results of the comprehensive genome-wide methylation profile of SCLC. We investigated the genome-wide DNA methylation status of 28 tumor and 13 normal lung tissues, and gene expression profiling of 25 SCLC tissues. Following unsupervised hierarchical clustering and non-negative matrix factorization, gene ontology analysis was performed. Clustering of SCLC led to the important identification of a CpG island methylator phenotype (CIMP) of the tumor, with a significantly poorer prognosis (P = 0.002). Multivariate analyses revealed that postoperative chemotherapy and non-CIMP were significantly good prognostic factors. Ontology analyses suggested that the extrinsic apoptosis pathway was suppressed, including TNFRSF1A, TNFRSF10A and TRADD in CIMP tumors. Here we revealed that CIMP was an important prognostic factor for resected SCLC. Delineation of this phenotype may also be useful for the development of novel apoptosis-related chemotherapeutic agents for treatment of the aggressive tumor.

  16. Surgical treatment for early hepatocellular carcinoma: comparison of resection and liver transplantation.

    Science.gov (United States)

    Zhou, Jian; Wang, Zheng; Qiu, Shuang-Jian; Huang, Xiao-Wu; Sun, Jian; Gu, Wen; Fan, Jia

    2010-09-01

    The optimum strategy, hepatic resection (HR) or liver transplantation (LT), for treatment of early hepatocellular carcinoma (HCC) associated with liver diseases of Child-Pugh A is far from established. The aim of this study was to compare and determine which strategy is optimal for HCC fulfilling the Milan criteria. Consecutive data were collected in 1,018 HCC patients treated with HR and 89 HCC patients listed for LT (1 drop out for HCC progression) between January of 2003 and December of 2007. The independent prognostic factors identified by multivariate analysis were tumor size-plus-number, microscopic venous invasion, and operation type (LT or HR). When tumor size-plus-number was HR group. When tumor size-plus-number was >4 or microscopic venous invasion was present, OS was higher in the LT group. Since the pathological microscopic venous invasion was not easily available before operation which is limitation for widespread clinical use, thus in practice, we concluded that, for early HCC associated with Child-Pugh A cirrhosis, when tumor size-plus-number is >4, LT provides the best cure; when it is HR remains the initial treatment of choice.

  17. En bloc resection concept for endoscopic endonasal nasopharyngectomy: surgical anatomy and outcome

    Institute of Scientific and Technical Information of China (English)

    Hsu Ning-i; Shen Ping-hung; Chao Siew-shuen; Ong Yew-kwang; Li Cho-shun

    2014-01-01

    Background Nasopharyngeal carcinoma (NPC) patients have a 19%-56% locoregional recurrence rate after primary therapy.For those recurrent NPC (rNPC) patients,re-irradiation may cause some complications.In recent years,endoscopic endonasal nasopharyngectomy (EEN) has become a surgical option for rNPC patients.Here we introduce the concept of en bloc excision (EBE) technique for EEN,including the surgical technique and clinical outcomes.Methods A retrospective study was conducted covering September 2009 to May 2013,involving the collection of Iocoregional rNPC cases from two institutions (Kuang-Tien General Hospital (KTGH) in Taiwan and National University Health System (NUHS) in Singapore).These patients failed prior therapy and then underwent EEN.We reported the 2-year overall survival rate,the 2-year disease-free survival rate,and related complications.Results Nine patients (five from KTGH and four from NUHS) completed this study,with five,two,and two patients of recurrence tumors (rT1),rT2,and rT3,respectively.The mean age was 46.4 years (range 32-63); the mean follow-up period was 24.9 months (range 10-45).The 2-year survival rate and the 2-year disease-free rate were 100% and 80%,respectively,in five patients.No significant complications or cases of mortality occurred.Conclusions The EBE concept of EEN is suitable for early rT1 and has relatively encouraging short-term outcomes.In selected rT2,careful EBE can be performed by expanding the surgical field.A clear view of the internal carotid arteryrelated anatomy is indispensable.In the future,more series may be needed to determine the role of EEN in rNPC patients.

  18. Analysis of the learning curve for transurethral resection of the prostate. Is there any influence of musical instrument and video game skills on surgical performance?

    Science.gov (United States)

    Yamaçake, Kleiton Gabriel Ribeiro; Nakano, Elcio Tadashi; Soares, Iva Barbosa; Cordeiro, Paulo; Srougi, Miguel; Antunes, Alberto Azoubel

    2015-09-01

    To evaluate the learning curve for transurethral resection of the prostate (TURP) among urology residents and study the impact of video game and musical instrument playing abilities on its performance. A prospective study was performed from July 2009 to January 2013 with patients submitted to TURP for benign prostatic hyperplasia. Fourteen residents operated on 324 patients. The following parameters were analyzed: age, prostate-specific antigen levels, prostate weight on ultrasound, pre- and postoperative serum sodium and hemoglobin levels, weight of resected tissue, operation time, speed of resection, and incidence of capsular lesions. Gender, handedness, and prior musical instrument and video game playing experience were recorded using survey responses. The mean resection speed in the first 10 procedures was 0.36 g/min and reached a mean of 0.51 g/min after the 20(th) procedure. The incidence of capsular lesions decreased progressively. The operation time decreased progressively for each subgroup regardless of the difference in the weight of tissue resected. Those experienced in playing video games presented superior resection speed (0.45 g/min) when compared with the novice (0.35 g/min) and intermediate (0.38 g/min) groups (p=0.112). Musical instrument playing abilities did not affect the surgical performance. Speed of resection, weight of resected tissue, and percentage of resected tissue improve significantly and the incidence of capsular lesions reduces after the performance of 10 TURP procedures. Experience in playing video games or musical instruments does not have a significant effect on outcomes.

  19. The effect of an external hip joint stabiliser on gait function after surgery for tumours located around the circumference of the pelvis: analysis of seven cases of internal hemipelvectomy or proximal femur resection.

    Science.gov (United States)

    Akiyama, Toru; Saita, Kazuo; Ogura, Koichi; Kawai, Akira; Imanishi, Jungo; Yazawa, Yasuo; Kawashima, Noritaka; Ogata, Toru

    2016-03-01

    Limb-sparing resection of malignant pelvic tumours provides the opportunity for patients to obtain better post-operative mobility. However, because few studies have examined in detail the gait function of patients following pelvic tumour resection, the factors affecting gait performance remain to be clarified. Here, with the laboratory-based computer-assisted gait analysis, we evaluated these patients' gait objectively and the impact of a hip-stabilising supporter on gait improvement was simultaneously examined. Three-dimensional gait analysis was performed to obtain cross-sectional data for seven post-operative patients (mean age, 42.7 years; range, 20-61 years) who underwent various types of resection, including P1/4 internal hemipelvectomy (IH), P1/2/3 IH, and proximal femur resection with prosthetic reconstruction. To assess the immediate effects of a hip joint stabiliser, we instructed subjects to walk at their self-selected preferred speed and compared gait parameters with and without use of the hip stabiliser. At baseline, the average walking speed was 0.75 m/s (95% CI 0.53-0.97). As shown by the intra-subject comparison, the hip stabiliser increased walking speed in all but one subject, increasing both temporal and spatial parameters. Ground reaction force of operated limbs increased for some subjects, while step length increased on at least one side in all subjects. Improvement in the gait parameters is indicative of better control provided by the external hip stabiliser over the affected limb. Moreover, our findings show the potential of a biomechanical approach to improve gait function following pelvic tumour resection.

  20. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-09-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  1. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction - An alternative surgical technique for central pancreatic mass resection

    Directory of Open Access Journals (Sweden)

    Iswanto Sucandy

    2010-01-01

    Full Text Available Context: Central pancreatectomy has gained popularity in the past decade as treatment of choice for low malignant potential tumor in the midpancreas due to its ability to achieve optimal preservation of pancreatic parenchyma. Simultaneously, advancement in minimally invasive approach has contributed to numerous novel surgical techniques with significantly lower morbidity and mortality. With the purpose of improving patient outcomes, we describe a laparoscopic assisted central pancreatectomy with pancreaticogastrostomy as an alternative method to the previously described open central pancreatectomy with roux-en-y pancreaticojejunostomy reconstruction. Case Report: A 39 year old man presented to our clinic with a 2.5 cm neuroendocrine tumor at the neck of the pancreas. Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction was successfully performed. Operative time was 210 minutes with blood loss of 200 ml. Postoperative course was uneventful except for a minimal pancreatic leak which was controlled by an intraoperatively placed closed suction drain. At 2 week follow up, patient was asymptomatic with well preserved pancreatic endo and exocrine functions. Permanent pathology findings showed a well differentiated neuroendocrine tumor with negative margins and nodes. Conclusions: Laparoscopic assisted central pancreatectomy with pancreaticogastrostomy reconstruction is feasible and safe for a centrally located tumor. Laparoscopic assisted technique facilitates application of minimally invasive approach by increasing surgical feasibility in typically complex pancreatic operations.

  2. Systematic review of surgical innovation reporting in laparoendoscopic colonic polyp resection.

    Science.gov (United States)

    Currie, A; Brigic, A; Blencowe, N S; Potter, S; Faiz, O D; Kennedy, R H; Blazeby, J M

    2015-01-01

    The IDEAL framework (Idea, Development, Exploration, Assessment, Long-term study) proposes a staged assessment of surgical innovation, but whether it can be used in practice is uncertain. This study aimed to review the reporting of a surgical innovation according to the IDEAL framework. Systematic literature searches identified articles reporting laparoendoscopic excision for benign colonic polyps. Using the IDEAL stage recommendations, data were collected on: patient selection, surgeon and unit expertise, description of the intervention and modifications, outcome reporting, and research governance. Studies were categorized by IDEAL stages: 0/1, simple technical preclinical/clinical reports; 2a, technique modifications with rationale and safety data; 2b, expanded patient selection and reporting of both innovation and standard care outcomes; 3, formal randomized controlled trials; and 4, long-term audit and registry studies. Each stage has specific requirements for reporting of surgeon expertise, governance details and outcome reporting. Of 615 abstracts screened, 16 papers reporting outcomes of 550 patients were included. Only two studies could be put into IDEAL categories. One animal study was classified as stage 0 and one clinical study as stage 2a through prospective ethical approval, protocol registration and data collection. Studies could not be classified according to IDEAL for insufficient reporting details of patient selection, relevant surgeon expertise, and how and why the technique was modified or adapted. The reporting of innovation in the context of laparoendoscopic colonic polyp excision would benefit from standardized methods. © 2015 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  3. A Rare Case of Endolymphatic Sac Tumour: Clinicopathologic Study and Surgical Management

    Directory of Open Access Journals (Sweden)

    Emanuele Ferri

    2014-01-01

    Full Text Available Objective. Endolymphatic sac tumor (ELST is a rare neoplasm arising from the intrapetrous portion of the endolymphatic sac, either isolated or in association with the von Hippel-Lindau disease. We report a sporadic case of ELST with an overview of the literature and a discussion of clinic-radiological, histopathologic, and surgical findings. Case Report. A young woman presented with a progressive hearing loss in the left ear. Otoscopy showed a reddish, bleeding hypotympanic mass. CT demonstrated an expansile lytic mastoid lesion extending to the middle ear, with bone erosion. MRI confirmed a lesion of increased signal on T1-weighted sequences. The patient underwent a canal wall-down tympanoplasty with complete removal of the tumor. Histopathology was consistent with a papillary ELST. Immunohistochemistry was positive for cytokeratin and chromogranin A. Conclusion. This paper highlights the rarity of ELST, the need for an accurate neuroradiological and immunohistochemical study at the early stages, and the timeliness of surgical treatment.

  4. High mortality rates after non-elective colon cancer resection

    DEFF Research Database (Denmark)

    Bakker, I S; Snijders, H S; Grossmann, Irene

    2016-01-01

    AIM: Colon cancer resection in a non-elective setting is associated with high rates of morbidity and mortality. The aim of this retrospective study is to identify risk factors for overall mortality after colon cancer resection with a special focus on non-elective resection. METHOD: Data were...... obtained from the Dutch Surgical Colorectal Audit. Patients undergoing colon cancer resection in the Netherlands between January 2009 and December 2013 were included. Patient, treatment and tumour factors were analyzed in relation to the urgency of surgery. The primary outcome was the thirty day...... postoperative mortality. RESULTS: The study included 30,907 patients. In 5934 (19.2%) of patients, a non-elective colon cancer resection was performed. There was a 4.4% overall mortality rate, with significantly more deaths after non-elective surgery (8.5% vs 3.4%, P

  5. Predicting lung cancer prior to surgical resection in patients with lung nodules.

    Science.gov (United States)

    Deppen, Stephen A; Blume, Jeffrey D; Aldrich, Melinda C; Fletcher, Sarah A; Massion, Pierre P; Walker, Ronald C; Chen, Heidi C; Speroff, Theodore; Degesys, Catherine A; Pinkerman, Rhonda; Lambright, Eric S; Nesbitt, Jonathan C; Putnam, Joe B; Grogan, Eric L

    2014-10-01

    Existing predictive models for lung cancer focus on improving screening or referral for biopsy in general medical populations. A predictive model calibrated for use during preoperative evaluation of suspicious lung lesions is needed to reduce unnecessary operations for a benign disease. A clinical prediction model (Thoracic Research Evaluation And Treatment [TREAT]) is proposed for this purpose. We developed and internally validated a clinical prediction model for lung cancer in a prospective cohort evaluated at our institution. Best statistical practices were used to construct, evaluate, and validate the logistic regression model in the presence of missing covariate data using bootstrap and optimism corrected techniques. The TREAT model was externally validated in a retrospectively collected Veteran Affairs population. The discrimination and calibration of the model was estimated and compared with the Mayo Clinic model in both the populations. The TREAT model was developed in 492 patients from Vanderbilt whose lung cancer prevalence was 72% and validated among 226 Veteran Affairs patients with a lung cancer prevalence of 93%. In the development cohort, the area under the receiver operating curve (AUC) and Brier score were 0.87 (95% confidence interval [CI], 0.83-0.92) and 0.12, respectively compared with the AUC 0.89 (95% CI, 0.79-0.98) and Brier score 0.13 in the validation dataset. The TREAT model had significantly higher accuracy (p < 0.001) and better calibration than the Mayo Clinic model (AUC = 0.80; 95% CI, 75-85; Brier score = 0.17). The validated TREAT model had better diagnostic accuracy than the Mayo Clinic model in preoperative assessment of suspicious lung lesions in a population being evaluated for lung resection.

  6. Enhanced Metastatic Recurrence Via Lymphatic Trafficking of a High-Metastatic Variant of Human Triple-Negative Breast Cancer After Surgical Resection in Orthotopic Nude Mouse Models.

    Science.gov (United States)

    Yano, Shuya; Takehara, Kiyoto; Tazawa, Hiroshi; Kishimoto, Hiroyuki; Kagawa, Shunsuke; Bouvet, Michael; Fujiwara, Toshiyoshi; Hoffman, Robert M

    2017-03-01

    We previously developed and characterized a highly invasive and metastatic triple-negative breast cancer (TNBC) variant by serial orthotopic implantation of MDA-MB-231 human breast cancer cells in nude mice. Eventually, a highly invasive and metastatic variant of human TNBC was isolated after lymph node metastases was harvested and orthotopically re-implanted into the mammary gland of nude mice for two cycles. The variant thereby isolated is highly invasive in the mammary gland and metastasized to lymph nodes in 10 of 12 mice compared to 2 of 12 of the parental cell line. In the present report, we observed that high-metastatic MDA-MB-231H-RFP cells produced significantly larger subcutaneous tumors compared with parental MDA-MB-231 cells in nude mice. Extensive lymphatic trafficking by high-metastatic MDA-MB-231 cells was also observed. High-metastatic MDA-MB-231 developed larger recurrent tumors 2 weeks after tumor resection compared with tumors that were not resected in orthotopic models. Surgical resection of the MDA-MB-231 high-metastatic variant primary tumor in orthotopic models also resulted in rapid and enhanced lymphatic trafficking of residual cancer cells and extensive lymph node and lung metastasis that did not occur in the non-surgical mice. These results suggest that surgical resection of high metastatic TNBC can greatly increase the malignancy of residual cancer. J. Cell. Biochem. 118: 559-569, 2017. © 2016 Wiley Periodicals, Inc.

  7. Effect of Neoadjuvant Chemotherapy on Improvement of Surgical Resectibility and Survival of Patients with Stage ⅢA Non Small Cell Lung Cancer

    Institute of Scientific and Technical Information of China (English)

    LIJian; YULichao; 等

    2002-01-01

    Ojbective To assess the effect of neoadjuvant chemotherapy on surgical resectibility and survival in patients with stage ⅢA non small cell lung cancer(NSCLC).Methods 42 patients with stage ⅢA NSCLC were randomized to receive either two cycles chemotherapy followed by surgery(neoadjuvant chemotherapy group)or surgery alone(surgery alone group).All patients received four cycles chemotherapy after surgery.Results The overall response to chemotherapy was 42.9%(38.1% partial response and 4.8% complete response).Toxicity of chemotherapy was minor and consisted mainly of gastroenterological side effects and myelosuppression.Patients treated with neoadjuvant chemotherapy had estimated surgical resection rate of 95.2%(n=20)and a complete resection rate in 52.4%(n=11) compared to 66.7%(n=14)and 28.6%(n=6)respectively,for patients with surgery alone(P<0.05).None of the patients died from the operation.The median survival was 24.6 months in the neoadjuvant chemotherapy group as compared to only 10.8 months in the surgery alone group(P<0.05).The 2-year survival rate was 57.1% in the chemotherapy group as compared to 28.6% in the surgery alone group(P<0.05).Conclusion Neoadjuvant chemotherapy improves the surgical resectibility and increases the median survival and 2-year survival rate of patients with stage ⅢA NSCLC.

  8. Management of cannabis-induced periodontitis via resective surgical therapy: A clinical report.

    Science.gov (United States)

    Momen-Heravi, Fatemeh; Kang, Philip

    2017-03-01

    There is a lack of clinical research on the potential effect of cannabis use on the periodontium as well as its effect on treatment outcomes. The aim of this case report is to illustrate the clinical presentation of periodontal disease in a young woman who was a chronic cannabis user, as well as successful treatment involving motivating the patient to quit cannabis use and undergo nonsurgical and surgical therapy. A 23-year-old woman sought care at the dental clinic for periodontal treatment. During a review of her medical history, the patient reported using cannabis frequently during a 3-year period, which coincided with the occurrence of gingival inflammation. She used cannabis in the form of cigarettes that were placed at the mandibular anterior region of her mouth for prolonged periods. Localized prominent papillary and marginal gingival enlargement of the anterior mandible were present. The mandibular anterior teeth showed localized severe chronic periodontitis. The clinicians informed the patient about the potentially detrimental consequences of continued cannabis use; she was encouraged to quit, which she did. The clinicians performed nonsurgical therapy (scaling and root planing) and osseous surgery. The treatment outcome was evaluated over 6 months; improved radiographic and clinical results were observed throughout the follow-up period. Substantial availability and usage of cannabis, specifically among young adults, requires dentists to be vigilant about clinical indications of cannabis use and to provide appropriate treatments. Behavioral modification, nonsurgical therapy, and surgical therapy offer the potential for successful management of cannabis-related periodontitis. Copyright © 2017 American Dental Association. Published by Elsevier Inc. All rights reserved.

  9. Diagnostic performance of FDG PET/CT for surveillance in asymptomatic gastric cancer patients after curative surgical resection

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jeong Won [Catholic Kwandong University College of Medicine, Department of Nuclear Medicine, International St. Mary' s Hospital, Incheon (Korea, Republic of); Lee, Sang Mi [Soonchunhyang University Hospital, Department of Nuclear Medicine, 23-20 Byeongmyeong-dong, Dongnam-gu, Chungcheongnam-do, Cheonan (Korea, Republic of); Son, Myoung Won; Lee, Moon-Soo [Soonchunhyang University Hospital, Department of Surgery, Cheonan (Korea, Republic of)

    2016-05-15

    The present study evaluated the diagnostic performance of 2-[{sup 18}F] fluoro-2-deoxy-d-glucose (FDG) positron emission tomography/computed tomography (PET/CT) for surveillance in asymptomatic gastric cancer patients after curative surgical resection. We retrospectively recruited 190 gastric cancer patients (115 early gastric cancer patients and 75 advanced gastric cancer patients) who underwent 1-year (91 patients) or 2-year (99 patients) postoperative FDG PET/CT surveillance, along with a routine follow-up program, after curative surgical resection. All enrolled patients were asymptomatic and showed no recurrence on follow-up examinations performed before PET/CT surveillance. All PET/CT images were visually assessed and all abnormal findings on follow-up examinations including FDG PET/CT were confirmed with histopathological diagnosis or clinical follow-up. During follow-up, 19 patients (10.0 %) developed recurrence. FDG PET/CT showed abnormal findings in 37 patients (19.5 %). Among them, 16 patients (8.4 %) were diagnosed as cancer recurrence. Of 153 patients without abnormal findings on PET/CT, three patients were false-negative and diagnosed as recurrence on other follow-up examinations. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG PET/CT were 84.2 %, 87.7 %, 43.2 %, and 98.0 %, respectively. Among 115 early gastric cancer patients, PET/CT detected recurrence in four patients (3.5 %) and one patient with local recurrence. Among 75 advanced gastric cancer patients, PET/CT detected recurrence in 12 patients (16.0 %), excluding two patients experiencing peritoneal recurrence. In addition, FDG PET/CT detected secondary primary cancer in six (3.2 %) out of all the patients. Post-operative FDG PET/CT surveillance showed good diagnostic ability for detecting recurrence in gastric cancer patients. FDG PET/CT could be a useful follow-up modality for gastric cancer patients, especially those with advanced gastric cancer

  10. [Tumours of the upper cervical spine].

    Science.gov (United States)

    Hernández García, Borja Jesús; Isla Guerrero, Alberto; Castaño, Ana; Alvarez Ruiz, Fernando; Gómez de la Riva, Alvaro

    2013-01-01

    Vertebral tumours arising in the upper cervical spine are rare. We present our experience in managing these neoplasms. We retrospectively reviewed the case histories of patients treated at our institution between January 2000 and June 2011. There were 9 patients with tumours in C1-C2-C3: 2metastases, 3chordomas, 2plasmocytomas, 1chondrosarcoma and 1osteochondroma. All patients complained of neck pain at the time of diagnosis. Three patients underwent an anterior and posterior approach, 3 an exclusively posterior approach and 3 an exclusively anterior surgical approach. Tumour resection was intralesional in 7 cases. Chemo-radiotherapy was used as adjuvant therapy in patients with malignant tumours. Vertebral tumours in the upper cervical spine are usually malignant. Achieving en bloc resection is particularly challenging and is technically unfeasible in many cases. This worsens the prognosis and makes adjuvant treatment very important. Copyright © 2012 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  11. Postoperative Complications, In-Hospital Mortality and 5-Year Survival After Surgical Resection for Patients with a Pancreatic Neuroendocrine Tumor: A Systematic Review.

    Science.gov (United States)

    Jilesen, Anneke P J; van Eijck, Casper H J; in't Hof, K H; van Dieren, S; Gouma, Dirk J; van Dijkum, Els J M Nieveen

    2016-03-01

    Studies on postoperative complications and survival in patients with pancreatic neuroendocrine tumors (pNET) are sparse and randomized controlled trials are not available. We reviewed all studies on postoperative complications and survival after resection of pNET. A systematic search was performed in the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE from 2000-2013. Inclusion criteria were studies of resected pNET, which described postoperative complications separately for each surgical procedure and/or 5-year survival after resection. Prospective and retrospective studies were pooled separately and overall pooled if heterogeneity was below 75%. The random-effect model was used. Overall, 2643 studies were identified and after full-text analysis 62 studies were included. Pancreatic fistula (PF) rate of the prospective studies after tumor enucleation was 45%; PF-rates after distal pancreatectomy, pancreatoduodenectomy, or central pancreatectomy were, respectively, 14-14-58%. Delayed gastric emptying rates were, respectively, 5-5-18-16%. Postoperative hemorrhage rates were, respectively, 6-1-7-4%. In-hospital mortality rates were, respectively, 3-4-6-4%. The 5-year overall survival (OS) and disease-specific survival (DSS) of resected pNET without synchronous resected liver metastases were, respectively, 85-93%. Heterogeneity between included studies on 5-year OS in patients with synchronous resected liver metastases was too high to pool all studies. The 5-year DSS in patients with liver metastases was 80%. Morbidity after pancreatic resection for pNET was mainly caused by PF. Liver resection in patients with liver metastases seems to have a positive effect on DSS. To reduce heterogeneity, ISGPS criteria and uniform patient groups should be used in the analysis of postoperative outcome and survival.

  12. 5-Amino-4-oxopentanoic acid photodynamic diagnosis guided microsurgery and photodynamic therapy on VX2 brain tumour implanted in a rabbit model

    Institute of Scientific and Technical Information of China (English)

    XIAO Hong; LIAO Qiong; CHENG Ming; LI Fei; XIE Bing; LI Mei; FENG Hua

    2009-01-01

    Background Complete tumour resection is important for improving the prognosis of brain tumour patients. However,extensive resection remains controversial because the tumour margin is difficult to be distinguished from surrounding brain tissue. It has been established that 5-amino-4-oxopentanoic acid (5-aminolevulinic acid, ALA) can be used as a photodynamic diagnostic marker and a photosensitizer for photodynamic therapy in surgical treatment of brain tumours. We investigated the efficacy of ALA photodynamically guided microsurgery and photodynamic therapy on VX2 brain tumour implanted in a rabbit model.Methods Eighty New Zealand rabbits implanted with VX2 brain tumours were randomly assigned to five groups: control, conventional white light microsurgery, a photodynamic therapy group, a photodynamically guided microsurgery group and a group in which guided microsurgery was followed by photodynamic therapy. The VX2 tumour was resected under a surgical microscope. The tumour resection was confirmed with histological analysis. All animals were examined with MRI for presence of any residual tumour tissue. The survival time of each rabbit was recorded.Results All treatment groups showed a significantly extended survival time compared with the control group.Photodynamically guided microsurgery combined with photodynamic therapy significantly prolonged survival time, compared with guided microsurgery alone. MRI and the autopsy results confirmed removal of most of the tumours.Conclusions Our results suggest that photodynamically guided surgery and photodynamic therapy significantly reduce or delay local recurrence, increase the effectiveness of radical resection and prolong the survival time of tumour bearing rabbits, Their combination has the potential to be used as a rapid and highly effective treatment of metastatic brain tumours.

  13. Acute onset of generalised pruritus as presenting symptom of Klatskin tumour.

    Science.gov (United States)

    Tobbia, Patrick; Norris, Leslie A; Karimova, Nodira

    2012-08-08

    A 60-year-old Korean woman presented with generalised pruritus and abdominal pain. She was initially treated with oral antihistamine therapy, but upon progression of symptoms and jaundice involvement, she was found to have a Klatskin tumour. The patient was not a candidate for surgical resection and is currently undergoing palliative care.

  14. Extended mesometrial resection (EMMR): Surgical approach to the treatment of locally advanced cervical cancer based on the theory of ontogenetic cancer fields.

    Science.gov (United States)

    Wolf, Benjamin; Ganzer, Roman; Stolzenburg, Jens-Uwe; Hentschel, Bettina; Horn, Lars-Christian; Höckel, Michael

    2017-08-01

    Based on ontogenetic-anatomic considerations, we have introduced total mesometrial resection (TMMR) and laterally extended endopelvic resection (LEER) as surgical treatments for patients with cancer of the uterine cervix FIGO stages I B1 - IV A. For a subset of patients with locally advanced disease we have sought to develop an operative strategy characterized by the resection of additional tissue at risk for tumor infiltration as compared to TMMR, but less than in LEER, preserving the urinary bladder function. We conducted a prospective single center study to evaluate the feasibility of extended mesometrial resection (EMMR) and therapeutic lymph node dissection as a surgical treatment approach for patients with cervical cancer fixed to the urinary bladder and/or its mesenteries as determined by intraoperative evaluation. None of the patients received postoperative adjuvant radiotherapy. 48 consecutive patients were accrued into the trial. Median tumor size was 5cm, and 85% of all patients were found to have lymph node metastases. Complete tumor resection (R0) was achieved in all cases. Recurrence free survival at 5years was 54.1% (95% CI 38.3-69.9). The overall survival rate was 62.6% (95% CI 45.6-79.6) at 5years. Perioperative morbidity represented by grade II and III complications (determined by the Franco-Italian glossary) occurred in 25% and 15% of patients, respectively. We demonstrate in this study the feasibility of EMMR as a surgical treatment approach for patients with locally advanced cervical cancer and regional lymph node invasion without the necessity for postoperative adjuvant radiation. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Impact of thiopurines and anti-tumour necrosis factortherapy on hospitalisation and long-term surgical outcomesin ulcerative colitis

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    Ulcerative colitis (UC) is a chronic inflammatorycondition affecting the large bowel and is associatedwith a significant risk of both requirement for surgeryand the need for hospitalisation. Thiopurines, andmore recently, anti-tumour necrosis factor (aTNF)therapy have been used successfully to induce clinicalremission. However, there is less data available onwhether these agents prevent long-term colectomyrates or the need for hospitalisation. The focus of thisarticle is to review the recent and pertinent literatureon the long-term impact of thiopurines and aTNF onlong-term surgical and hospitalisation rates in UC. Datafrom population based longitudinal research indicatesthat thiopurine therapy probably has a protective roleagainst colectomy, if used in appropriate patients for asufficient duration. aTNF agents appear to have a shortterm protective effect against colectomy, but data islimited for longer periods. Whereas there is insufficientevidence that thiopurines affect hospitalisation, evidencefavours that aTNF therapy probably reduces the riskof hospitalisation within the first year of use, but it isless clear on whether this effect continues beyond thisperiod. More structured research needs to be conductedto answer these clinically important questions.

  16. Clinical impact of different detection methods for disseminated tumor cells in bone marrow of patients undergoing surgical resection of colorectal liver metastases: a prospective follow-up study

    Directory of Open Access Journals (Sweden)

    Tanke Hans J

    2010-04-01

    Full Text Available Abstract Background Large number of patients with colorectal liver metastasis show recurrent disease after curative surgical resection. Identification of these high-risk patients may guide therapeutic strategies. The aim of this study was to evaluate whether the presence of disseminated tumor cells in bone marrow from patients undergoing surgical resection of colorectal liver metastases can predict clinical outcome. Methods Sixty patients with colorectal liver metastases were planned for a curative resection between 2001 and 2007. All patients underwent bone marrow aspiration before surgery. Detection of tumor cells was performed using immunocytochemical staining for cytokeratin (CK-ICC combined with automated microscopy or indirectly using reverse transcription-polymerase chain reaction (RT-PCR. Results Disseminated tumor cells were found in 15 of the 46 patients (33% using CK-ICC and in 9 of 44 of the patients (20% using RT-PCR. Patients with negative results for RT-PCR had a significant better disease-free survival after resection of their liver metastases (p = 0.02. This group also showed significant better overall survival (p = 0.002. CK-ICC did not predict a worse clinical outcome. Conclusions The presence of disseminated tumor cells in bone marrow detected using RT-PCR did predict a worse clinical outcome. The presence of cells detected with CK-ICC did not correlate with poor prognosis.

  17. Three-year and five-year outcomes of surgical resection for pancreatic ductal adenocarcinoma: Long-term experiences in one medical center.

    Science.gov (United States)

    Hsu, Chih-Po; Hsu, Jun-Te; Liao, Chien-Hung; Kang, Shih-Ching; Lin, Being-Chuan; Hsu, Yu-Pao; Yeh, Chun-Nan; Yeh, Ta-Sen; Hwang, Tsann-Long

    2016-12-20

    Pancreatic ductal adenocarcinoma is one of the most malignant types of cancer. This study evaluated the 3-year and 5-year surgical outcomes associated with the cancer and determined whether statistically identified factors can be used to predict survival. This retrospective review was conducted from 1995 to 2010. Patients who had resectable pancreatic ductal adenocarcinoma and received surgical treatment were included. Cases of hospital mortality were excluded. The relationships between several clinicopathological factors and the survival rate were analyzed. A total of 223 patients were included in this study. The 3-year and 5-year survival rates were 21.4% and 10.1%, respectively, and the median survival was 16.1 months. Tumor size, N status, and resection margins were independent predictive factors for 3-year survival. Tumor size independently predicted 5-year survival. Tumor size is the most important independent prognostic factor for 3-year and 5-year survival. Lymph node status and the resection margins also independently affected the 3-year survival. These patient outcomes might be improved by early diagnosis and radical resection. Future studies should focus on the tumor biology of this aggressive cancer. Copyright © 2016. Published by Elsevier Taiwan.

  18. Neurohypophysis granular cell tumours. Upon neurohypophysis rare tumours; Les tumeurs a cellules granuleuses. Des tumeurs rares de la neurohypophyse

    Energy Technology Data Exchange (ETDEWEB)

    Barrande, G.; Kujas, M.; Gancel, A.; Turpin, G.; Bruckert, E.; Kuhn, J.M.; Luton, J.P. [Hopital Cochin, 75 - Paris (France)

    1995-10-01

    Granular cell tumours of neurohypophysis are rare. These tumours are more often encountered as incidental autopsy findings seen in up to 17 % of unselected adult autopsy cases. There are few reports of para-sellar granular cell tumours large enough to cause symptoms. We present three cases of neurohypophysis granular cell tumour and a review of the literature. In one patient, the asymptomatic granular cell tumour was incidentally discovered at surgical removal of a corticotrophic micro-adenoma. The remaining 2 patients had a symptomatic tumour which caused neurological symptoms such as visual disturbance and headaches and endocrine disorders such as hypopituitarism or hyper-prolactinaemia. In these 2 cases, computerized tomography showed a well-circumscribed, contrast-enhanced, intra-sellar and supra-sellar mass. Magnetic resonance imaging demonstrated an isointense gadolinium-enhanced mass in T1-weighted-images. Trans-sphenoidal partial resection was performed and histology was interpreted as a granular cell tumour. The immunohistochemical study was positive for glial fibrillary acidic protein (GEAP) and neuron specific enolase (NSE) in 1 of the 2 tumours and positive for S100 protein and vimentin in both tumours but negative for CD68. The histogenesis of neurohypophysis granular cell tumours is still controversial but ultrastructural and immunohistochemical studies support the theory that may arise from pituicytes, the glial cells of neurohypophysis. Management of these benign, slow growing, tumours is based mainly on neurosurgical resection. Data from the literature do not support a beneficial effect of post operative radiation therapy on postoperative recurrences. (authors). 23 refs., 4 figs., 1 tab.

  19. Initial single-port thoracoscopy to reduce surgical trauma during open en bloc chest wall and pulmonary resection for locally invasive cancer

    Science.gov (United States)

    Bayarri, Clara I.; de Guevara, Antonio Cueto Ladron; Martin-Ucar, Antonio E.

    2013-01-01

    OBJECTIVES En bloc pulmonary and chest wall resection is the preferred method of treatment for locally invasive lung carcinoma. However, it carries major trauma to the chest wall, especially in cases with chest wall involvement distant to the potential location of ‘traditional’ thoracotomies. We describe an alternative method of estimating the boundaries of chest wall resection employing video assisted thoracoscopic surgery (VATS) and hypodermic needles. METHODS VATS delineation of boundaries of chest wall involvement by lung cancer has been performed in six patients who gave written consent. In one case the single–port thoracoscopic examination revealed unexpected distant pleural metastases thus preventing from resection. The other 5 patients, three males and two females [median age of 60.5 (range 39 to 75) years] underwent en bloc anatomical lung resection in addition to chest wall excision and reconstruction for T3N0 lung cancer. RESULTS In these five cases the chest wall opening was restricted to the extent of the rib excision, and the pulmonary resection was performed via the existing chest wall opening without requiring extension of the thoracotomy or any rib spreading. DISCUSSION Minimally invasive techniques aid to delineate the boundaries of chest wall involvement of lung cancer and intraoperative staging. This helped tailoring the surgical approach and location of the thoracotomy, and prevented rib-spreading or additional thoracotomies in our cases. PMID:23592724

  20. [Results of surgical treatment of intrathoracic recurrence after complete resection of non-small cell lung cancer: clinical significance of subsequent lesion in lung parenchyma].

    Science.gov (United States)

    Saito, Y; Takahashi, S; Sato, M; Sagawa, M; Kanma, K; Usuda, K; Endo, C; Chen, Y; Sakurada, A; Aikawa, H

    1995-01-01

    Results of surgical treatment for 33 intrathoracic recurrence after complete resection of non-small cell lung cancer were analyzed. Prognosis of the second surgical treatment were favorable in patients with subsequent cancer with in situ component and solitary lesion in lung parenchyma. Retrospective study of 53 patients who recurred and were thoroughly followed up their clinical course until lung cancer death revealed that the solitary one tends to be confined to the intrathoracic location, and the multiple one did not confined to the intrathoracic location but also extended to the extrathoracic distant metastasis or to the supraclavicular lymph nodes.

  1. Extended cervico-thoracic metastasectomy for testicular non-seminomatous germ cell tumour masses through an inverse T and combined collar incision.

    Science.gov (United States)

    Schweiger, Thomas; Hoetzenecker, Konrad; Taghavi, Shahrokh; Klepetko, Walter

    2015-05-01

    Non-seminomatous germ cell tumours (NSGCT) are the most common malignancy from testicular origin in young males. They are characterized by early formation of metastases along retroperitoneal and subsequent mediastinal lymph node stations. Following cisplatin-based induction chemotherapy, residual tumour masses should be removed surgically, although this implies the need for extended procedures. Such an approach can result in cure rates of over 70%. Herein, we report 2 cases of maximally extended surgery for metastatic malignant germ cell tumour of the testis. In both patients, diagnostic work-up revealed a NSGCT with retroperitoneal, mediastinal and cervical lymph node metastases. Multimodal protocols including induction chemotherapy and surgical removal of all primary and secondary tumour masses with curative intent were applied. An 'inverse T' incision in combination with a collar incision was chosen to approach the excessive supra-diaphragmatic tumour spread. This large-scaled surgical access offered an excellent exposure and allowed complete resection of all cervical and thoracic metastases in both patients. Abdominal tumour masses were resected through a standard median laparotomy. These 2 cases illustrate that complete tumour resection is feasible even in stages of NSGCT with generalized lymphatic spread. Metastasectomy should be offered to NSGCT patients despite the necessity of extended surgical approaches.

  2. Use of Lugol's iodine in the resection of oral and oropharyngeal squamous cell carcinoma.

    Science.gov (United States)

    McMahon, Jeremy; Devine, John C; McCaul, James A; McLellan, Douglas R; Farrow, Adrian

    2010-03-01

    We evaluated the use of Lugol's iodine in achieving surgical margins free from dysplasia, carcinoma in situ, and invasive carcinoma by an observational study of two series of 50 consecutive patients having resection of oral and oropharyngeal squamous cell carcinoma (SCC) between November 2004 and March 2007. The standard group had resection of the primary tumour with a macroscopic 1cm margin and removal of adjacent visibly abnormal mucosa. The Lugol's iodine group had identical treatment with resection of any adjacent mucosa that did not stain after the application of Lugol's iodine (where this was feasible). In the standard group 16 patients (32%) had dysplasia, carcinoma in situ, or invasive SCC at a surgical margin. In the Lugol's iodine group two patients (4%) had dysplasia or carcinoma in situ; none had invasive SCC. Lugol's iodine is a simple, inexpensive, and apparently effective means of reducing the likelihood of unsatisfactory surgical margins in the resection of oral and oropharyngeal SCC.

  3. Predictors of circumferential resection margin involvement in surgically resected rectal cancer: A retrospective review of 23,464 patients in the US National Cancer Database

    Science.gov (United States)

    Al-Sukhni, Eisar; Attwood, Kristopher; Gabriel, Emmanuel; Nurkin, Steven J.

    2017-01-01

    Introduction The circumferential resection margin (CRM) is a key prognostic factor after rectal cancer resection. We sought to identify factors associated with CRM involvement (CRM+). Methods A retrospective review was performed of the National Cancer Database, 2004–2011. Patients with rectal cancer who underwent radical resection and had a recorded CRM were included. Multivariable analysis of the association between clinicopathologic characteristics and CRM was performed. Tumor patients, 13.3% were CRM+. Factors associated with CRM+ were diagnosis later in the study period, lack of insurance, advanced stage, higher grade, undergoing APR, and receiving radiation. Nearly half of CRM+ patients did not receive neoadjuvant therapy. CRM+ patients who did not receive neoadjuvant therapy were more likely to be female, older, with more comorbidities, smaller tumors, earlier clinical stage, advanced pathologic stage, and CEA-negative disease compared to those who received it. Conclusions Factors associated with CRM+ include features of advanced disease, undergoing APR, and lack of health insurance. Half of CRM+ patients did not receive neoadjuvant treatment. These represent cases where CRM status may be modifiable with appropriate pre-operative selection and multidisciplinary management. PMID:26906328

  4. High-grade ureteroscopic biopsy is associated with advanced pathology of upper-tract urothelial carcinoma tumors at definitive surgical resection.

    Science.gov (United States)

    Clements, Thomas; Messer, Jamie C; Terrell, John D; Herman, Michael P; Ng, Casey K; Scherr, Douglas S; Scoll, Benjamin; Boorjian, Stephen A; Uzzo, Robert G; Wille, Mark; Eggener, Scott E; Lucas, Steven M; Lotan, Yair; Shariat, Shahrokh F; Raman, Jay D

    2012-04-01

    Accurate assessment of upper-tract urothelial carcinoma (UTUC) pathology may guide use of endoscopic vs extirpative therapy. We present a multi-institutional cohort of patients with UTUC who underwent surgical resection to characterize the association of ureteroscopic (URS) biopsy features with final pathology results. URS biopsy data were available in 238 patients who underwent surgical resection of UTUC. Biopsies were performed using a brush biopsy kit, mechanical biopsy device, or basket. Stage was classified as a positive brush, nonmuscle-invasive (biopsy, 88/238 (37%) patients had a positive brush, 140 (59%) had a diagnosis of non-MI, and 10 (4%) had MI disease. Biopsy results showed low-grade cancer in 140 (59%) and high-grade cancer in 98 (41%). Pathologic evaluation at surgical resection demonstrated non-MI tumors in 140 (59%) patients, MI in 98 (41%), and high-grade disease in 150 (63%). On univariate analysis, high URS biopsy grade was associated with high-grade (positive predictive value [PPV] 92%, Pbiopsy stage, however, was associated with surgical pathology grade (P=0.005), but not MI (P=0.16) disease. On multivariate analysis, high URS grade, but not biopsy stage, was associated with high final pathology grade (hazard ratio [HR] 16.6, 95% confidence interval [CI] 7.0-39.5, Pbiopsy grade, but not stage, is associated with adverse tumor pathology. This information may play a valuable role for risk stratification and in the appropriate selection of endoscopic management vs surgical extirpation for UTUC.

  5. Small peripheral lung carcinomas with five-year post-surgical follow-up: assessment by semi-automated volumetric measurement of tumour size, CT value and growth rate on TSCT

    Energy Technology Data Exchange (ETDEWEB)

    Sone, Shusuke [JA Nagano Azumi General Hospital, Ikeda, Nagano (Japan); Nagano Health Promotion Corporation, Inasato, Nagano (Japan); Hanaoka, Takaomi [JA Nagano Azumi General Hospital, Department of Chest Surgery, Ikeda, Nagano (Japan); Ogata, Hiroyuki [JA Nagano Azumi General Hospital, Division of Clinical Laboratory and Pathology, Ikeda, Nagano (Japan); Takayama, Fumiyoshi [JA Nagano Azumi General Hospital, Department of Radiology, Ikeda, Nagano (Japan); Ichinose Neurosurgery Hospital, Matsumoto, Nagano (Japan); Watanabe, Tomofumi [Iida Municipal Hospital, Iida, Nagano (Japan); Haniuda, Masayuki [Aichi Medical University, Division of Chest Surgery, Aichi (Japan); Kaneko, Kazuhiko [Shinshu University School of Medicine, Department of Surgery, Matsumoto (Japan); Okaya-Enrei Hospital, Okaya, Nagano (Japan); Kondo, Ryoichi [National Chushin Matsumoto Hospital, Matsumoto (Japan); Yoshida, Kazuo [Shinshu University School of Medicine, Department of Surgery, Matsumoto (Japan); Honda, Takayuki [Shinshu University School of Medicine, Department of Laboratory Medicine, Matsumoto (Japan)

    2012-01-15

    To retrospectively assess the utility of semi-automated measurements by stratification of CT values of tumour size, CT value and doubling time (DT) using thin-section computed tomography (CT) images. The post-surgical outcomes of favourable and problematic tumours (more advanced p stage than IA, post-surgical recurrence or mortality from lung cancer) were compared using the measured values. The computed DTs were compared with manually measured values. The study subjects comprised 85 patients (aged 33-80 years, 48 women, 37 men), followed-up for more than 5 years postoperatively, with 89 lung lesions, including 17 atypical adenomatous hyperplasias and 72 lung cancers. DTs were determined in 45 lesions. For problematic lesions, whole tumour diameter and density were >18 mm and >-400 HU, respectively. The respective values for the tumour core (with CT values of -350 to 150 HU) were >15 mm and >-70 HU. Analysis of tumour core DTs showed interval tumour progression even if little progress was seen by standard tumour volume DT (TVDT). Software-based volumetric measurements by stratification of CT values provide valuable information on tumour core and help estimate tumour aggressiveness and interval tumour progression better than standard manually measured 2D-VDTs. (orig.)

  6. Correlation between the survival rate of the patients with synchronous hepatic metastases from gastric carcinoma after surgical resection and patient's index

    Institute of Scientific and Technical Information of China (English)

    YANG Xin-wei; LI Zhe; LIU Kai; FU Xiao-hui; YANG Jia-he; WU Meng-chao

    2012-01-01

    Background Many studies have reported the benefit of hepatic resection for solitary and metachronous metastases from gastric cancer.However,indications and surgical results for synchronous hepatic metastases from gastric carcinoma have not been clearly defined.This study was performed to assess the benefits and limits of simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases,as well as to identify prognostic factors affecting the survival.Methods Between January 2005 and June 2008,13 patients with synchronous hepatic metastases underwent simultaneous combined resection.The clinicopathologic features and the surgical results of the 13 patients were retrospectively analyzed.Patient,tumor (primary and metastatic carcinoma),and operative parameters were analyzed for their influence on survival.Results No patient died and two patients (15.4%) developed complications during peri-operative course.The actuarial 6-month,1-year,and 2-year survival rates after hepatic resection were 76.9%,38.5%,and 30.8%,respectively,and two patients survived for more than 2 years after surgery without any signs of recurrences until latest follow-up.In univariate analysis,hepatic tumor distribution (P=0.01) and number of hepatic metastases (P=0.003) were significant prognostic factors that influenced survival.Factors associated with the primary lesion were not significant prognostic factors.Conclusions Satisfactory survival may be achieved by simultaneous combined resection of both primary gastric cancer and synchronous hepatic metastases in strictly selected patients.The number of hepatic metastases and hepatic tumor distribution are significant prognostic determinants of survival.

  7. Diagnosis and surgical treatment of pancreatic endocrine tumours%胰腺内分泌肿瘤的诊断和外科治疗

    Institute of Scientific and Technical Information of China (English)

    蔡端; 张延龄

    2014-01-01

    Objective: To investigate the diagnosis and surgical treatment of pancreatic endocrine tumours (PET). Methods:The clinical data of 77 cases with PET from 1973 to 2006 in our hospital were analyzed retrospectively. Results: Forty-six (59.7%) cases were female. The functional PET accounted for 72.7% and benign 81.8%. Sixty-five (84.4%) cases were diagnosed as pancreatic lesions by CT and ultrasonography preoperatively. The single lesion was located at head (18.2%), body (28.6%) and tail (45.5%) of pancreas and 6 cases had multiple PET. The diameter of the largest tumor was 8 cm. All of 77 cases were identified by pathological examination, of which 43 (55.8%) cases were insulinoma, 7 cases gastrinoma, 5 cases glucagonoma, 1 case vipoma and 21 cases nonfunctional PET. Two cases with gastrinoma complicated parathyroidoma were diagnosed as multiple endocrine neoplasia type 1 (MEN1). The patients with glucagonoma experienced diabetes and skin damage. Vipoma patient had diarrhea and kaliopenia. Nonfunctioning PET cases showed upper abdominal pain. The mainway for the surgical treatment of PET was local tumor resection. Blood glucose was returned to normal postoperatively in 39 of 43 cases with insulinoma. The postoperative symptoms of the patients with gastrinoma, glucagonoma and vipoma disappeared or relieved at some extent. Pancreatic leakage was the main postoperative complication. Conclusions: The onset of PET conceals. The location of PET may be identiifed with ultrasonography and CT. The ifnal diagnosis depends on pathological examination. The prognosis of PET is better than that of pancreatic cancer obviously. Therefore the best selection to treat PET is to resect the lesion completely when the diagnosis is set up. However malignant PET with metastasis has higher postoperative mortality.%目的:探讨胰腺内分泌肿瘤(pancreatic endocrine tumours, PET)的临床特点,藉以提高临床诊治水平。方法:对我院1973年1月至2006年12月收治的77

  8. Increase in Annual Number of Pancreatic Head Resections Does not Affect Mortality of Pancreatic Cancer in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Efthymios Ypsilantis

    2009-07-01

    Full Text Available Dear Sir, Lee and Saif urged for new effective methods for early diagnosis of pancreatic head adenocarcinoma, emphasizing that at the time of initial presentation, the majority of patients have non-resectable tumours [1]. Also, Li and Saif, in their thorough overview of current advancements in the management of the disease, summarized that pancreatic cancer requires a multidisciplinary therapeutic approach that should aim to increase the chances of surgical resection [2].

  9. [Mandibular tumours: epidemology, diagnostic and therapeutic aspects concerning 91 cases].

    Science.gov (United States)

    Kpemissi, E; Amana, B; Tchandana, K

    2009-01-01

    Oro-facial tumours are frequent and raise post-operational functional and aesthetic problems. What might be the situation of the mandibular tumours at CHU Tokoin-Lome (University Hospital Centre of Lome-Tokion). The aim of this study was to determined epidemiological, diagnostic and therapeutic aspects concerning the mandibular tumours. This retrospective study concerning 91 colligated files from January 1988 to December 2006 at the Oto-rhino-laryngologic and Cervico-Maxillo-Facial Surgery Service of the University Hospital Centre ( CHU) of Lome-Tokoin. The main inclusion criteria was the anatomopathological examination of the tumour. The mandibular tumours represented 19.95% of the Oto-rhino-laryngological and Cervico-Maxillo-Facial tumours. They were diagnosed with annual average of 5 cases. The most affected age bracket was one going from 10 to 39 years , or the equivalent of 68.13% of the patients. The spreading of these tumours in both sexes was equal. 80.21% of patients were examined after a development period going from 0 to 4 years. The major circumstances of findings were the mandibular tumefaction (98.9%) dental or mandibular pains (48.35%). The favourite seat of these mandibular tumours was the hemi mandible (48.35%). The odontologic tumours were the predominant histological types or the equivalent of 64.84% of the mandibular tumours. The benign forms were the most frequent (72.88%), the ameloblastoma in particular. The treatment was a surgical one. The partial resection of the mandibular bone was the surgical technique that was the most used (67.03%). The short-term development was preferred (69%). The long-term follow-up was difficult. The mandibular tumours were relatively frequent and predominated by the ameloblastoma. The findings circumstances were predominated by the mandibular tumefaction. The treatment was the preservative surgery as advocated by the majority of authors.

  10. Surgical techniques in the radical resection of hilar cholangiocarcinoma%肝门部胆管癌根治性切除手术技巧

    Institute of Scientific and Technical Information of China (English)

    彭淑牖; 钱浩然

    2010-01-01

    @@ 肝门部胆管癌是具有挑战性的疑难病症,其根治性切除一直是外科医生不断追求的目标之一.围手术期治疗策略的优化,影像学技术的提高,特别是手术器械的改进为肝门部胆管癌治疗的发展起到了重要的推动作用[1].肝门部胆管癌手术策略的制定以及规范化操作是获得满意远期疗效的基础.%Hilar cholangiocarcinoma remains a formi-dable challenge to hepatopancreatobiliary surgeons since the reported resection of a primary cancer originating at the hepatic duct confluence by Brown and Myers in 1954. Emerging evidence has indicated that aggressive surgery with a curative resection offers a better option for long-term survival compared with conservative therapy. Liver transplantation has also been considered as a management opportunity for the treatment of cholangiocarcinoma. However, the survival rate has been poor due to the high proportion of disease recurrence. This review highlights recent techniques in hilar cholangiocarcinoma resec-tion, with special attention to the management of the resection margin, clinical skills of liver resection, lymph node clearance, and portal vein or hepatic artery resection or reconstruction. In addition, technical advances have been proposed in hepatopan-creatoduodenectomy and liver transplantation for hilar cholangio-carcinoma treatment. In the current hepatic procedures, promis-ing survival outcomes have been obtained in patients with hilar cholangiocarcinoma, exhibiting a decreased operative mortality and a steady improvement in long-term survival. Overall, the correct clinical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholan-giocarcinoma.

  11. Computer-aided hepatic tumour ablation requirements and preliminary results

    CERN Document Server

    Voirin, D; Amavizca, M; Letoublon, C; Troccaz, J; Voirin, David; Payan, Yohan; Amavizca, Miriam; Letoublon, Christian; Troccaz, Jocelyne

    2002-01-01

    Surgical resection of hepatic tumours is not always possible, since it depends on different factors, among which their location inside the liver functional segments. Alternative techniques consist in local use of chemical or physical agents to destroy the tumour. Radio frequency and cryosurgical ablations are examples of such alternative techniques that may be performed percutaneously. This requires a precise localisation of the tumour placement during ablation. Computer-assisted surgery tools may be used in conjunction with these new ablation techniques to improve the therapeutic efficiency, whilst they benefit from minimal invasiveness. This paper introduces the principles of a system for computer-assisted hepatic tumour ablation and describes preliminary experiments focusing on data registration evaluation. To keep close to conventional protocols, we consider registration of pre-operative CT or MRI data to intra-operative echographic data.

  12. Non-pituitary origin sellar tumours mimicking pituitary macroadenomas

    Energy Technology Data Exchange (ETDEWEB)

    Abele, T.A., E-mail: travaus@gmail.com [University of Texas Southwestern Medical Center at Dallas, Dallas, TX (United States); Yetkin, Z.F.; Raisanen, J.M.; Mickey, B.E.; Mendelsohn, D.B. [University of Texas Southwestern Medical Center at Dallas, Dallas, TX (United States)

    2012-08-15

    Although the large majority of sellar tumours are pituitary adenomas, several other pituitary and non-pituitary origin tumours arise in the sellar and parasellar regions. Given their location, non-adenomatous lesions frequently mimic pituitary macroadenomas and can pose a diagnostic challenge for the radiologist. Distinguishing rare sellar lesions from the common macroadenoma helps to direct the correct surgical approach and reduce the risk of incomplete resection and/or complications such as cerebrospinal fluid leak with the potential for meningitis. The purpose of this article is to review the imaging features of non-pituitary-origin sellar tumours, focusing on characteristics that may distinguish them from pituitary macroadenomas. Lesions include meningioma, metastatic disease, epidermoid cyst, germinoma, chondrosarcoma, giant cell tumour, and giant aneurysm.

  13. Tratamiento combinado de los queloides mediante cirugía y braquiterapia Treatment of queloids with surgical resection and brachytherapy

    Directory of Open Access Journals (Sweden)

    J. Bisbal

    2009-12-01

    Full Text Available Presentamos nuestra experiencia en el tratamiento de los queloides mediante resección quirúrgica y radioterapia inmediata posterior. La radioterapia transforma el queloide en un tejido hipocelular, hipovascular e hipóxico, impidiendo la excesiva migración de fibroblastos. Si se administra la dosis adecuada de radiación, se consigue un equilibrio entre la formación de cicatriz y la proliferación excesiva de tejido, evitando la formación de queloide, sin impedir la cicatrización normal. Nuestro protocolo se divide en dos fases: la primera consiste en la exéresis del queloide mediante una incisión que sigue el trayecto del mismo, con un cuidadoso cierre en dos planos siendo siempre el superficial una sutura intradérmica. La segunda fase será la radioterapia, con dos modalidades posibles de tratamiento: 1- Braquiterapia (tratamiento a corta distancia, requiere la colocación de un catéter bajo la sutura, a través del cual se introduce una fuente radiactiva, normalmente Ir192. Se emplea especialmente en heridas longitudinales. 2- Radioterapia externa con electrones de baja energía. Se emplea en heridas complejas o extensas. Generalmente, dosis de 20 Gy. en 4 fracciones de 500 cGy, ofrecen excelentes resultados con mínimas secuelas o efectos secundarios. El volumen blanco debe incluir la herida quirúrgica más un margen de 4 mm. alrededor de ella. Con este procedimiento, hemos observado unos excelentes resultados, con un índice de recidivas inferior al 4%, y una mejora en los síntomas clínicos en el 100% de los casos. Como efectos secundarios observamos telangiectasias (15,4 % o cambios en la pigmentación cutánea (5,9%.We present our experience in treatment of keloid scars with surgical resection and immediately postoperative radiotherapy. Radiotherapy changes keloid into an hypocellular, hypovascular and hypotoxic tissue, avoiding the excessive migration of fibroblasts. If the suitable dose of radiation is delivered, balance

  14. Comprehensive review of post-liver resection surgical complications and a new universal classification and grading system

    Institute of Scientific and Technical Information of China (English)

    Masayuki; Ishii; Toru; Mizuguchi; Kohei; Harada; Shigenori; Ota; Makoto; Meguro; Tomomi; Ueki; Toshihiko; Nishidate; Kenji; Okita; Koichi; Hirata

    2014-01-01

    Liver resection is the gold standard treatment for certain liver tumors such as hepatocellular carcinoma and metastatic liver tumors. Some patients with such tumors already have reduced liver function due to chronic hepatitis, liver cirrhosis, or chemotherapy-associated steatohepatitis before surgery. Therefore, complications due to poor liver function are inevitable after liver resection. Although the mortality rate of liver resection has been reduced to a few percent in recent case series, its overall morbidity rate is reported to range from 4.1% to 47.7%. The large degree of variation in the post-liver resection morbidity rates reported in previous studies might be due to the lack of consen-sus regarding the definitions and classification of postliver resection complications. The Clavien-Dindo(CD) classification of post-operative complications is widely accepted internationally. However, it is hard to apply to some major post-liver resection complications because the consensus definitions and grading systems for posthepatectomy liver failure and bile leakage established by the International Study Group of Liver Surgery are incompatible with the CD classification. Therefore, a unified classification of post-liver resection complications has to be established to allow comparisons between academic reports.

  15. EFFICACY OF DIFFERENT RESECTIONS ON NON-MUSCLE-INVASIVE BLADDER CANCER AND ANALYSIS OF THE OPTIMAL SURGICAL METHOD.

    Science.gov (United States)

    Chen, G F; Shi, T P; Wang, B J; Wang, X Y; Zang, Q

    2015-01-01

    This study aimed to analyze the clinical efficacy of different resections in treating non-muscle-invasive bladder cancer (NMIBC), including partial cystectomy, transurethral resection of bladder tumor (TURBT) and holmium laser resection of bladder tumor. Two hundred and sixteen patients were recruited with NMIBC who were available for follow-up visits in hospital, including 62 cases treated with partial cystectomy, 90 cases treated with TURBT and 64 cases with holmium laser resection. Analysis was made on the cases with tumor relapse in the two years, on operation time, blood loss, time for indwelling urinary catheter, hospital stay and complications after operation. Results were compared to the clinical efficacy of these operation patterns. It was found that the two-year relapse rate for TURBT group, partial cystectomy group and Holmium laser resection group was 41%, 31%, and 33% respectively, and the difference had no statistical significance (p>0.05). Both the TURBT group and holmium laser resection group had shorter operation time, hospital stay and time for indwelling urinary catheter as well as much less blood loss when compared with the partial cystectomy group; the difference had statistical significance (pspasm. Therefore, this study presumes that holmium laser resection and TURBT are much safer and quicker for recovery and obviously superior to the partial cystectomy.

  16. Use of a midline mandibular osteotomy to improve surgical access for transoral robotic resection of the base of tongue in a patient with trismus.

    Science.gov (United States)

    Tay, Gerald; Ferrell, Jay; Andersen, Peter

    2017-09-01

    The utilization of transoral robotic surgery (TORS) in patients with trismus is limited because of poor surgical exposure. This report is about a 46-year-old man with a recurrent right base of tongue cancer who had severe postradiation trismus. We performed a midline mandibular osteotomy without a lip split and this resulted in a markedly improved surgical exposure. He underwent a TORS resection of the right base of the tongue with no significant complications. The midline mandibular osteotomy significantly improved the surgical exposure and facilitated exposure for TORS in a patient who otherwise would not be able to undergo TORS. Utilization of a midline mandibular osteotomy allowed for increased exposure for TORS in a patient with limited mouth opening from postradiation trismus. Postoperative hemorrhage remains a significant concern and appropriate measures to mitigate the catastrophic consequences of this should be considered. © 2017 Wiley Periodicals, Inc.

  17. Outcome of surgical resection for brain metastases and radical treatment of the primary tumor in Chinese non–small-cell lung cancer patients

    Directory of Open Access Journals (Sweden)

    Li Z

    2015-04-01

    Full Text Available Zhenye Li,1,3,* Xiangheng Zhang,1,* Xiaobing Jiang,1 Chengcheng Guo,1 Ke Sai,1 Qunying Yang,1 Zhenqiang He,1 Yang Wang,1 Zhongping Chen,1 Wei Li,2 Yonggao Mou1 1Department of Neurosurgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 2Department of Anesthesiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People’s Republic of China; 3Beijing Neurosurgical Institute, Capital Medical University, Beijing, People’s Republic of China *These authors have contributed equally to this work Purpose: Brain metastasis is the most common complication of brain cancer; nevertheless, primary lung cancer accounts for approximately 20%–40% of brain metastases cases. Surgical resection is the preferred treatment for brain metastases. However, no studies have reported the outcome of surgical resection of brain metastases from non–small-cell lung cancer (NSCLC in the People’s Republic of China. Moreover, the optimal treatment for primary NSCLC in patients with synchronous brain metastases is hitherto controversial. Patients and methods: We retrospectively analyzed the cases of NSCLC patients with brain metastases who underwent neurosurgical resection at the Sun Yat-sen University Cancer Center, and assessed the efficacy of surgical resection and the necessity of aggressive treatment for primary NSCLC in synchronous brain metastases patients. Results: A total of 62 patients, including 47 men and 15 women, with brain metastases from NSCLC were enrolled in the study. The median age at the time of craniotomy was 54 years (range 29–76 years. At the final follow-up evaluation, 50 patients had died. The median OS time was 15.1 months, and the survival rates were 70% and 37% at 1 and 2 years, respectively. The median OS

  18. 经口入路机器人辅助咽喉部肿瘤切除术的临床经验%Application of transoral robotic surgery in pharyngolaryngeal tumour resection

    Institute of Scientific and Technical Information of China (English)

    陈伟; 许风雷; 陈琰; 张勇; 吴昆旻; 程友; 季俊峰; 郑宏良

    2016-01-01

    目的 总结经口入路机器人辅助咽喉部肿瘤切除术的临床经验.方法 回顾性分析2013年11月至2015年7月,第二军医大学长海医院耳鼻咽喉科应用“达芬奇”机器人手术系统进行的6例经口入路机器人手术(transoral robotic surgery,TORS)患者的临床资料.结果 所有手术均顺利完成;术野暴露平均用时35(30 ~ 40) min,调整开口器2~5次,平均手术完成时间72(30~130) min.手术出血量平均约15(5 ~30)ml.平均住院时间为10(6~14)d,恢复经口进食平均需要6(2 ~10)d,出院时均可经口进食,术中及术后均未出现并发症;术后病理学检查切缘均未见癌细胞残留,平均随访时间13个月,均未有肿瘤复发.结论 在掌握好适应证的前提下,应用TORS手术切除下咽部肿瘤,功能保留好,手术创伤小,术后并发症少,康复进程明显快,有巨大的临床应用价值.%Objective To summarize clinical experience on application of transoral robotic surgery (TORS) in pharyngeal tumour resection.Methods Six patients underwent TORS with da Vinci(R) surgical system in our department from November 2013 to July 2015 and their clinical data were analyzed retrospectively.Results TORS was accomplished successfully in all 6 patients.The surgical field-exposed time ranged from 30 to 40 minutes with an average of 35 minutes.The operative time ranged from 30 to 130 minutes with an average of 72 minutes.The hospital stays ranged from 6 to 14 days with an average of 10 days,and recovery time for oral intake ranged from 2 to 10 days with an average of 6 days.During TORS,the mouth gag needed to be adjusted 2 to 5 times.Surgical blood loss ranged from 5 to 30 ml with an average of 15 ml.No complications occurred during or after operation.Postoperative pathological examination of incisal edge in patients with malignant tumors showed no residual tumor cell.The mean follow-up was 14 months with no recurrence.Conclusion With proper indications

  19. Laparoscopic instrument use in laryngeal surgery: transoral resection of a supraglottic haemangioma.

    Science.gov (United States)

    Bannon, R; Gohil, R; Manickavasagam, J

    2017-09-01

    Adult laryngeal haemangiomas are rare vascular tumours that have been managed by a variety of surgical techniques. This paper describes a case of near-fatal acute airway obstruction secondary to such a lesion, followed by our approach to surgical resection using a laparoscopic bipolar tissue-sealing device. This technique resulted in successful excision of the lesion, with no evidence of recurrence at one year of follow up. Laparoscopic bipolar instruments can be used for the resection of moderate to large laryngeal haemangiomas as an alternative to laser excision.

  20. Intraoperative application of thermal camera for the assessment of during surgical resection or biopsy of human's brain tumors

    Science.gov (United States)

    Kastek, M.; Piatkowski, T.; Polakowski, H.; Kaczmarska, K.; Czernicki, Z.; Bogucki, J.; Zebala, M.

    2014-05-01

    Motivation to undertake research on brain surface temperature in clinical practice is based on a strong conviction that the enormous progress in thermal imaging techniques and camera design has a great application potential. Intraoperative imaging of pathological changes and functionally important areas of the brain is not yet fully resolved in neurosurgery and remains a challenge. A study of temperature changes across cerebral cortex was performed for five patients with brain tumors (previously diagnosed using magnetic resonance or computed tomography) during surgical resection or biopsy of tumors. Taking into account their origin and histology the tumors can be divided into the following types: gliomas, with different degrees of malignancy (G2 to G4), with different metabolic activity and various temperatures depending on the malignancy level (3 patients), hypervascular tumor associated with meninges (meningioma), metastatic tumor - lung cancer with a large cyst and noticeable edema. In the case of metastatic tumor with large edema and a liquid-filled space different temperature of a cerebral cortex were recorded depending on metabolic activity. Measurements have shown that the temperature on the surface of the cyst was on average 2.6 K below the temperature of surrounding areas. It has been also observed that during devascularization of a tumor, i.e. cutting off its blood vessels, the tumor temperature lowers significantly in spite of using bipolar coagulation, which causes additional heat emission in the tissue. The results of the measurements taken intra-operatively confirm the capability of a thermal camera to perform noninvasive temperature monitoring of a cerebral cortex. As expected surface temperature of tumors is different from surface temperature of tissues free from pathological changes. The magnitude of this difference depends on histology and the origin of the tumor. These conclusions lead to taking on further experimental research, implementation

  1. Clinical evaluation of systemic inflammatory response syndrome (SIRS) in advanced lung cancer (T3 and T4) with surgical resection.

    Science.gov (United States)

    Iwasaki, Akinori; Shirakusa, Takayuki; Maekawa, Takafumi; Enatsu, Sotarou; Maekawa, Shinichi

    2005-01-01

    The systemic inflammatory response syndrome (SIRS) is well known to occur in patients who have suffered organ damage or trauma, or undergone surgery. SIRS provides useful information in patients with morbidity after surgery. To date, there has been no report of SIRS after surgery in patients with lung cancer. Therefore, based on this new concept of the syndrome, we review here a series of T3 and T4 NSCLC patients who underwent extended resection at our hospital, and attempt to identify the value and correlation of SIRS in predicting the morbidity of such patients. We retrospectively reviewed the patients with NSCLC treated at our hospital between January 1994 and August 2003. Among these 720 patients, a curative approach was attempted in 144 with advanced stage (T3, 100; T4, 44) cancer. The patients were consequently divided into three groups (G1, negative or less than 3 days in SIRS following surgery; G2, less than 7 days; G3, continued over 7 days). Pre- or peri-operative factors were evaluated, and the 5-year survival rates were analyzed. Post-operative morbidity was also compared between the three groups in association with SIRS. Pre-operative counts of WBC were 8848.28+/-3879.21/microl in G3 compared with 7383.33+/-3132.98/microl in G2 and 6778.31+/-3184.89/microl in G1. Values in G3 were significantly higher than those in the other groups (PSIRS after lung surgery was associated with high levels in WBC and low %FEV1. Post-operative morbidity such as bronchial fistula or ARDS were more frequent in the G3 and G2 groups than in G1. The 1-year survival was as follows; G1, 75.4%; G2, 47.9%; G3, 38.1%. Overall 5-year survival rate for NSCLC with T3 and T4 was 32.2%, and the difference between G3 and the other groups in terms of survival was statistically significant (PSIRS have been associated with post-operative complications and survival in NSCLC. Surgical candidates should be carefully according to the predicting factor of SIRS.

  2. Accuracy of Computed Tomography for Predicting Pathologic Nodal Extracapsular Extension in Patients With Head-and-Neck Cancer Undergoing Initial Surgical Resection

    Energy Technology Data Exchange (ETDEWEB)

    Prabhu, Roshan S., E-mail: roshansprabhu@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Magliocca, Kelly R. [Department of Pathology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hanasoge, Sheela [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Aiken, Ashley H.; Hudgins, Patricia A. [Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Hall, William A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Chen, Susie A. [Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas (United States); Eaton, Bree R.; Higgins, Kristin A. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Saba, Nabil F. [Department of Hematology and Medical Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Beitler, Jonathan J. [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2014-01-01

    Purpose: Nodal extracapsular extension (ECE) in patients with head-and-neck cancer increases the loco-regional failure risk and is an indication for adjuvant chemoradiation therapy (CRT). To reduce the risk of requiring trimodality therapy, patients with head-and-neck cancer who are surgical candidates are often treated with definitive CRT when preoperative computed tomographic imaging suggests radiographic ECE. The purpose of this study was to assess the accuracy of preoperative CT imaging for predicting pathologic nodal ECE (pECE). Methods and Materials: The study population consisted of 432 consecutive patients with oral cavity or locally advanced/nonfunctional laryngeal cancer who underwent preoperative CT imaging before initial surgical resection and neck dissection. Specimens with pECE had the extent of ECE graded on a scale from 1 to 4. Results: Radiographic ECE was documented in 46 patients (10.6%), and pECE was observed in 87 (20.1%). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 43.7%, 97.7%, 82.6%, and 87.3%, respectively. The sensitivity of radiographic ECE increased from 18.8% for grade 1 to 2 ECE, to 52.9% for grade 3, and 72.2% for grade 4. Radiographic ECE criteria of adjacent structure invasion was a better predictor than irregular borders/fat stranding for pECE. Conclusions: Radiographic ECE has poor sensitivity, but excellent specificity for pECE in patients who undergo initial surgical resection. PPV and NPV are reasonable for clinical decision making. The performance of preoperative CT imaging increased as pECE grade increased. Patients with resectable head-and-neck cancer with radiographic ECE based on adjacent structure invasion are at high risk for high-grade pECE requiring adjuvant CRT when treated with initial surgery; definitive CRT as an alternative should be considered where appropriate.

  3. A Panel of Genetic Polymorphism for the Prediction of Prognosis in Patients with Early Stage Non-Small Cell Lung Cancer after Surgical Resection.

    Directory of Open Access Journals (Sweden)

    Shin Yup Lee

    Full Text Available This study was conducted to investigate whether a panel of eight genetic polymorphisms can predict the prognosis of patients with early stage non-small cell lung cancer (NSCLC after surgical resection.We selected eight single nucleotide polymorphisms (SNPs which have been associated with the prognosis of lung cancer patients after surgery in our previous studies. A total of 814 patients with early stage NSCLC who underwent curative surgical resection were enrolled. The association of the eight SNPs with overall survival (OS and disease-free survival (DFS was analyzed.The eight SNPs (CD3EAP rs967591, TNFRSF10B rs1047266, AKT1 rs3803300, C3 rs2287845, HOMER2 rs1256428, GNB2L1 rs3756585, ADAMTSL3 rs11259927, and CD3D rs3181259 were significantly associated with OS and/or DFS. Combining those eight SNPs, we designed a prognostic index to predict the prognosis of patients. According to relative risk of death, a score value was assigned to each genotype of the SNPs. A worse prognosis corresponded to a higher score value, and the sum of score values of eight SNPs defined the prognostic index of a patient. When we categorized the patients into two groups based on the prognostic index, high risk group was significantly associated with worse OS and DFS compared to low risk group (aHR for OS = 2.21, 95% CI = 1.69-2.88, P = 8.0 x 10-9, and aHR for DFS = 1.58, 95% CI = 1.29-1.94, P = 1.0 x 10-5.Prognostic index using eight genetic polymorphisms may be useful for the prognostication of patients with surgically resected NSCLC.

  4. The Effect of Endoscopic Resection on Short-Term Surgical Outcomes in Patients with Additional Laparoscopic Gastrectomy after Non-Curative Resection for Gastric Cancer

    Science.gov (United States)

    Lee, Eun-Gyeong; Eom, Bang-Wool; Yoon, Hong-Man; Kim, Yong-Il; Cho, Soo-Jeong; Lee, Jong-Yeul; Kim, Young-Woo

    2017-01-01

    Purpose Endoscopic submucosal dissection (ESD) in early gastric cancer causes an artificial gastric ulcer and local inflammation that has a negative intraprocedural impact on additional laparoscopic gastrectomy in patients with noncurative ESD. In this study, we analyzed the effect of ESD on short-term surgical outcomes and evaluated the risk factors. Materials and Methods From January 2003 to January 2013, 1,704 patients of the National Cancer Center underwent laparoscopic gastrectomy with lymph node dissection because of preoperative stage Ia or Ib gastric cancer. They were divided into 2 groups: (1) with preoperative ESD or (2) without preoperative ESD. Clinicopathologic factors and short-term surgical outcomes were retrospectively evaluated along with risk factors such as preoperative ESD. Results Several characteristics differed between patients who underwent ESD-surgery (n=199) or surgery alone (n=1,505). The mean interval from the ESD procedure to the operation was 43.03 days. Estimated blood loss, open conversion rate, mean operation time, and length of hospital stay were not different between the 2 groups. Postoperative complications occurred in 23 patients (11.56%) in the ESD-surgery group and in 189 patients (12.56%) in the surgery-only group, and 3 deaths occurred among patients with complications (1 patient [ESD-surgery group] vs. 2 patients [surgery-only group]; P=0.688). A history of ESD was not significantly associated with postoperative complications (P=0.688). Multivariate analysis showed that male sex (P=0.008) and laparoscopic total or proximal gastrectomy (P=0.000) were independently associated with postoperative complications. Conclusions ESD did not affect short-term surgical outcomes during and after an additional laparoscopic gastrectomy.

  5. The resection map, a proposal for intraoperative hepatectomy guidance

    Energy Technology Data Exchange (ETDEWEB)

    Lamata, P.; Declerck, J. [Siemens Molecular Imaging, Oxford (United Kingdom); Jalote-Parmar, A. [Delft University of Technology, Industrial Design Department and Engineering, Delft (Netherlands); Lamata, F. [Hospital Clinico Universitario of Zaragoza, Zaragoza (Spain)

    2008-09-15

    To propose a new concept of an intra-operative 3D visualisation system to support hepatectomies. This system aims at improving the transfer of pre-operative planning into the intra-operative stage, both in laparoscopic and open approaches. User (surgeon) centred developmental process to identify the surgical requirements is applied. The surgical workflow of hepatectomy is analyzed, including observations of liver surgeries and focus group sessions. Based on this analysis, specifications for the ''Resection Map'' are defined. A first implementation is developed, and preliminary clinical acceptance results are gathered. Control of main veins and tumour margins are the two critical aspects. The ''Resection Map'' provides an intuitive visualisation of structures nearby the resection plane without any registration to the patient space. The first prototype subjectively increases the surgeon's confidence and orientation, but it should be further developed for non anatomical resections. The Resection Map is proposed as a pragmatic solution to enhance liver resection accuracy and safety. (orig.)

  6. Perioperative Allogeneic Blood Transfusion Is Associated With Surgical Site Infection After Abdominoperineal Resection-a Space for the Implementation of Patient Blood Management Strategies.

    Science.gov (United States)

    Kaneko, Kensuke; Kawai, Kazushige; Tsuno, Nelson H; Ishihara, Soichiro; Yamaguchi, Hironori; Sunami, Eiji; Watanabe, Toshiaki

    2015-05-01

    Allogeneic blood transfusion (ABT) has been reported as a major risk factor for surgical site infection (SSI) in patients undergoing colorectal surgery. However, the association of ABT with SSI in patients undergoing abdominoperineal resection (APR) and total pelvic exenteration (TPE) still remains to be evaluated. Here, we aim to elucidate this association. The medical records of all patients undergoing APR and TPE at our institution in the period between January 2000 and December 2012 were reviewed. Patients without SSI (no SSI group) were compared with patients who developed SSI (SSI group), in terms of clinicopathologic features, including ABT. In addition, data for 262 patients who underwent transabdominal rectal resection at our institution in the same period were also enrolled, and their data on differential leukocyte counts were evaluated. Multivariate analysis showed that intraoperative transfusion was an independent predictive factor for SSI after APR and TPE (P = 0.004). In addition, the first-operative day lymphocyte count of patients undergoing APR, TPE, and transabdominal rectal resection was significantly higher in nontransfusion patients compared with transfusion ones (P = 0.026). ABT in the perioperative period of APR and TPE may have an important immunomodulatory effect, leading to an increased incidence of SSI. This fact should be carefully considered, and efforts to avoid allogeneic blood exposure while still achieving adequate patient blood management would be very important for patients undergoing APR and TPE as well.

  7. Primitive neuroectodermal tumour of kidney with thrombosis of the inferior vena cava and good responsive to surgical and medical treatment: description of a case and revision of literature.

    Science.gov (United States)

    Giliberto, Giovanni L; Di Franco, Carmelo A; Rovereto, Bruno

    2017-03-15

    Primitive neuroectodermal tumour (PNET) of kidney is a rare cancer typical of young adults with few cases described in the literature. We report a case of renal PNET in a 31-year-old man who presented to our department with a computed tomographic (CT)-scan revealing a large renal mass of 20 cm, massive thrombosis of the inferior vena cava (IVC). The patient underwent radical nephrectomy with contextual retroperitoneal lymphadenectomy and resection of IVC needing Dacron prosthesis substitution. Definitive histopathological examination showed PNET of kidney infiltrating ipsilateral adrenal gland, massive cava thrombosis with infiltration of vena cava wall and one lymph nodal metastasis. Postoperative PET-scan showed metastatic lesions in bilateral adrenal glands and pancreas. The patient received chemotherapy, and currently, he is in follow-up after 26 months from first diagnosis without any sign of recurrence of disease. Kidney PNET usually is associated with poor prognosis, so, it needs an early identification and differentiation from other similar small cells tumours in order to obtain a good response to the treatments.

  8. Determining gastric cancer resectability by dynamic MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Pan, Zilai; Zhang, Huan; Du, Lianjun; Ding, Bei; Song, Qi; Ling, Huawei; Huang, Baisong; Chen, Kemin [Jiaotong University, Department of Radiology, Shanghai (China); Yan, Chao [Jiaotong University, Department of Surgery, Shanghai (China)

    2010-03-15

    Multi-detector row CT (MDCT) has been widely used to detect primary lesions and to evaluate TNM staging. In this study we evaluated the accuracy of dynamic MDCT in the preoperative determination of the resectability of gastric cancer. MDCT was used to image 350 cases of gastric cancer diagnosed by biopsy before surgery. MDCT findings regarding TNM staging and resectability were correlated with surgical and pathological findings. The accuracy of MDCT for staging gastric cancer was high, especially for tumour stage T1 (94.3%), lymph node stage N2 (87.3%), and for predicting distant metastases (>96.6%). When resectability was considered to be the outcome, the total accuracy of MDCT was 87.4%, sensitivity was 89.7% and specificity was 76.7%. Results showed high sensitivity for identifying peritoneal seeding (90.0%) and for predicting liver metastasis (80.0%). Dynamic enhanced MDCT is useful for TNM staging of gastric cancers and for predicting tumour respectability preoperatively. (orig.)

  9. Successful treatment of primary advanced gastric plasmacytoma using a combination of surgical resection and chemotherapy with bortezomib: A case report

    Directory of Open Access Journals (Sweden)

    Sotaro Fukuhara

    2016-01-01

    Conclusions: This is the first reported case of advanced gastric plasmacytoma using adjuvant chemotherapy involving bortezomib and auto-PBSCT after the resection, and the patient has maintained a good course over a year. This protocol could be a new way to treat these tumors.

  10. A Simple and Safe Technique for CT Guided Lung Nodule Marking prior to Video Assisted Thoracoscopic Surgical Resection Revisited

    Directory of Open Access Journals (Sweden)

    James A. Stephenson

    2015-01-01

    Full Text Available Aim. We describe our experience of a simple, safe, and reproducible technique for lung nodule marking prethoracoscopic metastasectomy. Thoracoscopic lung nodule resection reduces patient discomfort, complications, higher level of care, hospital stay, and cost; however, small deeply placed lung nodules are difficult to locate and resect thoracoscopically. Materials and Methods. We describe and review the success of our novel technique, where nodules are identified on a low dose CT and marked with methylene blue using CT fluoroscopy guidance immediately prior to surgery. Results. 30 nodules were marked with a mean size of 8 mm (4–18 mm located at a mean depth of 17 mm, distributed through both lungs. Dye was detected at the pleural surface in 97% of the patients and at the nodule in 93%. There were no major complications. Thoracoscopic resection was possible in 90%. Conclusion. This is a simple and safe method of lung nodule marking to facilitate thoracoscopic resection in cases where this may not be technically possible due to nodule location.

  11. The challenge of extraabdominal desmoid tumour management in patients with Gardner's syndrome: radiofrequency ablation, a promising option.

    Science.gov (United States)

    Cobianchi, Lorenzo; Ravetta, Valentina; Viera, Francesca Torello; Filisetti, Claudia; Siri, Barbara; Segalini, Edoardo; Maestri, Marcello; Dominioni, Tommaso; Alessiani, Mario; Rossi, Sandro; Dionigi, Paolo

    2014-11-27

    Desmoid tumours are benign, myofibroblastic stromal neoplasms common in Gardner's syndrome, which is a subtype of familial adenomatous polyposis characterized by colonic polyps, osteomas, thyroid cancer, epidermoid cysts, fibromas and sebaceous cysts. The primary treatment is surgery, followed by adjuvant radiotherapy, but the local recurrence rate is high, and wide resection can result in debilitating loss of function. We report the case of a 39-year-old man with Gardner's syndrome who had already undergone a total prophylactic colectomy. He developed desmoid tumours localized in the mesenteric root, abdominal wall and dorsal region, which were treated from 2003 through 2013 with several surgical procedures and percutaneous radiofrequency ablation. In 2008 and 2013, RFA was applied under ultrasonographic guidance to two desmoid tumours localized in the dorsal thoracic wall. The outcomes were low-grade pain and one case of superficial skin necrosis, but so far there has been no recurrence of desmoid tumours in these locations. Surgical resection remains the first-line therapy for patients with desmoid tumours, but wide resection may lead to a poor quality of life. Radiofrequency ablation is less invasive and expensive and is a possible therapeutic option for desmoid tumours in patients with Gardner's syndrome.

  12. The pri-let-7a-2 rs1143770C>T is associated with prognosis of surgically resected non-small cell lung cancer.

    Science.gov (United States)

    Shin, Kyung Min; Jung, Deuk Kju; Hong, Mi Jeong; Kang, Hyo Jung; Lee, Won Kee; Yoo, Seung Soo; Lee, Shin Yup; Cha, Seung Ick; Lee, Jaehee; Kim, Chang Ho; Seok, Yangki; Cho, Sukki; Son, Ji Woong; Lee, Eung Bae; Jheon, Sanghoon; Kim, Young Tae; Park, Jae Yong

    2016-02-15

    Evidence indicates that let-7 of microRNA may be a prognostic factor in lung cancer. Genetic variation in microRNA precursors could influence the processing and expression of microRNAs, which could affect the prognosis of lung cancer. We aimed to investigate the impact of single nucleotide polymorphisms (SNPs) of pri-let-7 on the prognosis of non-small cell lung cancer (NSCLC). A total of 761 patients with surgically resected NSCLC were included. Four SNPs (pri-let-7a-2 rs1143770 and rs629367, pri-let-7a-1 rs10739971, and pri-let-7f-2 rs17276588) were genotyped using sequenom mass spectrometry-based genotyping assay. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier method and Cox proportional hazards model. Of the 4 SNPs evaluated, the rs1143770C>T was found to be significantly associated with OS and DFS. The rs1143770 CT or TT genotype exhibited a significantly better OS and DFS compared with the rs1143770 CC genotype (adjusted hazard ratio for OS=0.67, confidence interval, 0.49-0.91, P=0.01 and adjusted hazard ratio for DFS=0.74, confidence interval, 0.58-0.95, P=0.02). This observation indicates that pri-let-7a-2 rs1143770C>T may have a prognostic impact on surgically resected NSCLC. Copyright © 2015 Elsevier B.V. All rights reserved.

  13. Radiofrequency ablation versus surgical resection for the treatment of hepatocellular carcinoma conforming to the Milan criteria: systemic review and meta-analysis.

    Science.gov (United States)

    Yi, Hui-Ming; Zhang, Wei; Ai, Xi; Li, Kai-Yan; Deng, You-Bin

    2014-01-01

    Radiofrequency ablation (RFA) is a promising ablation technique and has become one of the best alternatives for hepatocellular carcinoma (HCC) patients. But whether RFA or surgical resection (SR) is the better treatment for HCC conforming to the Milan criteria has long been debated. A meta-analysis of trials that compared RFA versus SR was conducted regarding the survival rate and recurrence rate. Pooled odds ratios (OR) with 95% confidence intervals (95% CI) were calculated using fixed or random effects models. Nineteen studies, comprising 2 randomized controlled trials and 17 non-randomized controlled trials, were included with a total of 2895 patients. The 5 years overall survival rate for SR group was significantly higher than that for RFA group. In the SR group, the local recurrence rate was significantly lower when compared with the RFA group. This meta-analysis yielded no significant differences between laparoscopic RFA and SR in 5-year overall survival rate. In conclusion, surgical resection remains the better choice of treatment for HCC conforming to the Milan criteria, whereas RFA should be considered as an effective alternative treatment when surgery is not feasible. As for RFA technique, laparoscopic approach may be more effective than percutaneous approach for HCC conforming to Milan criteria.

  14. Resecting diffuse low-grade gliomas to the boundaries of brain functions: a new concept in surgical neuro-oncology.

    Science.gov (United States)

    Duffau, H

    2015-12-01

    The traditional dilemma making surgery for diffuse low-grade gliomas (DLGGs) challenging is underlain by the need to optimize tumor resection in order to significantly increase survival versus the risk of permanent neurological morbidity. Development of neuroimaging led neurosurgeons to achieve tumorectomy according to the oncological limits provided by preoperative or intraoperative structural and metabolic imaging. However, this principle is not coherent, neither with the infiltrative nature of DLGGs nor with the limited resolution of current neuroimaging. Indeed, despite technical advances, MRI still underestimates the actual spatial extent of gliomas, since tumoral cells are present several millimeters to centimeters beyond the area of signal abnormalities. Furthermore, cortical and subcortical structures may be still crucial for brain functions despite their invasion by this diffuse tumoral disease. Finally, the lack of reliability of functional MRI has also been demonstrated. Therefore, to talk about "maximal safe resection" based upon neuroimaging is a non-sense, because oncological MRI does not show the tumor and functional MRI does not show critical neural pathways. This review proposes an original concept in neuro-oncological surgery, i.e. to resect DLGG to the boundaries of brain functions, thanks to intraoperative electrical mapping performed in awake patients. This paradigmatic shift from image-guided resection to functional mapping-guided resection, based upon an accurate study of brain connectomics and neuroplasticity in each patient throughout tumor removal has permitted to solve the classical dilemma, by increasing both survival and quality of life in DLGG patients. With this in mind, brain surgeons should also be neuroscientists.

  15. External-beam radiation therapy after surgical resection and intraoperative electron-beam radiation therapy for oligorecurrent gynecological cancer. Long-term outcome

    Energy Technology Data Exchange (ETDEWEB)

    Sole, C.V. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Instituto de Radiomedicina, Service of Radiation Oncology, Santiago (Chile); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Calvo, F.A. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lozano, M.A.; Gonzalez-Sansegundo, C. [Hospital General Universitario Gregorio Maranon, Department of Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Gonzalez-Bayon, L. [Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Alvarez, A. [Hospital General Universitario Gregorio Maranon, Service of Radiation Oncology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Lizarraga, S. [Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Institute of Research Investigation, Madrid (Spain); Garcia-Sabrido, J.L. [Complutense University, School of Medicine, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Service of General Surgery, Madrid (Spain); Hospital General Universitario Gregorio Maranon, Department of Gynecology, Madrid (Spain)

    2014-02-15

    The goal of the present study was to analyze prognostic factors in patients treated with external-beam radiation therapy (EBRT), surgical resection and intraoperative electron-beam radiotherapy (IOERT) for oligorecurrent gynecological cancer (ORGC). From January 1995 to December 2012, 61 patients with ORGC [uterine cervix (52 %), endometrial (30 %), ovarian (15 %), vagina (3 %)] underwent IOERT (12.5 Gy, range 10-15 Gy), and surgical resection to the pelvic (57 %) and paraaortic (43 %) recurrence tumor bed. In addition, 29 patients (48 %) also received EBRT (range 30.6-50.4 Gy). Survival outcomes were estimated using the Kaplan-Meier method, and risk factors were identified by univariate and multivariate analyses. Median follow-up time for the entire cohort of patients was 42 months (range 2-169 months). The 10-year rates for overall survival (OS) and locoregional control (LRC) were 17 and 65 %, respectively. On multivariate analysis, no tumor fragmentation (HR 0.22; p = 0.03), time interval from primary tumor diagnosis to locoregional recurrence (LRR) < 24 months (HR 4.02; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.95; p = 0.02) retained significance with regard to LRR. Time interval from primary tumor to LRR < 24 months (HR 2.32; p = 0.02) and no EBRT at the time of pelvic recurrence (HR 3.77; p = 0.04) showed a significant association with OS after adjustment for other covariates. External-beam radiation therapy at the time of pelvic recurrence, time interval for relapse ≥24 months and not multi-involved fragmented resection specimens are associated with improved LRC in patients with ORGC. As suggested from the present analysis a significant group of ORGC patients could potentially benefit from multimodality rescue treatment. (orig.)

  16. Comparison of long-term survival between temozolomide-based chemoradiotherapy and radiotherapy alone for patients with low-grade gliomas after surgical resection

    Science.gov (United States)

    Gai, Xiu-juan; Wei, Yu-mei; Tao, Heng-min; An, Dian-zheng; Sun, Jia-teng; Li, Bao-sheng

    2016-01-01

    Purpose This study was designed to compare the survival outcomes of temozolomide-based chemoradiotherapy (TMZ + RT) vs radiotherapy alone (RT-alone) for low-grade gliomas (LGGs) after surgical resection. Patients and methods In this retrospective analysis, we reviewed postoperative records of 69 patients with LGGs treated with TMZ + RT (n=31) and RT-alone (n=38) at the Shandong Cancer Hospital Affiliated to Shandong University between June 2011 and December 2013. Patients in the TMZ + RT group were administered 50–100 mg oral TMZ every day until the radiotherapy regimen was completed. Results The median follow-up since surgery was 33 months and showed no significant intergroup differences (P=0.06). There were statistically significant intergroup differences in the progression-free survival rate (P=0.037), with 83.9% for TMZ-RT group and 60.5% for RT-alone group. The overall 2-year overall survival (OS) rate was 89.86%. Age distribution (≥45 years and <45 years) and resection margin (complete resection or not) were significantly associated with OS (P=0.03 and P=0.004, respectively). Conclusion Although no differences were found in the 2-year OS between the TMZ + RT and RT-alone groups, there was a trend toward increased 2-year progression-free survival in the TMZ + RT group. With better tolerability, concurrent TMZ chemoradiotherapy may be beneficial for postoperative patients with LGGs. Age distribution and surgical margin are likely potential indicators of disease prognosis. The possible differences in long-term survival between the two groups and the links between prognostic factors and long-term survival may be worthy of further investigation. PMID:27574452

  17. Suggestion of optimal radiation fields in rectal cancer patients after surgical resection for the development of the patterns of care study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jong Hoon; Park, Jin Hong; Kim, Dae Yong [College of Medicine, Ulsan Univ., Seoul (Korea, Republic of)] [and others

    2003-06-01

    To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study. A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 2-3 cm distal to the anastomosis in patient whose sphincter was saved, and 2-3 cm distal to the perineal scar in patients whose anal sphincter was sacrificed; anterior margin at the posterior tip of the symphysis pubis or 2-3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.5-2 cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). These recommendations should be tailored to each patient according to the clinical characteristics such as tumor location, pathological and operative findings, for the optimal treatment. The adequacy of these guidelines should be proved by following the Korean Patterns of Care

  18. CyberKnife with tumor tracking: An effective alternative to wedge resection for high-risk surgical patients with stage I non-small cell lung cancer (NSCLC

    Directory of Open Access Journals (Sweden)

    Sean eCollins

    2012-02-01

    Full Text Available Published data suggests that wedge resection for stage I NSCLC results in improved overall survival compared to stereotactic body radiation therapy (SBRT. We report CyberKnife outcomes for high-risk surgical patients with biopsy-proven stage I NSCLC. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs were contoured using lung windows; the margins were expanded by 5 mm to establish the planning treatment volume (PTV. Treatment plans were designed using hundreds of pencil beams. Doses delivered to the PTV ranged from 42-60 Gy in 3 fractions. The 30-Gy isodose contour extended at least 1cm from the GTV to eradicate microscopic disease. Treatments were delivered using the CyberKnife system with tumor tracking. Examination and PET/CT imaging occurred at 3-month follow-up intervals. Forty patients (median age 76 with a median maximum tumor diameter of 2.6 cm (range, 1.4-5.0 cm and a mean post-bronchodilator percent predicted forced expiratory volume in 1 second (FEV1 of 57% (range, 21 - 111% were treated. A mean dose of 50 Gy was delivered to the PTV over 3 to 13 days (median, 7 days. The 30-Gy isodose contour extended a mean 1.9 cm from the GTV. At a median 44 months (range, 12 -72 months follow-up, the 3-year Kaplan-Meier locoregional control and overall survival estimates compare favorably with contemporary wedge resection outcomes at 91% and 75% , respectively. CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1 to 2 cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.

  19. SPECTRUM OF NEUROENDOCRINE TUMOURS- A TERTIARY CARE CENTRE EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Pasupuleti Prathima

    2016-11-01

    Full Text Available BACKGROUND Neuroendocrine tumours occur at various sites in the human body. They are considered as one of the close differentials for many tumours. Various benign and malignant tumours undergo neuroendocrine differentiation. Its incidence is slightly increasing due to advanced imaging modalities. Although rare, they can be seen in breast, gallbladder and skin. The aim of the study is to study the spectrum of neuroendocrine tumours from various sites, their clinical presentation, histomorphological features with immunohistochemistry and review of literature. MATERIALS AND METHODS This is a retrospective study for a period of 3 years (June 2013-June 2016. Surgical resection specimens were included in the study. Out of the total specimens received, 24 cases were of neuroendocrine tumours. Differential diagnosis of small round cell tumours also was considered and a panel of immunohistochemical markers were included to rule out them. Biopsy specimens were excluded from the study. RESULTS Out of the 24 cases, 18 cases were benign lesions. 6 cases were malignant lesions. Female preponderance was noted. Peak incidence was seen in 20-30 years of age group. CONCLUSION Neuroendocrine tumours can occur anywhere in the body and it should be considered in one of the differential diagnosis. Diagnosis must be accurately made.

  20. PET-Guided Surgery - High Correlation between Positron Emission Tomography with 11C-5-Hydroxytryptophane (5-HTP) and Surgical Findings in Abdominal Neuroendocrine Tumours.

    Science.gov (United States)

    Orlefors, Håkan; Sundin, Anders; Eriksson, Barbro; Skogseid, Britt; Oberg, Kjell; Akerström, Göran; Hellman, Per

    2012-02-08

    Positron emission tomography (PET) with 11C-labeled 5-hydroxytryptophane (5-HTP) is a sensitive technique to visualize neuroendocrine tumours (NETs), due to high intracellular uptake of amine-precursors like L-dihydroxyphenylalanine (L-DOPA) and 5-HTP. NETs are often small and difficult to localize in spite of overt clinical symptoms due to hormonal excess. In our study, 38 consecutive NET patients underwent 11C-5-HTP-PET and morphological imaging by CT within 12 weeks prior to surgery. Surgical, histopathological and 5-HTP PET findings were correlated. 11C-5-HTP-PET corresponded to the surgical findings in 31 cases, was false negative in six, and true negative in one case resulting in 83.8% sensitivity and 100% specificity. Positive predicted value was 100%. In 11 patients 11C-5-HTP-PET was the only imaging method applied to localize the tumour. Thus, we could demonstrate that functional imaging by 11C-5-HTP-PET in many cases adds vital preoperative diagnostic information and in more than every fourth patient was the only imaging method that will guide the surgeon in finding the NET-lesion. Although the present results demonstrates that 11C-5-HTP may be used as an universal NET tracer, the sensitivity to visualize benign insulinomas and non functioning pancreatic NETs was lower.

  1. PET-Guided Surgery — High Correlation between Positron Emission Tomography with 11C-5-Hydroxytryptophane (5-HTP) and Surgical Findings in Abdominal Neuroendocrine Tumours

    Science.gov (United States)

    Örlefors, Håkan; Sundin, Anders; Eriksson, Barbro; Skogseid, Britt; Öberg, Kjell; Åkerström, Göran; Hellman, Per

    2012-01-01

    Positron emission tomography (PET) with 11C-labeled 5-hydroxytryptophane (5-HTP) is a sensitive technique to visualize neuroendocrine tumours (NETs), due to high intracellular uptake of amine-precursors like L-dihydroxyphenylalanine (L-DOPA) and 5-HTP. NETs are often small and difficult to localize in spite of overt clinical symptoms due to hormonal excess. In our study, 38 consecutive NET patients underwent 11C-5-HTP-PET and morphological imaging by CT within 12 weeks prior to surgery. Surgical, histopathological and 5-HTP PET findings were correlated. 11C-5-HTP-PET corresponded to the surgical findings in 31 cases, was false negative in six, and true negative in one case resulting in 83.8% sensitivity and 100% specificity. Positive predicted value was 100%. In 11 patients 11C-5-HTP-PET was the only imaging method applied to localize the tumour. Thus, we could demonstrate that functional imaging by 11C-5-HTP-PET in many cases adds vital preoperative diagnostic information and in more than every fourth patient was the only imaging method that will guide the surgeon in finding the NET-lesion. Although the present results demonstrates that 11C-5-HTP may be used as an universal NET tracer, the sensitivity to visualize benign insulinomas and non functioning pancreatic NETs was lower. PMID:24213229

  2. PET-Guided Surgery — High Correlation between Positron Emission Tomography with 11C-5-Hydroxytryptophane (5-HTP and Surgical Findings in Abdominal Neuroendocrine Tumours

    Directory of Open Access Journals (Sweden)

    Barbro Eriksson

    2012-02-01

    Full Text Available Positron emission tomography (PET with 11C-labeled 5-hydroxytryptophane (5-HTP is a sensitive technique to visualize neuroendocrine tumours (NETs, due to high intracellular uptake of amine-precursors like L-dihydroxyphenylalanine (L-DOPA and 5-HTP. NETs are often small and difficult to localize in spite of overt clinical symptoms due to hormonal excess. In our study, 38 consecutive NET patients underwent 11C-5-HTP-PET and morphological imaging by CT within 12 weeks prior to surgery. Surgical, histopathological and 5-HTP PET findings were correlated. 11C-5-HTP-PET corresponded to the surgical findings in 31 cases, was false negative in six, and true negative in one case resulting in 83.8% sensitivity and 100% specificity. Positive predicted value was 100%. In 11 patients 11C-5-HTP-PET was the only imaging method applied to localize the tumour. Thus, we could demonstrate that functional imaging by 11C-5-HTP-PET in many cases adds vital preoperative diagnostic information and in more than every fourth patient was the only imaging method that will guide the surgeon in finding the NET-lesion. Although the present results demonstrates that 11C-5-HTP may be used as an universal NET tracer, the sensitivity to visualize benign insulinomas and non functioning pancreatic NETs was lower.

  3. Controversies in the Management of Borderline Resectable Proximal Pancreatic Adenocarcinoma with Vascular Involvement

    Directory of Open Access Journals (Sweden)

    Olga N. Tucker

    2008-01-01

    Full Text Available Synchronous major vessel resection during pancreaticoduodenectomy (PD for borderline resectable pancreatic adenocarcinoma remains controversial. In the 1970s, regional pancreatectomy advocated by Fortner was associated with unacceptably high morbidity and mortality rates, with no impact on long-term survival. With the establishment of a multidisciplinary approach, improvements in preoperative staging techniques, surgical expertise, and perioperative care reduced mortality rates and improved 5-year-survival rates are now achieved following resection in high-volume centres. Perioperative morbidity and mortality following PD with portal vein resection are comparable to standard PD, with reported 5-year-survival rates of up to 17%. Segmental resection and reconstruction of the common hepatic artery/proper hepatic artery (CHA/PHA can be performed to achieve an R0 resection in selected patients with limited involvement of the CHA/PHA at the origin of the gastroduodenal artery (GDA. PD with concomitant major vessel resection for borderline resectable tumours should be performed when a margin-negative resection is anticipated at high-volume centres with expertise in complex pancreatic surgery. Where an incomplete (R1 or R2 resection is likely neoadjuvant treatment with systemic chemotherapy followed by chemoradiation as part of a clinical trial should be offered to all patients.

  4. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983

    NARCIS (Netherlands)

    Tanis, E.; Nordlinger, B.; Mauer, M.; Sorbye, H.; van Coevorden, F.; Gruenberger, T.M.; Schlag, P.M.; Punt, C.J.A.; Ledermann, J.; Ruers, Theo J.M.

    2014-01-01

    Aim The aim of this study is to describe local tumour control after radiofrequency ablation (RFA) and surgical resection (RES) of colorectal liver metastases (CLM) in two independent European Organisations for Research and Treatment of Cancer (EORTC) studies. Background Only 10–20% of patients with

  5. Local recurrence rates after radiofrequency ablation or resection of colorectal liver metastases. Analysis of the European Organisation for Research and Treatment of Cancer #40004 and #40983

    NARCIS (Netherlands)

    Tanis, E.; Nordlinger, B.; Mauer, M.; Sorbye, H.; Coevorden, van F.; Gruenberger, T.M.; Schlag, P.M.; Punt, C.J.A.; Ledermann, J.; Ruers, T.J.M.

    2014-01-01

    Aim The aim of this study is to describe local tumour control after radiofrequency ablation (RFA) and surgical resection (RES) of colorectal liver metastases (CLM) in two independent European Organisations for Research and Treatment of Cancer (EORTC) studies. Background Only 10–20% of patients with

  6. The Effects of Microwave Ablation and Surgical Resection on Hematogenous Dissemination of Cancer Cells in Treating Patients with Small Primary Hepatocellular Carcinoma

    Institute of Scientific and Technical Information of China (English)

    Chaoyang Wen; Baowei Dong; Ping Liang; Xiaoling Yu; Li Su; Dejiang Yu; Hongtian Xia

    2006-01-01

    OBJECTIVE To conduct a comparative study of the effects of treatment using microwave ablation versus surgical resection on hematogenous dissemination of cancer cells, and on the level of immune cells of the peripheral blood in patients with small primary hepatocellular carcinoma (PHC, ≤5 cm).METHODS Forty patients with small PHC (maximal diameter ≤5 cm) were divided into a microwave group (19 cases) and a surgical operation group (21 cases). A real-time (RT) quantitative nested RT-PCR examination was performed for peripheral blood alpha-fetoprotein (AFP) mRNA. Studies were conducted to determine the level of CD3, CD4, CD8 and CD4/CD8 cells and for liver function at 30 min before, and 30 min,1 day and 3 days after the treatment.RESULTS Compared to the value before ablation, no obvious changes of CD3, CD4, CD8 and CD4/CD8 cells were found in patients of the microwave group within 7 days after ablation, but CD3, CD4 and CD4/CD8 cells in the operation group were lower compared to that before operatioh. The copy number of AFP mRNA in the peripheral blood samples of the patients of the 2 groups before operation was determined in 67.5% of the patients (27/40). There was an rise in the expression after treatment but no statistical difference was found in comparing the 2 groups. Follow-up of the patients was conducted for 1 to 16 months. For patients with continuous expression of peripheral blood AFP mRNA, the possibility of relapse and metastasis was increased.CONCLUSION Surgical resection or microwave ablation can cause more exfoliation of hepatoma carcinoma cells in the peripheral blood of patients with small PHC. The immune function of peripheral blood cells decreased in the patients after surgical resection, however, the immune function was better protected following microwave ablation. Microwave ablation causes minor reduction in liver function, and the treatment method presents a definite value for PHC therapy.

  7. Hepatic resection beyond barcelona clinic liver cancer indication: When and how

    Science.gov (United States)

    Garancini, Mattia; Pinotti, Enrico; Nespoli, Stefano; Romano, Fabrizio; Gianotti, Luca; Giardini, Vittorio

    2016-01-01

    Hepatocellular carcinoma (HCC) is the main common primary tumour of the liver and it is usually associated with cirrhosis. The barcelona clinic liver cancer (BCLC) classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver Disease. According to this algorithm, hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension (PHT) or hyperbilirubinemia. BCLC classification has been criticised and many studies have shown that multiple tumors and large tumors, as wide as those with macrovascular infiltration and PHT, could benefit from liver resection. Consequently, treatment guidelines should be revised and patients with intermediate/advanced stage HCC, when technically resectable, should receive the opportunity to be treated with radical surgical treatment. Nevertheless, the surgical treatment of HCC on cirrhosis is complex: The goal to be oncologically radical has always to be balanced with the necessity to minimize organ damage. The aim of this review was to analyze when and how liver resection could be indicated beyond BCLC indication. In particular, the role of multidisciplinary approach to assure a proper indication, of the intraoperative ultrasound for intra-operative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced. PMID:27099652

  8. Survival Analyses for Patients With Surgically Resected Pancreatic Neuroendocrine Tumors by World Health Organization 2010 Grading Classifications and American Joint Committee on Cancer 2010 Staging Systems.

    Science.gov (United States)

    Yang, Min; Ke, Neng-wen; Zeng, Lin; Zhang, Yi; Tan, Chun-lu; Zhang, Hao; Mai, Gang; Tian, Bo-le; Liu, Xu-bao

    2015-12-01

    In 2010, World Health Organization (WHO) reclassified pancreatic neuroendocrine tumors (p-NETs) into 4 main groups: neuroendocrine tumor G1 (NET G1), neuroendocrine tumor G2 (NET G2), neuroendocrine carcinoma G3 (NEC G3), mixed adeno and neuroendocrine carcinoma (MANEC). Clinical value of these newly updated WHO grading criteria has not been rigorously validated. The authors aimed to evaluate the clinical consistency of the new 2010 grading classifications by WHO and the 2010 tumor-node metastasis staging systems by American Joint Committee on Cancer (AJCC) on survivals for patients with surgically resected p-NETs. Moreover, the authors would validate the prognostic value of both criteria for p-NETs.The authors retrospectively collected the clinicopathologic data of 120 eligible patients who were all surgically treated and histopathologically diagnosed as p-NETs from January 2004 to February 2014 in our single institution. The new WHO criteria were assigned to 4 stratified groups with a respective distribution of 62, 35, 17, and 6 patients. Patients with NET G1 or NET G2 obtained a statistically better survival compared with those with NEC G3 or MANEC (P systems were respectively defined in 61, 36, 12, and 11 patients for each stage. Differences of survivals of stage I with stage III and IV were significant (P systems were both significant in univariate and multivariate analysis (P systems could consistently reflect the clinical outcome of patients with surgically resected p-NETs. Meanwhile, both criteria could be independent predictors for survival analysis of p-NETs.

  9. A Phase II Study of a Paclitaxel-Based Chemoradiation Regimen With Selective Surgical Salvage for Resectable Locoregionally Advanced Esophageal Cancer: Initial Reporting of RTOG 0246

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    Swisher, Stephen G., E-mail: sswisher@mdanderson.org [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Winter, Kathryn A. [Headquarters, Radiation Therapy Oncology Group Statistical Center, Philadelphia, Pennsylvania (United States); Komaki, Ritsuko U. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Ajani, Jaffer A. [Department of Gastrointestinal Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Wu, Tsung T. [Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (United States); Hofstetter, Wayne L. [Department of Thoracic and Cardiovascular Surgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Konski, Andre A. [Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States); Willett, Christopher G. [Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States)

    2012-04-01

    Purpose: The strategy of definitive chemoradiation with selective surgical salvage in locoregionally advanced esophageal cancer was evaluated in a Phase II trial in Radiation Therapy Oncology Group (RTOG)-affiliated sites. Methods and Materials: The study was designed to detect an improvement in 1-year survival from 60% to 77.5% ({alpha} = 0.05; power = 80%). Definitive chemoradiation involved induction chemotherapy with 5-fluorouracil (5-FU) (650 mg/mg{sup 2}/day), cisplatin (15 mg/mg{sup 2}/day), and paclitaxel (200 mg/mg{sup 2}/day) for two cycles, followed by concurrent chemoradiation with 50.4 Gy (1.8 Gy/fraction) and daily 5-FU (300 mg/mg{sup 2}/day) with cisplatin (15 mg/mg{sup 2}/day) over the first 5 days. Salvage surgical resection was considered for patients with residual or recurrent esophageal cancer who did not have systemic disease. Results: Forty-three patients with nonmetastatic resectable esophageal cancer were entered from Sept 2003 to March 2006. Forty-one patients were eligible for analysis. Clinical stage was {>=}T3 in 31 patients (76%) and N1 in 29 patients (71%), with adenocarcinoma histology in 30 patients (73%). Thirty-seven patients (90%) completed induction chemotherapy followed by concurrent chemoradiation. Twenty-eight patients (68%) experienced Grade 3+ nonhematologic toxicity. Four treatment-related deaths were noted. Twenty-one patients underwent surgery following definitive chemoradiation because of residual (17 patients) or recurrent (3 patients) esophageal cancer,and 1 patient because of choice. Median follow-up of live patients was 22 months, with an estimated 1-year survival of 71%. Conclusions: In this Phase II trial (RTOG 0246) evaluating selective surgical salvage after definitive chemoradiation in locoregionally advanced esophageal cancer, the hypothesized 1-year RTOG survival rate (77.5%) was not achieved (1 year, 71%; 95% confidence interval< 54%-82%).

  10. Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

    Science.gov (United States)

    Sutton, Elie; Miyagaki, Hiromichi; Bellini, Geoffrey; Shantha Kumara, H M C; Yan, Xiaohong; Howe, Brett; Feigel, Amanda; Whelan, Richard L

    2017-01-01

    Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI. A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay. Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be

  11. Incidence of Diabetes Insipidus in Postoperative Period among the Patients Undergoing Pituitary Tumour Surgery.

    Science.gov (United States)

    Kadir, M L; Islam, M T; Hossain, M M; Sultana, S; Nasrin, R; Hossain, M M

    2017-07-01

    Post operative complications after pituitary tumour surgery vary according to procedure. There are several surgical procedures being done such as transcranial, transsphenoidal microsurgical and transsphenoidal endoscopic approaches. One of the commonest complications is diabetes insipidus (DI). Our main objective was to find out the incidence of diabetes insipidus in post operative period among patients undergoing surgical intervention for pituitary tumour in our institute. The presence of diabetes insipidus in the postoperative period was established by measuring serum Na+ concentration, hourly urine output and urinary specific gravity to find out the incidence of diabetes insipidus in postoperative period in relation to age, gender, tumour diameter, function of tumour (i.e., either hormone secreting or not) and operative procedure used for surgical resection of pituitary tumor. As it is the most common postoperative complication so, in this study we tried to find out how many of the patients develop diabetes insipidus in postoperative period following surgical resection of pituitary tumour. This cross sectional type of observational study was carried out in the department of Neurosurgery, BSMMU from May 2014 to October 2015 on 33 consecutive patients who underwent surgical intervention for pituitary tumour for the first time. Data was collected by using a data collection sheet. The incidence of diabetes insipidus was found 23.1% of patients in diabetes insipidus (p=0.073). Regarding tumour size 30.8% and 69.2% of patients developed diabetes insipidus having tumour diameter diabetes insipidus who was operated by transsphenoidal endoscopic approach, 23.1% and 7.7% of patients developed diabetes insipidus who underwent pituitary tumour resection through transsphenoidal microscopic approach and transcranial microscopic approach respectively (p=0.432). 17.6% of patients develop DI having functioning pituitary macroadenoma and 62.5% of patients develop DI having

  12. A New Surgical Technique of Pancreaticoduodenectomy with Splenic Artery Resection for Ductal Adenocarcinoma of the Pancreatic Head and/or Body Invading Splenic Artery: Impact of the Balance between Surgical Radicality and QOL to Avoid Total Pancreatectomy

    Directory of Open Access Journals (Sweden)

    Ryosuke Desaki

    2014-01-01

    Full Text Available For pancreatic ductal adenocarcinoma (PDAC of the head and/or body invading the splenic artery (SA, we developed a new surgical technique of proximal subtotal pancreatectomy with splenic artery and vein resection, so-called pancreaticoduodenectomy with splenic artery resection (PD-SAR. We retrospectively reviewed a total of 84 patients with curative intent pancreaticoduodenectomy (PD for PDAC of the head and/or body. These 84 patients were classified into the two groups: conventional PD (n=66 and PD-SAR (n=18. Most patients were treated by preoperative chemoradiotherapy (CRT. Postoperative MDCT clearly demonstrated enhancement of the remnant pancreas at 1 and 6 months in all patients examined. Overall survival rates were very similar between PD and PD-SAR (3-year OS: 23.7% versus 23.1%, P=0.538, despite the fact that the tumor size and the percentages of UICC-T4 determined before treatment were higher in PD-SAR. Total daily insulin dose was significantly higher in PD-SAR than in PD at 1 month, while showing no significant differences between the two groups thereafter. PD-SAR with preoperative CRT seems to be promising surgical strategy for PDAC of head and/or body with invasion of the splenic artery, in regard to the balance between operative radicality and postoperative QOL.

  13. Factors Associated with Abducens Nerve Recovery in Patients Undergoing Surgical Resection of Sixth Nerve Schwannoma: A Systematic Review and Case Illustration.

    Science.gov (United States)

    Sun, Hai; Sharma, Kanika; Kalakoti, Piyush; Thakur, Jai Deep; Patra, Devi Prasad; Konar, Subhas; Maiti, Tanmoy; Akbarian-Tefaghi, Hesam; Bollam, Papireddy; Notarianni, Christina; Nanda, Anil

    2017-08-01

    Limited or no literature exists identifying factors associated with functional nerve recovery in patients undergoing resection of sixth cranial nerve (CN VI) schwannomas. A systematic review of literature was performed on CN VI schwannomas that were treated surgically. Synthesizing the findings pooled from the literature, we investigated associations of patient demographics and clinical characteristics with postsurgical CN VI functional recovery in multivariable regression models. In addition, we present the findings of an adolescent woman surgically managed for intracavernous CN VI schwannoma. Complete encasement of the cavernous segment of the internal carotid artery is unique to our case. We synthesized data of 32 patients from 29 studies, and our index case. Overall, the mean age of the patients was 44.0 ± 16.5 years, and approximately 52% (n = 17) were female. Most tumors were left-sided (n = 18; 54.5%), with an average size of 3.46 ± 1.71 cm. The most common location was cisternal (n = 11; 33%), followed by cavernous sinus (CS) proper (n = 9; 27%), cisterocavernous (n = 8; 24%), orbital (n = 4; 12%) and caverno-orbital (n = 1; 3%). CN VI recovery was reported in less than half the cohort (n = 14; 45%). Tumor extension in the CS was significantly associated with lesser likelihood (odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-0.98; P = 0.048) of postsurgical CN VI recovery. Although female gender (OR, 0.86; 95% CI, 0.07-10.09; P = 0.906), large tumor size (>2.5 cm) (OR, 0.45; 95% CI, 0.07-2.89; P = 0.397), and solid consistency (OR, 0.37; 95% CI, 0.03-4.19; P = 0.421) were associated with lesser odds for recovery, these were not statistically significant. Likewise, although gross total resection (OR, 6.28; 95% CI, 0.33-118.25; P = 0.220) was associated with higher odds of nerve recovery, the estimates were statistically insignificant. CS involvement is associated with lesser odds for functional nerve recovery in patients undergoing

  14. [Laparoscopic liver resection: lessons learned after 132 resections].

    Science.gov (United States)

    Robles Campos, Ricardo; Marín Hernández, Caridad; Lopez-Conesa, Asunción; Olivares Ripoll, Vicente; Paredes Quiles, Miriam; Parrilla Paricio, Pascual

    2013-10-01

    After 20 years of experience in laparoscopic liver surgery there is still no clear definition of the best approach (totally laparoscopic [TLS] or hand-assisted [HAS]), the indications for surgery, position, instrumentation, immediate and long-term postoperative results, etc. To report our experience in laparoscopic liver resections (LLRs). Over a period of 10 years we performed 132 LLRs in 129 patients: 112 malignant tumours (90 hepatic metastases; 22 primary malignant tumours) and 20 benign lesions (18 benign tumours; 2 hydatid cysts). Twenty-eight cases received TLS and 104 had HAS. 6 right hepatectomies (2 as the second stage of a two-stage liver resection); 6 left hepatectomies; 9 resections of 3 segments; 42 resections of 2 segments; 64 resections of one segment; and 5 cases of local resections. There was no perioperative mortality, and morbidity was 3%. With TLS the resection was completed in 23/28 cases, whereas with HAS it was completed in all 104 cases. Transfusion: 4,5%; operating time: 150min; and mean length of stay: 3,5 days. The 1-, 3- and 5-year survival rates for the primary malignant tumours were 100, 86 and 62%, and for colorectal metastases 92, 82 and 52%, respectively. LLR via both TLS and HAS in selected cases are similar to the results of open surgery (similar 5-year morbidity, mortality and survival rates) but with the advantages of minimally invasive surgery. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  15. Surgical management of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Tony CY Pang; Vincent WT Lam

    2015-01-01

    Hepatocellular carcinoma (HCC) is the second mostcommon cause of death from cancer worldwide.Standard potentially curative treatments are eitherresection or transplantation. The aim of this paper isto provide an overview of the surgical managementof HCC, as well as highlight current issues in hepaticresection and transplantation. In summary, due to therelationship between HCC and chronic liver disease,the management of HCC depends both on tumourrelatedand hepatic function-related considerations. Assuch, HCC is currently managed largely through nonsurgicalmeans as the criteria, in relation to the aboveconsiderations, for surgical management is still largelyrestrictive. For early stage tumours, both resectionand transplantation offer fairly good survival outcomes(5 years overall survival of around 50%). Selectiontherefore would depend on the level of hepatic functionderangement, organ availability and local expertise.Patients with intermediate stage cancers have limitedoptions, with resection being the only potential forcure. Otherwise, locoregional therapy with transarterialchemoembolization or radiofrequency ablation are viableoptions. Current issues in resection and transplantationare also briefly discussed such as laparoscopic resection,ablation vs resection, anatomical vs non-anatomicalresection, transplantation vs resection, living donor livertransplantation and salvage liver transplantation.

  16. Solid pseudopapillary epithelial neoplasm--a rare but curable pancreatic tumour in young women.

    Science.gov (United States)

    Frost, M; Krige, J E J; Bornman, P C; Panieri, E; Beningfield, S J; Wainwright, H

    2011-04-01

    Solid pseudopapillary epithelial neoplasms (SPENs) of the pancreas are rare but curable tumours that have a low-grade malignant potential and occur almost exclusively in young women, with an excellent prognosis after complete resection. This study examines the clinicopathological characteristics of these tumours and evaluates the role of surgery in relation to their size and location. We reviewed the pre-, intra- and postoperative data on 21 patients with SPENs who underwent resection during a 30-year period. Data including demographic information, presenting symptoms and signs, extent of operation, histology, tumour markers and postoperative complications were evaluated to establish the optimal surgical management. All 21 tumours occurred in women (mean age 24.6 years, range 13-51 years). Sixteen patients presented with nonspecific abdominal complaints and a palpable abdominal mass, in 1 patient the tumour was found during emergency laparotomy for a complicated ovarian cyst, 1 patient presented with severe abdominal pain and shock due to a ruptured tumour, and in 3 patients the tumour was detected incidentally during imaging. The correct pre-operative diagnosis of SPEN was made in 10 patients. Incorrect preoperative diagnoses included hydatid cyst (3 patients), mesenteric cyst (2), pancreatic cystadenoma (2), ovarian cysts (1), islet cell tumour of the pancreas (1), and cavernous haemangioma of the liver (1). The mean diameter of the tumours was 12.5 cm (range 8 - 20 cm), and they occurred in the head (8), neck (5), body (2), and tail (6) of the pancreas. All SPENs were resected. Five patients had a pylorus-preserving pancreaticoduodenectomy, 4 a central pancreatectomy with distal pancreaticogastrostomy, 8 a distal pancreatectomy, 3 a local resection and one a total pancreatectomy and portal vein graft. In 1 patient, 2 liver metastases were resected in addition to the pancreatic primary tumour. The patient who presented in shock with tumour rupture and bleeding

  17. [Post-recurrence survival after surgical resection of non-small cell lung cancer with local recurrence].

    Science.gov (United States)

    Yokouchi, Hideoki; Miyazaki, Masaki; Miyamoto, Takeaki; Tsuji, Fumio; Ebisui, Chikara; Murata, Kohei

    2014-11-01

    We retrospectively evaluated the clinical outcomes of 192 consecutive patients with local recurrence after complete resection of non-small cell lung cancer NSCLC). The initial local recurrent site was the resection stump in 5 patients the chest wall in 3 patients, mediastinum in 1 patient, and diaphragm in 1 patient), and the hilar and/or mediastinal lymph node (HMLN) in 17 patients. The sites of distant metastasis were the lungs in 10 patients, pleura in 4 patients, brain in 7 patients, liver in 5 patients, bone in 4 patients, and other sites in 4 patients. Treatments after initial recurrence included surgery in 2 patients, radiotherapy in 5 patients, chemotherapy in 9 patients, and chemo-radiotherapy in 5 patients. Only 1 patient received supportive care. The response to radiotherapy was a complete response (R) in 1 patient, partial response (PR) in 5 patients, stable disease (SD )in 3 patients, and progressive disease (PD )in 1 patient. The best response of all lines of chemotherapy was CR in 3 patients, PR in 4 patients, SD in 3 patients, and PD in 4 patients. The median post-recurrence survival (PRS) time with local recurrence was better than that with distant metastasis (23 vs 14 months); however, the best PRS was obtained in patients with recurrence in the lungs (29 months). A CR for more than 2 years was obtained in 1 patient after surgery, in 1 patient after radiotherapy, and in 2 patients after chemotherapy. Although local recurrence of resected NSCLC can be potentially controlled by using local treatments - such as surgery and radiotherapy - or systemic chemotherapy, curative aggressive treatment should be considered when required.

  18. Clinicopathological features of five unusual cases of intraosseous myoepithelial carcinomas, mimicking conventional primary bone tumours, including EWSR1 rearrangement in one case.

    Science.gov (United States)

    Rekhi, Bharat; Joshi, Sujit; Panchwagh, Yogesh; Gulia, Ashish; Borges, Anita; Bajpai, Jyoti; Jambehekar, Nirmala A; Pant, Vinita; Mandholkar, Mahesh; Byregowda, Suman; Puri, Ajay

    2016-04-01

    Primary intraosseous myoepithelial tumours, including carcinomas are rare tumours. The concept of histopathological spectrum of these tumours is evolving. We describe clinicopathological and immunohistochemical features of five myoepithelial carcinomas, including molecular cytogenetic results in one case. There were five male patients within age-range of 8-40 years (median = 26). Four tumours occurred in the long bones, including two tumours, each, in the femur and fibula, respectively, while a single tumour occurred in the proximal phalanges. Tumour size (n = 3 cases) varied from 5.6 to 8.6 cm. On radiological imaging, most tumours appeared as expansile, lytic and destructive lesions. Two tumours appeared as sclerotic lesions. Two cases were referred with diagnoses of chondrosarcomas and a single case was referred with two different diagnoses, including an adamantinoma and an osteosarcoma. Histopathological examination in all these cases showed multinodular tumours comprising mostly polygonal cells, exhibiting moderate nuclear atypia and interspersed mitotic figures within a stroma containing variable amount of myxoid, chondroid, hyalinised and osteoid-like material. Three tumours revealed prominent squamous differentiation. By immunohistochemistry, tumour cells were positive for EMA (5/5), pan CK (AE1/AE3) (3/3), CK5/6 (4/4), CK MNF116 (1/1), S100 protein (5/5) and GFAP (3/5). The first tumour revealed EWSR1 rearrangement. The first patient, 10 months after tumour resection and a simultaneous lung metastatectomy, is free-of-disease (FOD). The second patient, 11 months after tumour resection is FOD. The third and fourth patients underwent wide resections and are on follow-up. The fifth patient underwent resections, including a lung metastatectomy. Primary intraosseous myoepithelial carcinomas are rare and mimic conventional primary bone tumours. Some primary intraosseous myoepithelial carcinomas display EWSR1 rearrangement. Squamous differentiation may be

  19. Chemokine receptor expression in tumour islets and stroma in non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Shikotra Aarti

    2010-04-01

    Full Text Available Abstract Background We have previously demonstrated that tumour islet infiltration by macrophages is associated with extended survival (ES in NSCLC. We therefore hypothesised that patients with improved survival would have high tumour islet expression of chemokine receptors known to be associated with favourable prognosis in cancer. This study investigated chemokine receptor expression in the tumour islets and stroma in NSCLC. Methods We used immunohistochemistry to identify cells expressing CXCR1, CXCR2, CXCR3, CXCR4, CXCR5 and CCR1 in the tumour islets and stroma in 20 patients with surgically resected NSCLC. Correlations were made with macrophage and mast cell expression. Results There was increased expression of CXCR2, CXCR3, and CCR1 in the tumour islets of ES compared with poor survival (PS patients (p = 0.007, 0.01, and 0.002, respectively. There was an association between 5 year survival and tumour islet CXCR2, CXCR3 and CCR1 density (p = 0.02, 0.003 and s = 0.520, p = 0.02 and between mast cell density and CXCR3 expression (rs = 0.499, p = 0.03 in the tumour islets. Conclusion Above median expression of CXCR2, CXCR3 and CCR1 in the tumour islets is associated with increased survival in NSCLC, and expression of CXCR3 correlates with increased macrophage and mast cell infiltration in the tumour islets.

  20. Influence of simultaneous liver and peritoneal resection on postoperative morbi-mortality and survival in patients with colon cancer treated with surgical cytoreduction and intraperitoneal hyperthermic chemotherapy.

    Science.gov (United States)

    Morales Soriano, Rafael; Morón Canis, José Miguel; Molina Romero, Xavier; Pérez Celada, Judit; Tejada Gavela, Silvia; Segura Sampedro, Juan José; Jiménez Morillas, Patricia; Díaz Jover, Paula; García Pérez, José María; Sena Ruiz, Fátima; González Argente, Xavier

    2017-04-01

    Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (HIPEC) has recently been established as the treatment of choice for selected patients with peritoneal carcinomatosis of colonic origin. Until recently, the simultaneous presence of peritoneal and hepatic dissemination has been considered a contraindication for surgery. The aim of this paper is to analyze the morbidity, mortality and survival of patients with simultaneous peritoneal and hepatic resection with HIPEC for peritoneal carcinomatosis secondary to colon cancer. Between January 2010 and January 2015, 61 patients were operated on, 16 had simultaneous peritoneal and hepatic dissemination (group RH+), and 45 presented only peritoneal dissemination (group RH-). There were no differences between the groups in terms of demographic data, length of surgery and extension of peritoneal disease. Postoperative grade III-V complications were significantly higher in the RH+ group (56.3 vs. 26.6%; P=.032). For the whole group, mortality rate was 3.2% (two patients in group RH-, and none in group RH+). Patients with liver resection had a longer postoperative stay (14.4 vs. 23.1 days) (P=.027). Median overall survival was 33 months for RH-, and 36 for RH+ group. Median disease-free survival was 16 months for RH-, and 24 months for RH+ group. Simultaneous peritoneal cytoreduction and hepatic resection resulted in a significantly higher Clavien grade III-V morbidity and a longer hospital stay, although the results are similar to other major abdominal interventions. The application of multimodal oncological and surgical treatment may obtain similar long-term survival results in both groups. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Radiofrequency for the treatment of liver tumours.

    NARCIS (Netherlands)

    Ruers, T.J.M.; Jong, K.P. de; Ijzermans, J.N.M.

    2005-01-01

    Resection should still be considered the gold standard for many liver tumours. There is, however, growing interest in the use of radiofrequency (RFA) for the treatment of liver tumours. By RFA, tumour tissue can be destructed selectively without significant damage to vascular structures in the

  2. Radiofrequency for the treatment of liver tumours

    NARCIS (Netherlands)

    Ruers, TJM; de Jong, KP; Ijzermans, JNM

    2005-01-01

    Resection should still be considered the gold standard for many liver tumours. There is, however, growing interest in the use of radiofrequency (RFA) for the treatment of liver tumours. By RFA, tumour tissue can be destructed selectively without significant damage to vascular structures in the

  3. Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection

    Science.gov (United States)

    Chen, Chuangui; Gao, Yongyin; Xiao, Xiangming; Tang, Peng; Duan, Xiaofeng; Yang, Mingjian; Jiang, Hongjing; Yu, Zhentao

    2016-01-01

    This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio (HR) and a −2log likelihood. The prediction accuracy of the model was assessed by using the area under the curve (AUC) and the Harrell's C-index. The number of examined lymph nodes (LNs) was correlated with metastatic LNs (r = 0.322, P 0.05). The optimal cut-points of rN were calculated as 0, 0~0.3, 0.3~0.6, and 0.6~1.0. Univariate analysis revealed that pN and rN classifications significantly influenced patients’ RFS and OS (P TNM staging system in evaluating prognosis of AEG patients after curative resection. PMID:27517157

  4. Parapharyngeal space primary tumours.

    Science.gov (United States)

    Grilli, Gianluigi; Suarez, Vanessa; Muñoz, María Gabriela; Costales, María; Llorente, José Luis

    The aim of this study is to present our experience with the diagnostic and therapeutic approaches for parapharyngeal space tumours. This study is a retrospective review of 90 patients diagnosed with tumours of the parapharyngeal space and treated surgically between 1984 and 2015. Patients whose tumours were not primary but invaded the parapharyngeal space expanding from another region, tumours originating in the deep lobe of the parotid gland and head and neck metastasis were excluded from this study. 74% percent of the parapharyngeal space neoplasms were benign and 26% were malignant. Pleomorphic adenoma was the most common neoplasm (27%), followed by paragangliomas (25%), miscellaneous malignant tumours (16%), neurogenic tumours (12%), miscellaneous benign tumours (10%), and malignant salivary gland tumours (10%). The transcervical approach was used in 56 cases, cervical-transparotid approach in 15 cases, type A infratemporal fossa approach in 13 cases, transmandibular approach in 4 cases and transoral approach in 2 cases. The most common complications were those deriving from nervous injuries. Most parapharyngeal space tumours can be removed surgically with a low rate of complications and recurrence. The transcervical approach is the most frequently used. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  5. Minimally Invasive Resection of an Extradural Far Lateral Lumbar Schwannoma with Zygapophyseal Joint Sparing: Surgical Nuances and Literature Review

    Directory of Open Access Journals (Sweden)

    Vítor M. Gonçalves

    2014-01-01

    Full Text Available Introduction. Spinal schwannomas are benign nerve sheath tumors. Completely extradural schwannomas of the lumbar spine are extremely rare lesions, accounting for only 0,7–4,2% of all spinal NSTs. Standard open approaches have been used to treat these tumors, requiring extensive muscle dissection, laminectomy, radical foraminotomy, and facetectomy. In this paper the authors present the case of a minimally invasive resection of a completely extradural schwannoma. Operative technique literature review is presented. Material & Methods. A 50-year-old woman presented with progressive complains of chronic right leg pain and paresthesia. The magnetic resonance imaging revealed a giant well-encapsulated dumbbell-shaped extradural lesion at the L3-L4 level. The patient underwent a minimally invasive gross total resection of the tumor using a tubular expandable retractor system. Results. The patient had complete resolution of radiculopathy in the immediate postoperative period and she was discharged home, neurologically intact, on the second postoperative day. Postoperative MRI demonstrated no evidence of residual tumor. At latest follow-up (18 months the patient remains asymptomatic. Conclusion. Although challenging, this minimally invasive procedure is safe and effective, being an appropriate alternative, with many potential advantages, to the open approach.

  6. Length of Distal Resection Margin after Partial Mesorectal Excision for Upper Rectal Cancer Estimated by Magnetic Resonance Imaging

    DEFF Research Database (Denmark)

    Bondeven, Peter; Hagemann-Madsen, Rikke Hjarnø; Bro, Lise;

    BACKGROUND: Rectal cancer requires surgery for cure. Partial mesorectal excision (PME) is suggested for tumours in the upper rectum and implies transection of the mesorectum perpendicular to the bowel a minimum of 5 cm below the tumour. Reports have shown distal mesorectal tumour spread of up to 5...... cm from the primary tumour; therefore, guidelines for cancer of the upper rectum recommend PME with a distal resection margin (DRM) of at least 5 cm or total mesorectal excision (TME). PME exerts a hazard of removing less than 5 cm - leaving microscopic tumour cells that have spread in the mesorectum....... Studies at our department have shown inadequate DRM in 75 % of the patients estimated by post-operative MRI of the pelvis and by measurements of the histopathological specimen. Correspondingly, a higher rate of local recurrence in patients surgically treated with PME for rectal cancer - compared to TME...

  7. Prognostic significance of the combined score of endothelial expression of nucleolin and CD31 in surgically resected non-small cell lung cancer.

    Directory of Open Access Journals (Sweden)

    Hongyun Zhao

    Full Text Available Nucleolin is implicated to play a role in angiogenesis, a vital process in tumor growth and metastasis. However, the presence and clinical relevance of nucleolin in human non small cell lung cancer (NSCLC remains largely unknown. In this study, we explored the expression and prognostic implication of nucleolin in surgically resected NSCLC patients. A cohort of 146 NSCLC patients who underwent surgical resection was selected for tissue microarray. In this tissue microarray, nucleolin expression was measured by immunofluorescence. Staining for CD31, a marker of endothelial cells, was performed to mark blood vessels. A Cox proportional hazards model was used to assess the prognostic significance of nucleolin. Nucleolin expression was observed in 34.2% of all patients, and 64.1% in high CD31 expression patients. The disease-free survival (DFS was significantly shorter in patients with high nucleolin (CD31(hiNCL(hi compared to patients with low tumor blood vessels (CD31(loNCL(lo (5 ys of DFS 24% vs 64%, p = 0.002. Such a difference was demonstrated in the following stratified analyses: stage I (p<0.001, squamous cell carcinoma and adenosquamous cell carcinoma (p = 0.028, small tumor (<5 cm, p = 0.008, and surgery alone (p = 0.015. Multivariate analysis further revealed that nucleolin expression independently predicted for worse survival (p = 0.003. This study demonstrates that nucleolin is associated with the clinical outcomes in postoperative NSCLC patients. Thus, the expression levels of nucleolin may provide a new prognostic marker to identify patients at higher risk for treatment failure, especially in some subgroups.

  8. Meta-analysis of elective surgical complications related to defunctioning loop ileostomy compared with loop colostomy after low anterior resection for rectal carcinoma.

    Science.gov (United States)

    Geng, Hong Zhi; Nasier, Dilidan; Liu, Bing; Gao, Hua; Xu, Yi Ke

    2015-10-01

    Introduction Defunctioning loop ileostomy (LI) and loop colostomy (LC) are used widely to protect/treat anastomotic leakage after colorectal surgery. However, it is not known which surgical approach has a lower prevalence of surgical complications after low anterior resection for rectal carcinoma (LARRC). Methods We conducted a literature search of PubMed, MEDLINE, Ovid, Embase and Cochrane databases to identify studies published between 1966 and 2013 focusing on elective surgical complications related to defunctioning LI and LC undertaken to protect a distal rectal anastomosis after LARRC. Results Five studies (two randomized controlled trials, one prospective non-randomized trial, and two retrospective trials) satisfied the inclusion criteria. Outcomes of 1,025 patients (652 LI and 373 LC) were analyzed. After the construction of a LI or LC, there was a significantly lower prevalence of sepsis (p=0.04), prolapse (p=0.03), and parastomal hernia (p=0.02) in LI patients than in LC patients. Also, the prevalence of overall complications was significantly lower in those who received LIs compared with those who received LCs (p<0.0001). After closure of defunctioning loops, there were significantly fewer wound infections (p=0.006) and incisional hernias (p=0.007) in LI patients than in LC patients, but there was no significant difference between the two groups in terms of overall complications. Conclusions The results of this meta-analysis show that a defunctioning LI may be superior to LC with respect to a lower prevalence of surgical complications after LARRC.

  9. Comparison of long-term survival between temozolomide-based chemoradiotherapy and radiotherapy alone for patients with low-grade gliomas after surgical resection

    Directory of Open Access Journals (Sweden)

    Gai XJ

    2016-08-01

    Full Text Available Xiu-juan Gai,1,2 Yu-mei Wei,2 Heng-min Tao,1,2 Dian-zheng An,2 Jia-teng Sun,1,2 Bao-sheng Li2 1School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, Shandong, People’s Republic of China; 2Department of Radiation Oncology VI, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, Shandong, People’s Republic of China Purpose: This study was designed to compare the survival outcomes of temozolomide-based chemoradiotherapy (TMZ + RT vs radiotherapy alone (RT-alone for low-grade gliomas (LGGs after surgical resection. Patients and methods: In this retrospective analysis, we reviewed postoperative records of 69 patients with LGGs treated with TMZ + RT (n=31 and RT-alone (n=38 at the Shandong Cancer Hospital Affiliated to Shandong University between June 2011 and December 2013. Patients in the TMZ + RT group were administered 50–100 mg oral TMZ every day until the radiotherapy regimen was completed. Results: The median follow-up since surgery was 33 months and showed no significant intergroup differences (P=0.06. There were statistically significant intergroup differences in the progression-free survival rate (P=0.037, with 83.9% for TMZ-RT group and 60.5% for RT-alone group. The overall 2-year overall survival (OS rate was 89.86%. Age distribution (≥45 years and <45 years and resection margin (complete resection or not were significantly associated with OS (P=0.03 and P=0.004, respectively. Conclusion: Although no differences were found in the 2-year OS between the TMZ + RT and RT-alone groups, there was a trend toward increased 2-year progression-free survival in the TMZ + RT group. With better tolerability, concurrent TMZ chemoradiotherapy may be beneficial for postoperative patients with LGGs. Age distribution and surgical margin are likely potential indicators of disease prognosis. The possible differences in long-term survival between the two groups and the links between

  10. Combined surgical resective and regenerative therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation: a case report.

    Science.gov (United States)

    Schwarz, Frank; John, Gordon; Sahm, Narja; Becker, Jürgen

    2014-01-01

    This case report presents a 3-year follow-up of the clinical outcomes of a combined surgical therapy for advanced peri-implantitis with concomitant soft tissue volume augmentation using a collagen matrix. One patient suffering from advanced peri-implantitis and a thin mucosal biotype underwent access flap surgery, implantoplasty at buccally and supracrestally exposed implant parts, and augmentation of the intrabony components using a natural bone mineral and a native collagen membrane after surface decontamination. A collagen matrix was applied to the wound area to increase soft tissue volume and support transmucosal healing. The following clinical parameters were recorded over a period of 3 years: bleeding on probing (BOP), probing depth (PD), mucosal recession (MR), clinical attachment level (CAL), and width of keratinized mucosa (KM). At 36 months, the combined surgical procedure was associated with a clinically important reduction in mean BOP (100%), PD (4.3 ± 0.5 mm), and CAL (4.4 ± 0.4 mm). Site-level analysis of the buccal aspects pointed to an increase in MR (-1.0 ± 0.4 mm) and a decrease in KM (-1.3 ± 0.5 mm) values at 12 months. However, a regain in mucosal height and KM was noted at 24 months, even reaching respective baseline values after 36 months of healing. The presented combined surgical procedure was effective in controlling an advanced peri-implantitis lesion without compromising the overall esthetic outcome in the long term.

  11. The surgical treatment of acromegaly.

    Science.gov (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2017-02-01

    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  12. Large gastrointestinal stromal tumours of the stomach: Is laparoscopy reasonable?

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    Beatrice Ulloa Severino

    2016-01-01

    Full Text Available Background: Laparoscopic resection (LR offers significant advantages compared to open resections for gastric gastrointestinal stromal tumours (GISTs. We aimed to evaluate whether LR outcomes jeopardised short and long-term outcomes of patients with large GISTs. Patients and Methods: Among 50 patients undergoing surgery for gastric GISTs, 12 underwent LR for large GISTs (>5 cm. Their characteristics, perioperative results and survival were retrospectively compared to those of 22 patients who underwent LR for 'small GIST'. Results: The two groups were similar regarding demographics, rate of wedge resection and mean blood loss. No patient required transfusion or conversion. Operative time was significantly increased in the 'large GIST' group (160 min vs 112 min, P = 0.001. Mean tumour size was significantly lower in the 'small GIST' group (8.4 cm vs 2.4 cm, P = 0.0001. Resection margins were negative. The mortality rate was nil and the overall morbidity rates was similar in both groups. Median length of hospital stay was significantly increased in the 'large GIST' group (7 days vs 5 days, P = 0.004. Median follow-up was 47 months and one patient in the 'small GIST' group developed recurrence and died during follow-up 11 years after surgery. No patient died during follow-up. Conclusions: LR for large GISTs is safe and technically feasible and does not negatively influence the oncologic course. Prospective randomised trials should be performed before using this approach in routine surgical care.

  13. Surgical Innovation in Sarcoma Surgery.

    Science.gov (United States)

    Jeys, L; Morris, G; Evans, S; Stevenson, J; Parry, M; Gregory, J

    2017-08-01

    The field of orthopaedic oncology relies on innovative techniques to resect and reconstruct a bone or soft tissue tumour. This article reviews some of the most recent and important innovations in the field, including biological and implant reconstructions, together with computer-assisted surgery. It also looks at innovations in other fields of oncology to assess the impact and change that has been required by surgeons; topics including surgical margins, preoperative radiotherapy and future advances are discussed. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  14. Effects of Obesity and Diabetes on α- and β-Cell Mass in Surgically Resected Human Pancreas.

    Science.gov (United States)

    Inaishi, Jun; Saisho, Yoshifumi; Sato, Seiji; Kou, Kinsei; Murakami, Rie; Watanabe, Yuusuke; Kitago, Minoru; Kitagawa, Yuko; Yamada, Taketo; Itoh, Hiroshi

    2016-07-01

    The ethnic difference in β-cell regenerative capacity in response to obesity may be attributable to different phenotypes of type 2 diabetes among ethnicities. This study aimed to clarify the effects of diabetes and obesity on β- (BCM) and α-cell mass (ACM) in the Japanese population. We obtained the pancreases of 99 individuals who underwent pancreatic surgery and whose resected pancreas sample contained adequate normal pancreas for histological analysis. Questionnaires on a family history of diabetes and history of obesity were conducted in 59 patients. Pancreatic sections were stained for insulin or glucagon, and fractional β- and α-cell area were measured. Islet size and density as well as β-cell turnover were also quantified. In patients with diabetes, BCM was decreased by 46% compared with age- and body mass index-matched nondiabetic patients (1.48% ± 1.08% vs 0.80% ± 0.54%, P obesity or history of obesity on BCM and ACM irrespective of the presence or absence of diabetes. There was a negative correlation between BCM, but not ACM, and glycated hemoglobin before and after pancreatic surgery. In addition, reduced BCM was observed in patients with pancreatic cancer compared with those with other pancreatic tumors. These findings suggest that the increase in BCM in the face of insulin resistance is extremely limited in the Japanese, and BCM rather than ACM has a major role in regulating blood glucose level in humans.

  15. PINEAL GLAND TUMOURS - OUR EXPERIENCE AT TERTIARY CARE CENTRE: A 3-YEAR STUDY

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    Parsa Mani Mekhala

    2016-09-01

    Full Text Available BACKGROUND Pineal gland tumours are slow growing tumours arising in the pineal gland that resemble normal pineal gland. In WHO classification, they are considered as WHO Grade 1 tumours. Incidence of these tumours is very low. The germ cell tumours in this region are much more common arising from the pluripotent germ cells mistakenly lodged in this region during embryogenesis. Tumours which arise from the stroma are Gliomas and Atypical Teratoid Rhabdoid Tumours (ATRT. Commonest clinical presentation is hydrocephalus due to compression of tectum and upward gaze due to compression of superior colliculi. Radiology aids in giving a provisional diagnosis on CT and MRI. Confirmation with histopathology is important for proper treatment and prognosis. MATERIALS AND METHODS We present a retrospective study done over 3 years at a tertiary care centre. Radiologically diagnosed cases as pineal gland tumours, which were well demarcated within the region of pineal gland were included in the study. The surgically resected specimen were examined by squash cytology and then processed routinely for histopathology and immunohistochemistry. RESULTS AND CONCLUSION A total of 18 cases were studied and analysed. The lesions encountered were germ cell tumours, pineal parenchymal tumours and gliomas. On intraoperative squash, one case, which was diagnosed as glioma was later reported as Pineocytoma on histopathology and immunohistochemistry. Histological subtypes of pineal gland tumours on comparison with SEER database was correlated with our study. CONCLUSION Though pineal gland is a very small organ also considered as vestigial organ in lower primates the tumours present aggressively and are proved to be fatal except pineocytomas, which have a good prognosis with 5 year survival rate of 60 to 75% and hence exact diagnosis is critical to choose correct therapy.

  16. Impact of the epidermal growth factor receptor mutation status on the post-recurrence survival of patients with surgically resected non-small-cell lung cancer.

    Science.gov (United States)

    Takenaka, Tomoyoshi; Takenoyama, Mitsuhiro; Yamaguchi, Masafumi; Toyozawa, Ryo; Inamasu, Eiko; Kojo, Miyako; Toyokawa, Gouji; Yoshida, Tsukihisa; Shiraishi, Yoshimasa; Morodomi, Yosuke; Hirai, Fumihiko; Taguchi, Kenichi; Shimokawa, Mototsugu; Seto, Takashi; Ichinose, Yukito

    2015-03-01

    The impact of epidermal growth factor receptor (EGFR) status and the use of EGFR-tyrosine kinase inhibitor (EGFR-TKI) therapy have not been well discussed only in recurrent non-small-cell lung cancer (NSCLC). The purpose of this study was to identify the prognostic factors associated with post-recurrence survival after surgical resection of NSCLC in terms of the EGFR mutation status and the use of EGFR-TKI therapy. From 2000 through 2011, 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence by the end of 2012. We reviewed the cases of recurrence and analysed the predictors and length of post-recurrence survival. The median post-recurrence survival time and the 5-year survival rate of all patients were 25 months and 20.8%, respectively. A multivariate analysis identified the Eastern Cooperative Oncology Group (ECOG) performance status (PS), brain metastasis, number of sites of recurrence and EGFR mutation status to be independent prognostic factors for post-recurrence survival. Among all cases, the median post-recurrence survival time according to the use of EGFR-TKI therapy was as follows: 49 months in the EGFR mutation-positive patients treated with EGFR-TKI therapy, 20 months in the EGFR wild or unknown cases treated with EGFR-TKI therapy and 17 months in the patients not treated with EGFR-TKI therapy. As to EGFR mutation-positive cases, the patients treated with EGFR-TKIs exhibited significantly longer post-recurrence survival time than the patients treated without EGFR-TKIs (49 vs 12 months). It is essential for recurrent NSCLC patients to be examined for the EGFR mutation status. Patients with a positive EGFR mutation status receive significant benefits from EGFR-TKI therapy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  17. Lymph node ratio-based staging system as an alternative to the current TNM staging system to assess outcome in adenocarcinoma of the esophagogastric junction after surgical resection.

    Science.gov (United States)

    Zhang, Hongdian; Shang, Xiaobin; Chen, Chuangui; Gao, Yongyin; Xiao, Xiangming; Tang, Peng; Duan, Xiaofeng; Yang, Mingjian; Jiang, Hongjing; Yu, Zhentao

    2016-11-08

    This study aimed to assess the prognostic value of the hypothetical tumor-N-ratio (rN)-metastasis (TrNM) staging system in adenocarcinoma of the esophagogastric junction (AEG). The clinical data of 387 AEG patients who received surgical resection were retrospectively reviewed. The optimal cut-off point of rN was calculated by the best cut-off approach using log-rank test. Kaplan-Meier plots and Cox regressions model were applied for univariate and multivariate survival analyses. A TrNM staging system based on rN was proposed. The discriminating ability of each staging was evaluated by using an adjusted hazard ratio (HR) and a -2log likelihood. The prediction accuracy of the model was assessed by using the area under the curve (AUC) and the Harrell's C-index. The number of examined lymph nodes (LNs) was correlated with metastatic LNs (r = 0.322, P 0.05). The optimal cut-points of rN were calculated as 0, 0~0.3, 0.3~0.6, and 0.6~1.0. Univariate analysis revealed that pN and rN classifications significantly influenced patients' RFS and OS (P analysis adjusted for significant factors revealed that rN was recognized as an independent risk factor. A larger HR, a smaller -2log likelihood and a larger prediction accuracy were obtained for rN and the modified TrNM staging system. Taken together, our study demonstrates that the proposed N-ratio-based TrNM staging system is more reliable than the TNM staging system in evaluating prognosis of AEG patients after curative resection.

  18. EGFR Mutations in Surgically Resected Fresh Specimens from 697 Consecutive Chinese Patients with Non-Small Cell Lung Cancer and Their Relationships with Clinical Features

    Directory of Open Access Journals (Sweden)

    Yuanyang Lai

    2013-12-01

    Full Text Available We aimed to reveal the true status of epidermal growth factor receptor (EGFR mutations in Chinese patients with non-small cell lung cancer (NSCLC after lung resections. EGFR mutations of surgically resected fresh tumor samples from 697 Chinese NSCLC patients were analyzed by Amplification Refractory Mutation System (ARMS. Correlations between EGFR mutation hotspots and clinical features were also explored. Of the 697 NSCLC patients, 235 (33.7% patients had tyrosine kinase inhibitor (TKIs sensitive EGFR mutations in 41 (14.5% of the 282 squamous carcinomas, 155 (52.9% of the 293 adenocarcinomas, 34 (39.5% of the 86 adenosquamous carcinomas, one (9.1% of the 11 large-cell carcinomas, 2 (11.1% of the 18 sarcomatoid carcinomas, and 2 (28.6% of the 7 mucoepidermoid carcinomas. TKIs sensitive EGFR mutations were more frequently found in female patients (p < 0.001, non-smokers (p = 0.047 and adenocarcinomas (p < 0.001. The rates of exon 19 deletion mutation (19-del, exon 21 L858R point mutation (L858R, exon 21 L861Q point mutation (L861Q, exon 18 G719X point mutations (G719X, including G719C, G719S, G719A were 43.4%, 48.1%, 1.7% and 6.8%, respectively. Exon 20 T790M point mutation (T790M was detected in 3 squamous carcinomas and 3 adenocarcinomas and exon 20 insertion mutation (20-ins was detected in 2 patients with adenocarcinoma. Our results show the rates of EGFR mutations are higher in all types of NSCLC in Chinese patients. 19-del and L858R are two of the more frequent mutations. EGFR mutation detection should be performed as a routine postoperative examination in Chinese NSCLC patients.

  19. Predictors of Morbidity and Cleavage Plane in Surgical Resection of Pure Convexity Meningiomas Using Cerebrospinal Fluid Sensitive Image Subtraction Magnetic Resonance Imaging

    Science.gov (United States)

    THENIER-VILLA, José LUIS; CAMPOVERDE, Raúl ALEJANDRO GALÁRRAGA; DE LA LAMA ZARAGOZA, Adolfo RAMÓN; ALONSO, Cesáreo CONDE

    2017-01-01

    Meningiomas are the most common primary intracranial tumors. Since the adhesions in the plane of dissection are of interest in surgical planning, we suggest that digital image subtraction of FLAIR data from the T2 sequence of MRI may represent better the CSF spaces in the brain–tumor interface and may be a predictor of the intraoperative cleavage plane. From 2006 to 2016, 83 convexity meningiomas were resected in the Department of Neurosurgery of the University Hospital Complex of Vigo, an analysis of preoperative MRI was performed to assess peritumoral edema (PTE), tumor volume, among others; a digital subtraction of T2-FLAIR sequences was performed and analyzed in relationship to the cleavage plane described in the intraoperative report and postoperative neurological deficits. Simpson grade 1 resection was achieved in 85.54%, the overall 5-year PFS was 93.75%. Our rate of permanent new neurological deficit was 4.82% and the overall complication rate of 14.46%. The grade of PTE was proportional to tumor volume, 20 ± 2.8, 30 ± 5.3, and 34 ± 4.3 cm3 for grades 1, 2, and 3, respectively, positive cleft sign on image subtraction was predictive of good intraoperative cleavage plane and low grade cleavage plane (P = 0.04), and was a protective factor for postoperative neurological deficit (P = 0.02). Positive cleft sign in T2-FLAIR digital subtraction image is an independent predictor of good intraoperative cleavage plane, PTE is an independent predictor of the bad cleavage plane. Negative cleft sign in the image subtraction and a bad intraoperative cleavage plane are predictors of postoperative neurological deficit. PMID:27580930

  20. Auditory-perceptual speech analysis in children with cerebellar tumours: a long-term follow-up study.

    Science.gov (United States)

    De Smet, Hyo Jung; Catsman-Berrevoets, Coriene; Aarsen, Femke; Verhoeven, Jo; Mariën, Peter; Paquier, Philippe F

    2012-09-01

    Mutism and Subsequent Dysarthria (MSD) and the Posterior Fossa Syndrome (PFS) have become well-recognized clinical entities which may develop after resection of cerebellar tumours. However, speech characteristics following a period of mutism have not been documented in much detail. This study carried out a perceptual speech analysis in 24 children and adolescents (of whom 12 became mute in the immediate postoperative phase) 1-12.2 years after cerebellar tumour resection. The most prominent speech deficits in this study were distorted vowels, slow rate, voice tremor, and monopitch. Factors influencing long-term speech disturbances are presence or absence of postoperative PFS, the localisation of the surgical lesion and the type of adjuvant treatment. Long-term speech deficits may be present up to 12 years post-surgery. The speech deficits found in children and adolescents with cerebellar lesions following cerebellar tumour surgery do not necessarily resemble adult speech characteristics of ataxic dysarthria.

  1. Freqüência de pólipos em doentes operados de câncer colorretal Frequency of adenomatous polyps after surgical resection of colorectal cancer

    Directory of Open Access Journals (Sweden)

    Beatriz Pinho ROCHA

    2000-01-01

    Full Text Available Introdução - Estudos epidemiológicos e gênicos mostram que os pólipos colônicos do tipo adenoma são lesões pré-neoplásicas. O seguimento de um paciente com câncer colorretal visa principalmente o diagnóstico e retirada de pólipos adenomatosos. Objetivo - Estudar a freqüência do aparecimento de pólipos adenomatosos em doentes com câncer colorretal em acompanhamento clínico após ressecção tumoral. Casuística e Métodos - Foi estudada, retrospectivamente, a freqüência de pólipos do tipo adenoma em 68 pacientes com idade média de 59 anos, submetidos a cirurgia curativa para tratamento de câncer colorretal e a colonoscopia de controle. Resultados - A incidência de pólipos adenomatosos foi de 18%, sendo maior acima de 45 anos (20% e no cólon esquerdo (38%. Em relação ao tipo histológico, 61% eram tubulares, 22% vilosos e 17% túbulo-vilosos. Discussão - Assim como em outros relatos da literatura, a incidência de pólipos foi superior em indivíduos com mais de 45 anos, sendo em mais da metade do tipo tubular. A freqüência de pólipos foi maior nos dois primeiros anos de acompanhamento.Introduction - Epidemiologic and molecular biologic studies have already demonstrated that adenomatous colonic polyps are precancerous diseases. The main indication of the colonoscopy in the surveillance of colorectal cancer treated patients is the diagnosis and resection of adenomatous polyps. Aim - To study the frequency of adenomatous polyps after surgically resection of colorectal cancer. Material and Methods - Sixty eight patients, mean age 59 years old, with total resection of colorectal cancer, submitted to various colonoscopies during the follow up were studied retrospectively. The histological type and the characteristics of the polyp were described. Results - The frequency of polyps was 18%, being higher in the patients with more than 45 years (20%. The site of the polyps was in the left colon in 38% of the patients with

  2. Molecular markers in the surgical margin of oral carcinomas

    DEFF Research Database (Denmark)

    Bilde, A.; Buchwald, C. von; Dabelsteen, E.;

    2009-01-01

    BACKGROUND: Local or regional lymph node recurrence is the most common pattern of treatment failure in oral squamous cell carcinoma (SCC). The local recurrence rate is 30% even when the surgical resection margin is diagnosed as tumour free. Accumulation of genetic changes in histologically normal...... epithelium in the surgical resection margin may explain the local recurrence rate. The purpose of this study is to investigate the presence of senescence markers, which may represent early malignant changes in the margin that in routine pathological evaluations are classified as histologically normal....... METHODS: Formalin-fixed, paraffin-embedded surgical specimens from 16 consecutive patients with oral SCC and a clear surgical margin were obtained. The margin was analysed by immunohistochemistry for p53, p16, Chk2, Laminin-5 and glycosylated oncofetal fibronectin. RESULTS: Two patterns of p53 expression...

  3. Resection of gastric stump cancer using da vinci robotic surgical system%达芬奇机器人手术系统施行残胃癌切除术

    Institute of Scientific and Technical Information of China (English)

    钱锋; 余佩武; 石彦; 罗华星; 赵永亮; 唐波; 郝迎学

    2013-01-01

    达芬奇机器人手术系统行胃癌根治术的路径、方法逐渐成熟,但是残胃癌手术难度大,切除率低,目前未见使用达芬奇机器人手术系统行残胃癌切除术的报道.2012年11月第三军医大学西南医院采用达芬奇机器人手术系统成功实施1例残胃癌切除术,随访12个月,近期疗效较好.达芬奇机器人手术系统行残胃癌手术在视野显露、腹壁粘连松解、狭窄空间操作等方面具有优势,其机动灵活的操作、稳固持久的牵引是开腹手术和腹腔镜手术不可比拟的.%Although the surgical procedure and approach of da Vinci robotic surgical system-assisted radical resection of gastric cancer are gradually mature,it is rarely used for the resection of gastric stump cancer because of the complexity and low resection rate.In November of 2012,resection of gastric stump cancer using da Vinci robotic surgical system was performed in the Southwest Hospital.The short-term efficacy was satisfactory after the follow-up for 12 months.Da vinci robotic surgical system has the advantages of clear vision,easy manipulation of abdominal adhesion detaching,flexible operation and stable traction during resection of gastric stump cancer.

  4. Efficacy of resecting petroclival meningiomas via different surgical approaches%不同手术入路切除岩斜区脑膜瘤的疗效

    Institute of Scientific and Technical Information of China (English)

    施铭岗; 佟小光

    2016-01-01

    目的 探讨不同手术入路切除岩斜区脑膜瘤的疗效.方法 回顾性纳入天津市环湖医院2009年1月至2014年1月收治的36例岩斜区脑膜瘤患者.当肿瘤主体位于幕上,特别是侵犯海绵窦并突入中颅窝时,采用经颧-额-颞入路切除;当肿瘤主体位于后颅窝或仅侵犯Meckel囊,甚至少部分侵犯海绵窦时,行乙状窦后入路切除;对于肿瘤巨大同时侵犯中、后颅窝者,联合2种入路分期经幕上、幕下切除肿瘤.结果 经颧-额-颞入路切除肿瘤21例,经乙状窦后入路切除肿瘤12例,联合2种入路分期切除肿瘤3例.肿瘤全切除16例,次全切除14例,大部分切除5例,部分切除1例.出院随访6~60个月,平均(32.0±19.6)个月,恢复良好33例,恢复不良3例.术后发生并发症12例(33.3%),其中动眼神经瘫痪3例,2例恢复;滑车神经功能障碍5例,面部麻木2例,耳鸣1例,随访期间均得到不同程度的恢复;颞叶水肿1例,经保守治疗后好转.无脑脊液漏和死亡病例.肿瘤复发4例.3例肿瘤残留和4例复发者行γ-刀治疗.结论 经不同入路切除岩斜区脑膜瘤可获得较满意的疗效.%Objective To investigate the surgical approaches of effective resection of petroclival meningiomas.Methods Thirty-six patients with petroclival meningioma admitted to the Department of Neurosurgery, Tianjin Huanhu Hospital from January 2009 to January 2014 were enrolled retrospectively.When a major part of the tumor was located in supratentorium, in particular the invasion of the cavernous sinus and broking into the middle cranial fossa, resected it via zygomatic-frontal-temporal approach;when a major part of the tumor was located in posterior fossa or only invasion of Meckel capsule, even a small part of tumor invasion of the cavernous sinus, reseted it via retrosigmoid approach;for patients with huge tumor and invasion of middle or posterior fossa at the same time, the supratentorial and infratentorial tumors were

  5. Recurrent back and leg pain and cyst reformation after surgical resection of spinal synovial cysts: systematic review of reported postoperative outcomes.

    Science.gov (United States)

    Bydon, Ali; Xu, Risheng; Parker, Scott L; McGirt, Matthew J; Bydon, Mohamad; Gokaslan, Ziya L; Witham, Timothy F

    2010-09-01

    With improvements in neurological imaging, there are increasing reports of symptomatic spinal synovial cysts. Surgical excision has been recognized as the definitive treatment for symptomatic juxtafacet cysts. However, the role for concomitant fusion and the incidence of recurrent back pain and recurrent cyst formation after surgery remain unclear. To determine the cumulative incidence of postoperative symptomatic relief, recurrent back and leg pain after cyst resection and decompression, and synovial cyst recurrence. Systematic review of the literature. All published studies to date reporting outcomes of synovial cyst excision with and without spinal fusion. Cyst recurrence and Kawabata, Macnab, Prolo, or Stauffer pain scales. We performed a systematic literature review of all articles published between 1970 and 2009 reporting outcomes after surgical management of spinal synovial cysts. Eighty-two published studies encompassing 966 patients were identified and reviewed. Six hundred seventy-two (69.6%) patients presented with radicular pain and 467 (48.3%) with back pain. The most commonly involved spinal level was L4-L5 (75.4%), with only 25 (2.6%) and 12 (1.2%) reported synovial cysts in the cervical or thoracic area, respectively. Eight hundred eleven (84.0%) patients were treated with decompressive surgical excision alone, whereas 155 (16.0%) received additional concomitant spinal fusion. Six hundred fifty-four (92.5%) and 880 (91.1%) patients experienced complete resolution of their back or leg pain after surgery, respectively. By a mean follow-up of 25.4 months, back and leg pain recurred in 155 (21.9%) and 123 (12.7%) patients, respectively. Sixty (6.2%) patients required reoperation, of which the majority (n=47) required fusion for correction of spinal instability and mechanical back pain. Same-level synovial cyst recurrence occurred in 17 (1.8%) patients after decompression alone but has been reported in no (0%) patients after decompression and fusion

  6. Outcome Evaluation of Oligometastatic Patients Treated with Surgical Resection Followed by Hypofractionated Stereotactic Radiosurgery (HSRS) on the Tumor Bed, for Single, Large Brain Metastases

    Science.gov (United States)

    Pessina, Federico; Navarria, Pierina; Cozzi, Luca; Ascolese, Anna Maria; Maggi, Giulia; Riva, Marco; Masci, Giovanna; D’Agostino, Giuseppe; Finocchiaro, Giovanna; Santoro, Armando; Bello, Lorenzo; Scorsetti, Marta

    2016-01-01

    Purpose The aim of this study was to evaluate the benefit of a combined treatment, surgery followed by adjuvant hypofractionated stereotactic radiosurgery (HSRS) on the tumor bed, in oligometastatic patients with single, large brain metastasis (BM). Methods and Materials Fom January 2011 to March 2015, 69 patients underwent complete surgical resection followed by HSRS with a total dose of 30Gy in 3 daily fractions. Clinical outcome was evaluated by neurological examination and MRI 2 months after radiotherapy and then every 3 months. Local progression was defined as radiographic increase of the enhancing abnormality in the irradiated volume, and brain distant progression as the presence of new brain metastases or leptomeningeal enhancement outside the irradiated volume. Surgical morbidity and radiation-therapy toxicity, local control (LC), brain distant progression (BDP), and overall survival (OS) were evaluated. Results The median preoperative volume and maximum diameter of BM was 18.5cm3 (range 4.1–64.2cm3) and 3.6cm (range 2.1-5-4cm); the median CTV was 29.0cm3 (range 4.1–203.1cm3) and median PTV was 55.2cm3 (range 17.2–282.9cm3). The median follow-up time was 24 months (range 4–33 months). The 1-and 2-year LC in site of treatment was 100%; the median, 1-and 2-year BDP was 11.9 months, 19.6% and 33.0%; the median, 1-and 2-year OS was 24 months (range 4–33 months), 91.3% and 73.0%. No severe postoperative morbidity or radiation therapy toxicity occurred in our series. Conclusions Multimodal approach, surgery followed by HSRS, can be an effective treatment option for selected patients with single, large brain metastases from different solid tumors. PMID:27348860

  7. A meta-analysis of the long-term effects of chronic pancreatitis surgical treatments: duodenum-preserving pancreatic head resection versus pancreatoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    L(U) Wen-ping; SHI Qing; ZHANG Wen-zhi; CAI Shou-wang; JIANG Kai; DONG Jia-hong

    2013-01-01

    Background Surgery is regarded as the most effective treatment to relieve pain and reduce complications in chronic pancreatitis (CP).Two major strategies exist:duodenum-preserving pancreatic head resection (DPPHR) and pancreatoduodenectomy (PD).Many studies suggest that DPPHR offers advantages during surgery and in the short-term; however,the long-term effects have not been thoroughly investigated.We analyzed the long-term outcomes of DPPHR and PD,over follow-up times of at least 1 year,to determine the optimal surgical treatment for CP.Methods We systemically reviewed all CP surgical treatment reports,and only included randomized controlled trials (RCT) comparing DPPHR and PD,excluding unqualified studies using several pre-specified criteria.When multiple publications of a single trial were found,the most comprehensive current data were selected.Characteristics of the study populations and long-term postoperative outcome parameters were collected.The quality of the studies and data was analyzed using RevMan 4.2 software.Results Five trials were qualified for meta-analysis,with 261 participants in total (114 in the DPPHR group and 147 in the PD group).There were no significant differences in the age,gender,or indications for surgery of each group.At the mean of 5.7-year (1-14 years) follow-up examination,DPPHR and PD resulted in equally effective pain relief,exocrine and endocrine function,and similar mortality rates (P >0.05); however,DPPHR patients had improved global quality of life and weight gain,and reduced diarrhea and fatigue (P <0.05).Conclusion DPPHR and PD result in equal pain relief,mortality,and pancreatic function; however,DPPHR provides superior long-term outcomes.

  8. 成人型胆总管囊肿的机器人手术疗效分析%Resection of adult choledochal cysts using robotic surgical system

    Institute of Scientific and Technical Information of China (English)

    刘斐; 彭承宏; 吴志翀; 金佳斌; 邓侠兴; 詹茜; 陈皓; 沈柏用

    2015-01-01

    Objective To investigate the feasibility, security and efficacy of robot-assisted surgery in resection of adult choledochal cysts. Methods The clinical data of 4 patients with the resection of choledochal cysts and Roux-en-Y hepati-cojejunostomy using robotic surgical system from 2010 to 2014 were analyzed retrospectively. A comparative study was made with 12 patients who underwent open resection of choledochal cysts and Roux-en-Y hepaticojejunostomy. Results All the operations were performed successfully both in robotic group without the conversion to laparotomy and in open group. The operation time was (127.5±35.0) (90-170) min with blood loss (25.0±28.9) (0-50) mL. No transfusion was given during and after the operation. The postoperative hospital stay was (11.8±3.9)(8-16) days. The operation time was shorter and the blood loss less in the robotic group than in the open group (P<0.05). No complications was found during the period of follow-up 5-31 months. Conclusions The resection of adult choledochal cysts and Roux-en-Y hepaticojejunostomy with robot-assisted surgery is secure and feasible with the advantages of mini-invasive and quick recovery.%目的:探讨成人型胆总管囊肿机器人辅助手术治疗的有效性、安全性及临床疗效。方法:回顾分析2010~2014年间我院应用机器人手术系统治疗4例成人型胆总管囊肿病人,行“胆总管囊肿切除加Roux-en-Y胆肠吻合术”的临床资料,与同期12例开腹手术治疗资料进行对比分析。结果:机器人组手术均获成功,无一例中转开腹。机器人组手术时间(127.5±35.0)(90~170) min,术中出血量(25.0±28.9)(0~50) mL,术中、术后均未输血,术后住院时间(11.8±3.9)(8~16) d。机器人组手术时间及术中出血量均少于开腹组(P<0.05)。随访5~31个月,无特殊症状及其他并发症。结论:应用机器人手术系统行胆总管囊肿切除加Roux-en-Y胆肠吻合术安全、

  9. Comparative analysis of resection tools suited for transoral robot-assisted surgery.

    Science.gov (United States)

    Hoffmann, Thomas K; Schuler, Patrick J; Bankfalvi, Agnes; Greve, Jens; Heusgen, Lukas; Lang, Stephan; Mattheis, Stefan

    2014-05-01

    Introduction of transoral robot-assisted surgery (TORS) has a strong potential to facilitate surgical therapy of head and neck squamous cell cancer (HNSCC) by decreasing the indication for an external surgical approach. However, the availability of resection tools is limited and comparative studies in the context of TORS are not available. In the context of the newest da Vinci Si HD(®) robotic system, various dissection methods were compared in a surgical animal model using porcine tongue at three different sites representing mucosal, muscular and lymphatic tissue. Resection methods included (a) CO2 laser tube, (b) flexible fiber Tm:YAG laser, (c) monopolar blade, and (d) radio frequency (RF) needle. Specimens were formalin-fixed, paraffin-embedded, cut, and stained with haematoxylin-eosin. Dissected tissue was examined for the width of the incision as well as the individual coagulation zone of each tool at various tissue sites. In addition, instrument costs and performance were determined. The incisions made by the RF needle had the most favourable cutting width and also smaller coagulation defects, as opposed to other tools, granting the best preservation of tumour-adjacent structures and improved pathological assessment. Instrument performance was best evaluated for CO2 laser and RF needle, whereas financial expenses were lowest for RF needle and monopolar blade. Improvement and modification of resection tools for TORS become a relevant criterion in order to facilitate routine usage in the surgical therapy of HNSCC. A consequent decrease in surgical mortality and improved precision of surgical tumour resection could lead to a significant clinical growth potential of TORS.

  10. Clinical Significance of POU5F1P1 rs10505477 Polymorphism in Chinese Gastric Cancer Patients Receving Cisplatin-Based Chemotherapy after Surgical Resection

    Directory of Open Access Journals (Sweden)

    Lili Shen

    2014-07-01

    Full Text Available This study aimed to investigate the association between POU class5 homeobox 1 pseudogene 1 gene (POU5F1P1 rs10505477 polymorphism and the prognosis of Chinese gastric cancer patients, who received cisplatin-based chemotherapy after surgical resection. POU5F1P1 rs10505477 was genotyped using the SNaPshot method in 944 gastric cancer patients who received gastrectomy. The association of rs10505477 G > A polymorphism with the progression and prognosis in gastric cancer patients was statistically analyzed using the SPSS version 18.0 for Windows. The results reveal that rs10505477 polymorphism has a negatively effect on the overall survival of gastric cancer patients in cisplatin-based chemotherapy subgroup (HR = 1.764, 95% CI = 1.069–2.911, p = 0.023. Our preliminary study indicates for the first time that POU5F1P1 rs10505477 is correlated with survival of gastric cancer patients who receving cisplatin-based chemotherapy after gastrectomy. Further studies are warranted to investigate the mechanism and to verify our results in different populations.

  11. Low back pain as the presenting sign in a patient with primary extradural melanoma of the thoracic spine - A metastatic disease 17 Years after complete surgical resection

    Directory of Open Access Journals (Sweden)

    Katalinic Darko

    2011-11-01

    Full Text Available Abstract Primary spinal melanomas are extremely rare lesions. In 1906, Hirschberg reported the first primary spinal melanoma, and since then only 40 new cases have been reported. A 47-year-old man was admitted suffering from low back pain, fatigue and loss of body weight persisting for three months. He had a 17-year-old history of an operated primary spinal melanoma from T7-T9, which had remained stable for these 17 years. Routine laboratory findings and clinical symptoms aroused suspicion of a metastatic disease. Multislice computed tomography and magnetic resonance imaging revealed stage-IV melanoma with thoracic, abdominal and skeletal metastases without the recurrence of the primary process. Transiliac crest core bone biopsy confirmed the diagnosis of metastatic melanoma. It is important to know that in all cases of back ore skeletal pain and unexplained weight loss, malignancy must always be considered in the differential diagnosis, especially in the subjects with a positive medical history. Patients who have back, skeletal, or joint pain that is unresponsive to a few weeks of conservative treatment or have known risk factors with or without serious etiology, are candidates for imaging studies. The present case demonstrates that complete surgical resection alone may result in a favourable outcome, but regular medical follow-up for an extended period, with the purpose of an early detection of a metastatic disease, is highly recommended.

  12. CK19 and Glypican 3 Expression Profiling in the Prognostic Indication for Patients with HCC after Surgical Resection.

    Directory of Open Access Journals (Sweden)

    Jiliang Feng

    Full Text Available This retrospective study was designed to investigate the correlation between a novel immunosubtyping method for hepatocellular carcinoma (HCC and biological behavior of tumor cells. A series of 346 patients, who received hepatectomy at two surgical centers from January 2007 to October 2010, were enrolled in this study. The expressions of cytokeratin 19 (CK19, glypican 3 (GPC3, and CD34 were detected by immunohistochemical staining. The clinical stage was assessed using the sixth edition tumor-node-metastasis (TNM system (UICC/AJCC, 2010.Vascular invasion comprised both microscopic and macroscopic invasion. The tumor size, lymph node involvement, and metastasis were determined by pathological as well as imaging studies. Recurrence was defined as the appearance of new lesions with radiological features typical of HCC, seen by at least two imaging methods. Survival curves for the patients were plotted using the Kaplan-Meier method, and differences between the curves were assessed using the log-rank test. Significant differences in morphology, histological grading, and TNM staging were observed between groups. Based on the immunohistochemical staining, the enrolled cases were divided into CK19+/GPC3+, CK19-/GPC3+ and CK19-/GPC3- three subtypes. CK19+/GPC3+ HCC has the highest risk of multifocality, microvascular invasion, regional lymph node involvement, and distant metastasis, followed by CK19-/GPC3+ HCC, then CK19-/GPC3-HCC. CK19+/GPC3+ HCC has the shortest recurrence time compared to other immunophenotype HCCs. CK19 and GPC3 expression profiling is an independent prognostic indicator in patients with HCC, and a larger sample size is needed to further investigate the effect of this immunosubtyping model in stratifying the outcome of HCC patients.

  13. CK19 and Glypican 3 Expression Profiling in the Prognostic Indication for Patients with HCC after Surgical Resection

    Science.gov (United States)

    Chang, Chun; Yu, Lu; Cao, Fang; Zhu, Guohua; Chen, Feng; Xia, Hui; Lv, Fudong; Zhang, Shijie; Sun, Lin

    2016-01-01

    This retrospective study was designed to investigate the correlation between a novel immunosubtyping method for hepatocellular carcinoma (HCC) and biological behavior of tumor cells. A series of 346 patients, who received hepatectomy at two surgical centers from January 2007 to October 2010, were enrolled in this study. The expressions of cytokeratin 19 (CK19), glypican 3 (GPC3), and CD34 were detected by immunohistochemical staining. The clinical stage was assessed using the sixth edition tumor–node–metastasis (TNM) system (UICC/AJCC, 2010).Vascular invasion comprised both microscopic and macroscopic invasion. The tumor size, lymph node involvement, and metastasis were determined by pathological as well as imaging studies. Recurrence was defined as the appearance of new lesions with radiological features typical of HCC, seen by at least two imaging methods. Survival curves for the patients were plotted using the Kaplan–Meier method, and differences between the curves were assessed using the log-rank test. Significant differences in morphology, histological grading, and TNM staging were observed between groups. Based on the immunohistochemical staining, the enrolled cases were divided into CK19+/GPC3+, CK19−/GPC3+ and CK19−/GPC3− three subtypes. CK19+/GPC3+ HCC has the highest risk of multifocality, microvascular invasion, regional lymph node involvement, and distant metastasis, followed by CK19−/GPC3+ HCC, then CK19−/GPC3−HCC. CK19+/GPC3+ HCC has the shortest recurrence time compared to other immunophenotype HCCs. CK19 and GPC3 expression profiling is an independent prognostic indicator in patients with HCC, and a larger sample size is needed to further investigate the effect of this immunosubtyping model in stratifying the outcome of HCC patients. PMID:26977595

  14. Sunitinib malate (SU-11248) reduces tumour burden and lung metastasis in an intratibial human xenograft osteosarcoma mouse model

    OpenAIRE

    Kumar, Ram Mohan Ram; Arlt, Matthias JE; Kuzmanov, Aleksandar; Born, Walter; Fuchs, Bruno

    2015-01-01

    Osteosarcoma is a rare type of cancer that commonly occurs as a primary bone tumour in children and adolescents and is associated with a poor clinical outcome. Despite complex treatment protocols, including chemotherapy combined with surgical resection, the prognosis for patients with osteosarcoma and metastases remains poor and more effective therapies are required. In this study, we evaluated the therapeutic efficacy of sunitinib malate, a wide-spectrum tyrosine kinase inhibitor, in a precl...

  15. Assessing the short- and long-term outcomes after resection of benign insulinoma.

    Science.gov (United States)

    Tsang, Yi-Po; Lang, Brian Hung-Hin; Shek, Tony Wai-Hung

    2016-09-01

    Insulinoma is a rare functional pancreatic neuroendocrine tumour (NET) believed to have an excellent long-term outcome, but few studies have solely focused on this issue after apparently curative resection. This study aimed to assess post-operative and long-term outcomes after resection of benign insulinomas. From 1998 to 2013, 36 consecutive patients with insulinomas underwent surgery. Three patients had multiple endocrine neoplasia type-1 (MEN-1). Demographics, operative findings, tumour grade (2010 World Health Organization (WHO) NET classification), post-operative pancreatic fistula (POPF) grade (International Study Group of Pancreatic Fistula (ISGPF)), complications and recurrence were analysed. Eighteen (50%) had enucleation while the rest underwent pancreatic resection. The majority (86.1%) of insulinomas belonged to WHO NET grade G1. POPF occurred in 58.3% of patients while clinical fistula (ISGPF grades B and C) occurred in 19.4%. One (2.8%) patient required reoperation. The occurrence of POPF was not related to type of resection or surgical approach. There was no perioperative mortality. After a mean follow-up of 83.6 months, two patients (5.7%) developed disease recurrence at 34.4 and 131.9 months after initial surgery. No patients developed distant metastasis. The 10- and 15-year disease-free rates were 95.6 and 85.4%, respectively. POPF occurred frequently and posed a significant morbidity after resection of insulinoma. However, it occurred independently of type of resection or surgical approach. Although the immediate cure rate after resection was high (100%), long-term disease recurrence in sporadic (non-MEN-1) cases was not insignificant. Regular long-term follow-up is recommended. © 2014 Royal Australasian College of Surgeons.

  16. Outcome following Resection of Biliary Cystadenoma: A Single Centre Experience and Literature Review

    Directory of Open Access Journals (Sweden)

    M. Pitchaimuthu

    2015-01-01

    Full Text Available Background. Biliary cystadenomas (BCAs are rare, benign, potentially malignant cystic lesions of the liver, accounting for less than 5% of cystic liver tumours. We report the outcome following resection of biliary cystadenoma from a single tertiary centre. Methods. Data of patients who had resection of BCA between January 1993 and July 2014 were obtained from liver surgical database. Patient demographics, clinicopathological characteristics, operative data, and postoperative outcome were analysed. Results. 29 patients had surgery for BCA. Male : female ratio was 1 : 28. Clinical presentation was abdominal pain (74%, jaundice (20%, abdominal mass (14%, and deranged liver function tests (3%. Cyst characteristics included septations (48%, wall thickening (31%, wall irregularity (38%, papillary projections (10%, and mural nodule (3%. Surgical procedures included atypical liver resection (52%, left hemihepatectomy (34%, right hemihepatectomy (10%, and left lateral segmentectomy (3%. Median length of stay was 7 (IQ 6.5–8.5 days. Two patients developed postoperative bile leak. No patients had malignancy on final histology. Median follow-up was 13 (IQ 6.5–15.7 years. One patient developed delayed biliary stricture and one died of cholangiocarcinoma 11 years later. Conclusion. Biliary cystadenomas can be resected safely with significantly low morbidity. Malignant transformation and recurrence are rare. Complete surgical resection provides a cure.

  17. [Technical and organisational considerations regarding surgical debulking].

    Science.gov (United States)

    Marianeschi, Paolo Maria; Esperti, Luigi; Covarelli, Piero; Giovanetti, Micaela; Fratto, Antonio; Scalercio, Vittorio; Cristofani, Roberto

    2005-01-01

    The Authors report on their experience with debulking surgery, based on 46 patients affected by advanced cancers and treated between January 2001 and May 2003 to reduce the tumour mass. Thirty-eight out of 46 (82%) were women. The Authors performed 23 pelvic peritonectomies, 16 multicompartmental peritonectomies according to the Sugarbaker technique, 8 hysterectomies with bilateral ovariectomy, 4 ureteral resections with end-to-end reconstruction, 4 pelvic lymphectomies and 2 resections of the bladder. No perioperative mortality is reported, and major morbidity amounted to less than 5%. The Authors stress the problems encountered while performing debulking surgery and are of the opinion that the majority of the problems could be overcome by precise organization in dedicated surgical centres specifically or mainly devoted to surgical debulking.

  18. PET-CT offers accurate assessment of tumour length in oesophageal malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Rollins, K.E., E-mail: james.catton@nuh.nhs.uk [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Lucas, E. [University of Nottingham, Derby Road, Nottingham (United Kingdom); Tewari, N. [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); James, E. [Department of Oncology, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Hughes, S. [Department of Radiology, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom); Catton, J.A. [Department of Oesophago-Gastric Surgery, Nottingham University Hospitals, Hucknall Road, Nottingham (United Kingdom)

    2015-02-15

    Highlights: • We examine the accuracy of staging modalities in estimating tumour length of oesophageal malignancy. • PET CT correlates most strongly with histopathological length of resected specimen. • Better measure than EUS with OGD correlating poorly. • Potential impact in radiotherapy and surgical resection planning. - Abstract: Introduction: Radiotherapy is increasingly used for both curative and palliative treatment of oesophageal malignancy. Accurate treatment depends on determining tumour location and length. This study assessed the value of PET-CT versus other staging modalities in determining tumour length. Materials and methods: Oesophageal cancer patients who underwent staging with PET/CT and endoscopic ultrasound (EUS) in addition to their diagnostic upper GI endoscopy and subsequent surgical resection were assessed. PET/CT length was obtained retrospectively by using Hermes Hybrid Viewer™ with a 1–5 Standardised Uptake Value grey scale. An SUV of 5 was used as the cut off for determining length. Direct measurement by EUS and OGD were determined. Results: 53 patients underwent PET-CT, EUS, OGD and surgical resection for oesophageal cancer. Overall the correlation between PET-CT and histopathological length was strongest (Pearson r = 0.5977, 95% CI 0.390–0.747) versus EUS (Pearson R = 0.5365, 95% CI 0.311–0.705) and OGD (Pearson r = 0.1574, 95% CI −0.118 to 0.410). After excluding tumours with a significant chemotherapy response, PET-CT length correlated significantly with histopathological length (R = 0.5651, p = 0.0005). In comparison, the correlation between histological length and EUS (R = 0.4637, p = 0.0057) measurement was less significant and this did not correlate with OGD (R = −0.1084, p = 0.5417). Conclusion: Tumour length estimated by PET-CT correlated most strongly with histopathological length of oesophageal malignancy and is the most accurate determinant of tumour length of all the staging modalities. This suggests a

  19. Integrated Fluorine-18 Fluorodeoxyglucose (18F-FDG) PET/CT Compared to Standard Contrast-Enhanced CT for Characterization and Staging of Pulmonary Tumors Eligible for Surgical Resection

    Energy Technology Data Exchange (ETDEWEB)

    Quaia, E.; Tona, G.; Gelain, F.; Lubin, E.; Pizzolato, R.; Boscolo, E.; Bussoli, L. (Dept. of Radiology, Cattinara Hospital, Univ. of Trieste, Trieste (Italy))

    2008-11-15

    Background: Accurate staging is necessary to determine the appropriate therapy in patients with lung cancer. Few studies have compared integrated fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and contrast-enhanced CT in the characterization and staging of pulmonary tumors considered eligible for surgical resection. Purpose: To compare 18F-FDG PET/CT with standard contrast-enhanced CT for the diagnosis and staging of lung neoplasms eligible for surgical resection. Material and Methods: Seventy-six consecutive patients (56 male, 20 female; mean age+-SD, 63.4+-20 years) with 84 pulmonary tumors suspected for malignancy and considered eligible for surgical resection were prospectively enrolled. Seventy-three malignant (65 non-small-cell lung carcinomas, one small-cell lung cancer, two carcinoids, and five metastases) and 11 benign lung tumors (three hamartomas, two sarcoidosis, one amyloidosis, one Wegener granulomatosis, one tuberculosis, and three areas of scarring) were finally diagnosed by histology. Tumor staging was based on the revised American Joint Committee on Cancer. Results: In lesion characterization, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 90% vs. 83% and 18% vs. 63% (P<0.05, McNemar test), respectively. In nodal staging, the sensitivity and specificity of 18F-FDG PET/CT versus contrast-enhanced CT were 78% vs. 46% and 80% vs. 93% (P<0.05), respectively. Conclusion: In patients with lung neoplasms considered eligible for surgical resection, 18F-FDG PET/CT versus contrast-enhanced CT revealed higher sensitivity in nodal staging, but lower specificity both in lesion characterization and nodal staging.

  20. Novel Totally Laparoscopic Endolumenal Rectal Resection With Transanal Natural Orifice Specimen Extraction (NOSE) Without Rectal Stump Opening: A Modification of Our Recently Published Clean Surgical Technique in a Porcine Model.

    Science.gov (United States)

    Kvasha, Anton; Hadary, Amram; Biswas, Seema; Szvalb, Sergio; Willenz, Udi; Waksman, Igor

    2015-06-01

    Our group has recently described a novel technique for clean endolumenal bowel resection, in which abdominal and transanal approaches were used. In the current study, 2 modifications of this procedure were tested for feasibility in a porcine model. A laparoscopic approach to the peritoneal cavity was employed in rectal mobilization; this was followed by a transanal rectorectal intussusception and pull-through (IPT). IPT was established in a stepwise fashion. First, the proximal margin of resection was attached to the shaft of the anvil of an end-to-end circular stapler with a ligature around the rectum. Second, this complex was pulled transanally to produce IPT. Once IPT was established, a second ligature was placed around the rectum approximating the proximal and distal resection margins. This was followed by a purse string suture through 2 bowel walls, encircling the shaft of the anvil just proximal to the ligatures. The specimen was resected and extracted by making a full-thickness incision through the 2 bowel walls distal to the previously placed purse string suture and ligatures. The anastomosis was achieved by applying the stapler. The technique was found to be feasible. Peritoneal samples, collected after transanal specimen extraction, did not demonstrate bacterial growth. Although, this is a novel and evolving procedure, its minimally invasive nature, as well as aseptic bowel manipulation during endolumenal rectal resection, has the potential to limit the complications associated with abdominal wall incision and surgical site infection.

  1. Transarticular invasion of bone tumours across the sacroiliac joint

    Energy Technology Data Exchange (ETDEWEB)

    Chhaya, S. [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto (Canada); University of Texas Health Science Centre, Department of Radiology, San Antonio, TX (United States); White, L.M. [University of Toronto, Department of Medical Imaging, Mount Sinai Hospital and the University Health Network, Toronto (Canada); Kandel, R. [University of Toronto, Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto (Canada); Wunder, J.S.; Ferguson, P. [Univeristy of Toronto, University Musculoskeletal Oncology Unit, Department of Orthopedic Surgery, Mount Sinai Hospital, Toronto (Canada); Agur, A. [University of Toronto, Division of Anatomy, Department of Surgery, Toronto (Canada)

    2005-12-01

    The purpose of this study was to evaluate the pattern of tumour spread across the SI articulation, correlating with cadaveric anatomic observations, in order to better understand the local spread of tumour and to assist in the assessment of local staging. Twenty-four consecutive patients (14 male, 10 female; age range 22-89 years, mean 52 years) with primary bone tumours of the iliac bone or sacrum abutting the SI joint, in whom surgical resection of the SI joint was performed, were studied following institutional ethics approval. In all patients, preoperative magnetic resonance (MR) imaging studies of the pelvis and SI joint were reviewed for imaging evidence of transarticular extension across the SI joint. Gross pathologic and histologic assessment of possible transarticular SI joint tumour extension was performed in all patients. Nine cadaveric pelvic specimens without pelvic neoplastic disease (4 male, 5 female; age range 20-84 years, mean 59 years, median 58 years) were anatomically dissected and the articular anatomy of the SI joint examined macroscopically. Twelve of the twenty-four patients demonstrated imaging and histological evidence of transarticular SI joint invasion. Eight tumours infiltrated only the interosseous ligamentous aspect of the SI joint. In the remaining four cases, extensive tumour infiltrated both the cartilaginous and ligamentous aspects of the joint. No case showed tumour involvement isolated to the cartilaginous aspect of the joint. Among the cadaveric specimens studied, degenerative changes were found involving the majority of cases (6/9), with cartilage thinning and fibrillation and antero-superior marginal osteophytes seen involving the cartilaginous portion of the SI joint articulation. Four of the nine specimens demonstrated central ossification bridging the iliac and sacral aspects of the ligamentous (interosseous) SI joint. (orig.)

  2. A method for safely resecting anterior butterfly gliomas: the surgical anatomy of the default mode network and the relevance of its preservation.

    Science.gov (United States)

    Burks, Joshua D; Bonney, Phillip A; Conner, Andrew K; Glenn, Chad A; Briggs, Robert G; Battiste, James D; McCoy, Tressie; O'Donoghue, Daniel L; Wu, Dee H; Sughrue, Michael E

    2017-06-01

    OBJECTIVE Gliomas invading the anterior corpus callosum are commonly deemed unresectable due to an unacceptable risk/benefit ratio, including the risk of abulia. In this study, the authors investigated the anatomy of the cingulum and its connectivity within the default mode network (DMN). A technique is described involving awake subcortical mapping with higher attention tasks to preserve the cingulum and reduce the incidence of postoperative abulia for patients with so-called butterfly gliomas. METHODS The authors reviewed clinical data on all patients undergoing glioma surgery performed by the senior author during a 4-year period at the University of Oklahoma Health Sciences Center. Forty patients were identified who underwent surgery for butterfly gliomas. Each patient was designated as having undergone surgery either with or without the use of awake subcortical mapping and preservation of the cingulum. Data recorded on these patients included the incidence of abulia/akinetic mutism. In the context of the study findings, the authors conducted a detailed anatomical study of the cingulum and its role within the DMN using postmortem fiber tract dissections of 10 cerebral hemispheres and in vivo diffusion tractography of 10 healthy subjects. RESULTS Forty patients with butterfly gliomas were treated, 25 (62%) with standard surgical methods and 15 (38%) with awake subcortical mapping and preservation of the cingulum. One patient (1/15, 7%) experienced postoperative abulia following surgery with the cingulum-sparing technique. Greater than 90% resection was achieved in 13/15 (87%) of these patients. CONCLUSIONS This study presents evidence that anterior butterfly gliomas can be safely removed using a novel, attention-task based, awake brain surgery technique that focuses on preserving the anatomical connectivity of the cingulum and relevant aspects of the cingulate gyrus.

  3. Anthracycline-based induction chemotherapy followed by concurrent cyclophosphamide, methotrexate and 5-fluorouracil and radiation therapy in surgically resected axillary node-positive breast cancer.

    Science.gov (United States)

    Recchia, Francesco; Candeloro, Giampiero; Cesta, Alisia; DI Staso, Mario; Bonfili, Pierluigi; Gravina, Giovanni Luca; DI Cesare, Ernesto; Necozione, Stefano; Rea, Silvio

    2014-05-01

    The present study aimed to determine the toxicity and efficacy of 4 courses of anthracyclines-taxane (AT) chemotherapy followed by radiation therapy (XRT) concurrent with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) in surgically resected axillary node-positive (N+) breast cancer. A total of 200 women with N+ breast cancer were treated with adriamycin and docetaxel followed by XRT concurrent with six courses of CMF. Two courses of dose-dense chemotherapy with ifosfamide, carboplatin and etoposide, supported by pegfilgrastim, were administered to patients with >5 histologically confirmed axillary lymph node metastases and patients with triple-negative disease. Additional treatments included 1 year of trastuzumab in human epidermal growth factor receptor 2-positive patients, 5 years of a luteinizing hormone-releasing hormone analogue in premenopausal women and 5 years of an aromatase inhibitor (AI) in estrogen receptor-positive (ER+) patients. The mean number of positive axillary lymph nodes was 4.4 (range, 2-37), 52% of the patients were premenopausal, 74% were ER+ and 26% had triple-negative disease. After a median follow-up of 73 months, grade 2 and 3 hematological toxicity was observed in 20% of the patients. The 10-year disease-free survival (DFS) and overall survival (OS) rates were 73 and 77%, respectively. There was no significant difference in DFS between ER+ and estrogen receptor-negative (ER-) patients (P>0.05), whereas the OS was better in ER+ vs. ER- patients (P<0.05) and in premenopausal vs. postmenopausal patients (P<0.005). In conclusion, induction AT concurrent CMF and XRT and dose-dense chemotherapy followed by AI in N+ high-risk breast cancer was associated with a low level of systemic and late cardiac toxicity and excellent local control, DFS and OS.

  4. The Prognostic Significance of pSTAT1 and CD163 Expressions in Surgically Resected Stage 1 Pulmonary Squamous Cell Carcinomas.

    Science.gov (United States)

    Lin, Mong-Wei; Yang, Ching-Yao; Kuo, Shuenn-Wen; Wu, Chen-Tu; Chang, Yih-Leong; Yang, Pan-Chyr

    2016-09-01

    Tumor-associated macrophages (TAMs) play an important role in the initiation, progression, and metastasis of various solid tumors, and can polarize into M1 and M2 phenotypes. This study aimed to investigate whether TAM polarization is associated with clinical outcomes for early-stage pulmonary squamous cell carcinoma (SqCC). This retrospective study included 97 consecutive patients with stage 1 pulmonary SqCC. Immunohistochemical stains for M1 macrophage marker (pSTAT1) and M2 macrophage marker (CD163) were performed on paraffin-embedded tumors. The correlations of M1 and M2 macrophage expression, clinicopathologic characteristics, and clinical outcomes were analyzed. The 5-year disease-free survival (DFS) rate was 63.2 %, and the 5-year overall survival (OS) rate was 74.8 %. Positive pSTAT1 expression was noted in 42 patients (43.3 %) and CD163 expression in 26 patients (26.8 %). A statistically significant negative correlation between pSTAT1 and CD163 expression was found (p = 0.015). Univariate analysis showed that extensive surgical resection, incomplete tumor excision, negative pSTAT1 expression, and positive CD163 expression were significantly correlated with both a poor DFS and a poor OS, whereas male gender was significantly correlated with a poor DFS only. Multivariate analysis showed that the pSTAT1/CD163 expression status was the only independent predictor for both DFS (p = 0.023) and OS and (p = 0.004). Markers identifying M1 and M2 macrophages, including pSTAT1 and CD163, can be used as prognostic indicators for patients with stage 1 pulmonary SqCC.

  5. Tim-3 expression by peripheral natural killer cells and natural killer T cells increases in patients with lung cancer--reduction after surgical resection.

    Science.gov (United States)

    Xu, Li-Yun; Chen, Dong-Dong; He, Jian-Ying; Lu, Chang-Chang; Liu, Xiao-Guang; Le, Han-Bo; Wang, Chao-Ye; Zhang, Yong-Kui

    2014-01-01

    The purpose of this study was to investigate Tim-3 expression on peripheral CD3-CD56+ natural killer (NK) cells and CD3+CD56+ natural killer T (NKT) cells in lung cancer patients. We analyzed Tim-3+CD3-CD56+ cells, Tim-3+CD3-CD56dim cells, Tim-3+CD3-CD56bright cells, and Tim- 3+CD3+CD56+ cells in fresh peripheral blood from 79 lung cancer cases preoperatively and 53 healthy controls by flow cytometry. Postoperative blood samples were also analyzed from 21 members of the lung cancer patient cohort. It was showed that expression of Tim-3 was significantly increased on CD3-CD56+ cells, CD3- CD56dim cells and CD3+CD56+ cells in lung cancer patients as compared to healthy controls (p=0.03, p=0.03 and p=0.04, respectively). When analyzing Tim-3 expression with cancer progression, results revealed more elevated Tim-3 expression in CD3-CD56+ cells, CD3-CD56dim cells and CD3+CD56+ cells in cases with advanced stages (III/IV) than those with stage I and II (p=0.02, p=0.04 and p=0.01, respectively). In addition, Tim-3 expression was significantly reduced on after surgical resection of the primary tumor (pnatural killer cells from fresh peripheral blood may provide a useful indicator of disease progression of lung cancer. Furthermore, it was indicated that Tim-3 might be as a therapeutic target.

  6. [Gastric mesenchymal tumours (GIST)].

    Science.gov (United States)

    Spivach, Arrigo; Fezzi, Margherita; Sartori, Alberto; Belgrano, Manuel; Rimondini, Alessandra; Cuttin-Zernich, Roberto; Covab, Maria Assunta; Bonifacio, Daniela; Buri, Luigi; Pagani, Carlo; Zanconati, Fabrizio

    2008-01-01

    The incidence of gastrointestinal stromal tumours (GIST) has increased in recent years. A number of authors have attempted to define the actual nature of these tumours. Immunohistochemistry highlighting the positivity of tyrosine-kinase (CD117/c-Kit) has revealed the difference between gastrointestinal stromal tumours and other mesenchymal tumours and, therefore, the possibility of medical rather than surgical therapy. We retrospectively reviewed 19 patients affected by primary gastric GIST, who underwent surgery in recent years with subsequent follow-up. Gastroscopy and gastrointestinal tract radiography were used not only to obtain the diagnosis but also to establish the size, density, contours, ulceration, regional lymphadenopathy, mesenteric infiltration and the presence of metastases. The aim of this study was to evaluate the roles of endoscopy and radiology in this pathology and the advantages and limitations of each individual technique.

  7. High tumour cannabinoid CB1 receptor immunoreactivity negatively impacts disease-specific survival in stage II microsatellite stable colorectal cancer.

    Directory of Open Access Journals (Sweden)

    Sofia B Gustafsson

    Full Text Available BACKGROUND: There is good evidence in the literature that the cannabinoid system is disturbed in colorectal cancer. In the present study, we have investigated whether CB(1 receptor immunoreactive intensity (CB(1IR intensity is associated with disease severity and outcome. METHODOLOGY/PRINCIPAL FINDINGS: CB(1IR was assessed in formalin-fixed, paraffin-embedded specimens collected with a consecutive intent during primary tumour surgical resection from a series of cases diagnosed with colorectal cancer. Tumour centre (n = 483 and invasive front (n = 486 CB(1IR was scored from 0 (absent to 3 (intense staining and the data was analysed as a median split i.e. CB(1IR <2 and ≥2. In microsatellite stable, but not microsatellite instable tumours (as adjudged on the basis of immunohistochemical determination of four mismatch repair proteins, there was a significant positive association of the tumour grade with the CB(1IR intensity. The difference between the microsatellite stable and instable tumours for this association of CB(1IR was related to the CpG island methylation status of the cases. Cox proportional hazards regression analyses indicated a significant contribution of CB(1IR to disease-specific survival in the microsatellite stable tumours when adjusting for tumour stage. For the cases with stage II microsatellite stable tumours, there was a significant effect of both tumour centre and front CB(1IR upon disease specific survival. The 5 year probabilities of event-free survival were: 85±5 and 66±8%; tumour interior, 86±4% and 63±8% for the CB(1IR<2 and CB(1IR≥2 groups, respectively. CONCLUSIONS/SIGNIFICANCE: The level of CB(1 receptor expression in colorectal cancer is associated with the tumour grade in a manner dependent upon the degree of CpG hypermethylation. A high CB(1IR is indicative of a poorer prognosis in stage II microsatellite stable tumour patients.

  8. Glioblastoma brain tumours: estimating the time from brain tumour initiation and resolution of a patient survival anomaly after similar treatment protocols.

    Science.gov (United States)

    Murray, J D

    2012-01-01

    A practical mathematical model for glioblastomas (brain tumours), which incorporates the two key parameters of tumour growth, namely the cancer cell diffusion and the cell proliferation rate, has been shown to be clinically useful and predictive. Previous studies explain why multifocal recurrence is inevitable and show how various treatment scenarios have been incorporated in the model. In most tumours, it is not known when the cancer started. Based on patient in vivo parameters, obtained from two brain scans, it is shown how to estimate the time, after initial detection, when the tumour started. This is an input of potential importance in any future controlled clinical study of any connection between cell phone radiation and brain tumour incidence. It is also used to estimate more accurately survival times from detection. Finally, based on patient parameters, the solution of the model equation of the tumour growth helps to explain why certain patients live longer than others after similar treatment protocols specifically surgical resection (removal) and irradiation.

  9. Benign cylindroma: a rare differential diagnosis of external ear canal tumour.

    Science.gov (United States)

    Schwarz, David; Drebber, Uta; Ortmann, Monika; Anagiotos, Andreas

    2016-01-11

    Cylindromas are rare adnexal skin tumours that usually occur in the head and neck area. This article reports a case of benign cylindroma arising in the external auditory canal. A 75-year-old man presented with a 3-month history of right aural fullness; no other symptoms were reported. Ear microscopy examination revealed a skin mass on the floor of the external ear canal. Α CT scan of the skull showed a well-circumscribed soft tissue mass, with no signs of underlying cortical bone erosion. Tumour resection through an endaural approach was performed. Histological examination revealed a benign cylindroma with margins free of tumour, so that no further treatment was necessary. 8 months after surgery the patient is asymptomatic with normal findings in the ear microscopy examination. Benign cylindroma has a high recurrence rate and can undergo malignant transformation. Therefore, complete surgical removal and close follow-up are of great importance.

  10. [Solitary fibrous tumours of the kidney].

    Science.gov (United States)

    Gres, Pascal; Avances, Christophe; Ben Naoum, Kamel; Chapuis, Héliette; Costa, Pierre

    2004-02-01

    Solitary fibrous tumours (SFT) are mesenchymal tumours that usually arise from the pleura. Renal SFT are exceptional (9 cases reported in the literature). The authors report a new case discovered during assessment of HT and treated by radical right nephrectomy. The histological appearance is characteristic: a tumour with a fibrous centre, composed of a monomorphic proliferation of spindle cells, with positive CD 34, CD 99, and bcl 2 labelling. The prognosis after complete resection is generally favourable.

  11. Resection of Perihilar Cholangiocarcinoma.

    Science.gov (United States)

    Hartog, Hermien; Ijzermans, Jan N M; van Gulik, Thomas M; Groot Koerkamp, Bas

    2016-04-01

    Perihilar cholangiocarcinoma presents at the biliary and vascular junction of the hepatic hilum with a tendency to extend longitudinally into segmental bile ducts. Most patients show metastatic or unresectable disease at time of presentation or surgical exploration. In patients eligible for surgical resection, challenges are to achieve negative bile duct margins, adequate liver remnant function, and adequate portal and arterial inflow to the liver remnant. Surgical treatment is characterized by high rates of postoperative morbidity and mortality. This article reviews the various strategies and techniques, the role of staging laparoscopy, intraoperative frozen section, caudate lobectomy, and vascular reconstruction.

  12. 达芬奇机器人手术系统在结直肠癌根治术中的应用%Application of da Vinci robotic surgical system in the radical resection of colorectal cancer

    Institute of Scientific and Technical Information of China (English)

    许剑民; 陈竟文

    2013-01-01

    The da Vinci robotic surgical system assisted colorectal radical resection has been widely applied in many countries and regions.The advantages of the da Vinci robotic surgical system include stable and distinct stereoscopic vision,short learning curve,convenient operation and feasibility of remote manipulation,while its disadvantages are expensive cost,lack of tremor and prolonged operation time.The advantage of da Vinci robotic surgical system is not distinct when compared with traditional laparoscope in radical resection of colorectal cancer.With the accumulation of clinical data and the update of the system,the prospect of da Vinci robotic surgical system assisted colorectal radical resection is promising.%达芬奇机器人手术系统行结直肠癌根治术在许多国家和地区已经得到了开展.该系统的优势在于:三维显示图像,具有高度稳定性和清晰度,医师学习曲线较短,操作便利,可远程操控等.其劣势在于:价格昂贵,尚无力反馈,手术时间长等.目前,达芬奇机器人手术系统与腹腔镜手术比较,在结直肠癌根治术中尚未体现出足够的优势,但随着临床数据的积累和达芬奇机器人手术系统的更新换代,运用该系统行结直肠癌根治术的未来令人期待.

  13. [Resection of Klatskin tumors].

    Science.gov (United States)

    Seehofer, D; Kamphues, C; Neuhaus, P

    2012-03-01

    Curative treatment of Klatskin tumors by radical surgical procedures with surgical preparation distant to the tumor region results in 5-year survival rates of 30-50%. This requires mandatory en bloc liver resection and resection of the extrahepatic bile duct often together with vascular resection. Nevertheless, the ideal safety margin of 0.5-1 cm remote from the macroscopic tumor extensions cannot be achieved in all cases. Based on hilar anatomy the probability of an adequate safety margin is higher using extended right hemihepatectomy together with portal vein resection compared to left hemihepatectomy. However, due to severe atrophy of the left liver lobe solely left-sided hepatectomy is feasible in some patients. In cases of eligibility for both procedures right hemihepatectomy is preferentially used due to the higher oncological radicality if sufficient liver function is present. Postoperative hepatic insufficiency and bile leakage after demanding biliary reconstruction, often with several small orifices, contribute to the postoperative complication rate of this complex surgical disease pattern.

  14. [Case report: Rapidly growing abdominal wall giant desmoid tumour during pregnancy].

    Science.gov (United States)

    Palacios-Zertuche, Jorge Tadeo; Cardona-Huerta, Servando; Juárez-García, María Luisa; Valdés-Flores, Everardo; Muñoz-Maldonado, Gerardo Enrique

    Desmoid tumours are one of the rarest tumours worldwide, with an estimated yearly incidence of 2-4 new cases per million people. They are soft tissue monoclonal neoplasms that originate from mesenchymal stem cells. It seems that the hormonal and immunological changes occurring during pregnancy may play a role in the severity and course of the disease. The case is presented on 28-year-old female in her fifth week of gestation, in whom an abdominal wall tumour was found attached to left adnexa and uterus while performing a prenatal ultrasound. The patient was followed up under clinical and ultrasonographic surveillance. When she presented with abnormal uterine activity at 38.2 weeks of gestation, she was admitted and obstetrics decided to perform a caesarean section. Tumour biopsy was taken during the procedure. Histopathology reported a desmoid fibromatosis. A contrast enhanced abdominal computed tomography scan was performed, showing a tumour of 26×20.5×18cm, with well-defined borders in contact with the uterus, left adnexa, bladder and abdominal wall, with no evidence of infiltration to adjacent structures. A laparotomy, with tumour resection, hysterectomy and left salpingo-oophorectomy, components separation techniques, polypropylene mesh insertion, and drainage was performed. The final histopathology report was desmoid fibromatosis. There is no evidence of recurrence after 6 months follow-up. Desmoid tumours are locally aggressive and surgical resection with clear margins is the basis for the treatment of this disease, using radiotherapy, chemotherapy and hormone therapy as an adjunct in the treatment. Copyright © 2016 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Prognostic value of MET gene copy number and protein expression in patients with surgically resected non-small cell lung cancer: a meta-analysis of published literatures.

    Directory of Open Access Journals (Sweden)

    Baoping Guo

    Full Text Available BACKGROUND: The prognostic value of the copy number (GCN and protein expression of the mesenchymal-epithelial transition (MET gene for survival of patients with non-small cell lung cancer (NSCLC remains controversial. This study aims to comprehensively and quantitatively asses the suitability of MET GCN and protein expression to predict patients' survival. METHODS: PubMed, Embase, Web of Science and Google Scholar were searched for articles comparing overall survival in patients with high MET GCN or protein expression with those with low level. Pooled hazard ratio (HR and 95% confidence intervals (CIs were calculated using the random and the fixed-effects models. Subgroup and sensitivity analyses were also performed. RESULTS: Eighteen eligible studies enrolling 5,516 patients were identified. Pooled analyses revealed that high MET GCN or protein expression was associated with poor overall survival (OS (GCN: HR = 1.90, 95% CI 1.35-2.68, p<0.001; protein expression: HR = 1.52, 95% CI 1.08-2.15, p = 0.017. In Asian populations (GCN: HR = 2.22, 95% CI 1.46-3.38, p<0.001; protein expression: HR = 1.89, 95% CI 1.34-2.68, p<0.001, but not in the non-Asian subset. For adenocarcinoma, high MET GCN or protein expression indicated decreased OS (GCN: HR = 1.49, 95% CI 1.05-2.10, p = 0.025; protein expression: HR = 1.69, 95% CI 1.31-2.19, p<0.001. Results were similar for multivariate analysis (GCN: HR = 1.61, 95% CI 1.15-2.25, p = 0.005; protein expression: HR = 2.18, 95% CI 1.60-2.97, p<0.001. The results of the sensitivity analysis were not materially altered and did not draw different conclusions. CONCLUSIONS: Increased MET GCN or protein expression was significantly associated with poorer survival in patients with surgically resected NSCLC; this information could potentially further stratify patients in clinical treatment.

  16. A new application of the four-arm standard da Vinci® surgical system: totally robotic-assisted left-sided colon or rectal resection.

    Science.gov (United States)

    Koh, Dean Chi-Siong; Tsang, Charles Bih-Shou; Kim, Seon-Hahn

    2011-06-01

    The key to successful rectal cancer resection is to perform complete total mesorectal excision (TME). Laparoscopic TME can be challenging, especially in the narrow confines of the pelvis. Robotic-assisted surgery can overcome these limitations through superior three-dimensional (3-D) visualization and the increased range of movements provided by the endowrist function. To date, all totally robotic resections of the rectum have been described using da Vinci® S or Si systems. Due to the limitations of the standard system, only hybrid procedures have been described so far. To evaluate the feasibility and short-term outcomes of performing totally robotic-assisted laparoscopic colorectal resections using the standard da Vinci® system with a fourth arm extension. The standard system was docked from the patient's left hip. Four 8-mm robotic trocars were inserted. Upon completion of phase 1 (pedicle ligation, colonic mobilization, splenic flexure takedown), the two left-sided arms are repositioned to allow phase 2 (pelvic dissection), enabling the entire procedure except for the distal transection and anastomosis to be performed robotically. Twenty-one robotic procedures were performed from August 2008 to September 2009. The mean age of the patients was 61 years (13 males). The procedures performed included seven anterior resections, seven low anterior resections, five ultralow anterior resections, one abdominoperineal resection, and one resection rectopexy. The majority of the cases were performed in patients with colon or rectal cancer. Operative time ranged from 232 to 444 (mean 316) min. Postoperative morbidity occurred in three patients (14.3%) with no mortalities or conversions. Average hospital stay was 6.4 days. Mean lymph node yield for the cases with cancer was 17.8. The standard da Vinci® system with four arms can be used to perform totally robotic-assisted colorectal procedures for the left colon and rectum with short-term outcomes similar to those of

  17. Primary Leiomyoma of the Liver: A Review of a Rare Tumour

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    Ayodeji Oluwarotimi Omiyale

    2014-01-01

    Full Text Available Context. Primary leiomyoma of the liver is a rare tumour with uncertain pathogenesis with similar presentation with other tumours of the liver. Little is known about its clinical course. Objectives. To review the literature for case reports of primary leiomyoma of the liver. Methods. Extensive literature search was carried out for case reports of primary leiomyoma of the liver. Results. A total of 36 cases of primary leiomyoma of the liver were reviewed. The mean age of presentation is 43 years with slight female sex affectation; females accounted for 55.6% of the cases reported in the literature. The average size of the tumour is 8.7 cm. 34.4% of the cases reviewed were incidental finding with the mean follow-up time of 33 months with most cases reporting no evidence of disease. Conclusions. Primary leiomyoma of the liver is very rare tumour with complex pathogenesis which remains largely unknown. Imaging of the tumour does not allow for a tissue specific diagnosis; hence histological review of the tissue specimen and immunohistochemical stains are imperative for diagnosis. Surgical resection is both diagnostic and curative. The diagnosis of primary leiomyoma of the liver should be considered as a differential in the management of liver tumours.

  18. Carcinoid Syndrome and Carcinoid Heart Disease as Manifestations of Non-Metastatic Ovarian Neuroendocrine Tumour

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    Joana Simões-Pereira

    2017-05-01

    Full Text Available The carcinoid syndrome is rare but it is associated with carcinoid heart disease in more than a half of the cases. Carcinoid heart disease is typically characterised by morphological and functional modifications of right-sided valves. Its aetiology is probable multifactorial but serotonin appears to play a key role in the development of this valvular disease. Unlike gastrointestinal neuroendocrine tumours, ovarian neuroendocrine tumours can present with carcinoid syndrome and carcinoid heart disease in the absence of liver metastases; such ovarian neuroendocrine tumours are a unique clinical entity. The additional burden of cardiac impairment in these patients represents a significant reduction in survival. Early recognition and surgical valve replacement before advanced heart failure is established may improve the clinical outcome. We report the case of a woman with an ovarian neuroendocrine tumour and highly symptomatic carcinoid heart disease who was submitted to tumour resection followed by valvuloplasty. She demonstrated an outstanding clinical improvement and has remained free of tumour and symptomatology.

  19. [Commentary to the paper: immobilising malignant phyllodes tumour of the breast by E. Fritsche, U. Hug und D. Winterholer].

    Science.gov (United States)

    Horch, R E

    2015-04-01

    The size of a tumor should not be the limiting factor when it comes to the decision for surgical treatment of such entities. Due to modern plastic reconstructive techniques an R0 situaiton should always be attempted, and in the worst case an interdisciplinary palliative resection should be possible and recommendable. As the present case with a tumour that led to immobility clearly indicates, the gain in quality of life undoubtedly is a proof of the necessity and value of the surgical treatment of this entity.

  20. Neurosurgical experience with tumours of the pineal region at Clinica Puerta de Hierro.

    Science.gov (United States)

    Vaquero, J; Ramiro, J; Martínez, R; Bravo, G

    1992-01-01

    The clinicopathological experience with 50 cases of pineal region tumours at Clinica Puerta de Hierro is presented. In this series, 88% of the patients were evaluated by CT-scan. Pineal region tumours make up approximately 0.7% of the intracranial expansive processes in the Spanish population. The largest group of lesions appearing in this localization is that of the germinomas (38%), followed by nontumoural lesions (20%) and tumours generally considered to be of the vicinity, such as meningiomas, gliomas and metastases (18%), tumours of the pineal parenchyma (14%), and non-germinoma germinal tumours (10%). In our series, in addition to an intracranial hypertension syndrome, an ophthalmological and, to a minor degree, an endocrinological syndrome predominate in germ-cell tumours, with a cerebellar syndrome appearing in gliomas of the pineal region. All the patients in the series diagnosed as having a germinoma and treated by irradiation are alive, and free of disease, after follow-up ranging from 2 to 20 years (mean: 8 years). The experience obtained with the present series supports the opinion that, in radiosensitive tumours, surgical resection adds no therapeutic benefit to treatment with radiotherapy alone. We suggest that when dealing with a tumour of the pineal region, CT-scan and clinical assessment now permit an initial selection of patients susceptible to surgery as a first therapeutic option, indicating those patients who, because they are considered to have either a "probable germinoma" or a "tumour of uncertain diagnosis", should undergo stereotaxic biopsy or trial radiotherapy and, only when this has proved a failure, should be subjected to open surgery.

  1. The role of dual-phase helical CT in assessing resectability of carcinoma of the gallbladder

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    Kumaran, Vinay; Pande, Girish Kumar; Sahni, Peush; Chattopadhyay, Tushar Kanti [Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029 (India); Gulati, Manpreet Singh; Paul, Shashi Bala [Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029 (India)

    2002-08-01

    Our objective was to assess the ability of dual-phase helical CT (DHCT) to predict resectability of carcinoma of gallbladder (CaGB). Thirty-two consecutive patients suspected of having CaGB on clinical examination and sonography presented to our centre over 10-month period. All these 32 patients underwent DHCT. Fifteen patients were considered inoperable and 2 had xanthogranulomatous cholecystitis. The remaining 15 patients (10 women, 5 men; age range 33-72 years) underwent surgery and had histopathological confirmation of CaGB and were included in the study based on the following criteria: presence of mass in gallbladder fossa on sonography and DHCT, and confirmation at surgery and histopathological examination. Axial reconstructions of 2 mm were obtained (collimation 3 mm, table speed 4.5 mm/s) for arterial (scan delay 20 s) and venous (scan delay 60 s) phases on a helical scanner. The criteria used for unresectability were: distant metastasis (liver, peritoneum, lymph nodes), extensive local contiguous organ spread, involvement of secondary biliary confluence of both lobes of liver, tumoral invasion of main portal vein, or proper hepatic artery or simultaneous invasion of one side hepatic artery and the other side portal vein. The CT findings related to unresectability were correlated with surgical findings. On the basis of CT findings, 10 patients were unresectable and 5 were resectable. Of the 10 patients considered unresectable, 9 had tumours that were unresectable at surgery (sensitivity 100%, positive predictive value 90%). Five patients had more than one reason and 4 had one reason alone for being unresectable (lymph nodes, n=2; hepatic metastasis, n=1; and vascular invasion, n=1). All 5 patients considered resectable based on CT findings had resectable tumours at surgery (negative predictive value 100%). The overall accuracy of CT was 93.3%. Dual-phase helical CT comprehensively evaluates CaGB and may be a useful tool in preoperative staging of this

  2. Cytoreductive surgery in disseminated non-seminomatous germ cell tumours of testis.

    Science.gov (United States)

    Kulkarni, R P; Reynolds, K W; Newlands, E S; Dawson, P M; Makey, A R; Theodorou, N A; Bradley, J; Begent, R H; Rustin, G J; Bagshawe, K D

    1991-02-01

    Between 1977 and 1988, 67 patients underwent surgical removal of residual metastatic deposits following an aggressive chemotherapy regimen (cisplatin, vincristine, methotrexate and bleomycin alternating with etoposide, actinomycin D and cyclophosphamide) for disseminated germ cell tumours of the testis (stage IIB or above). Ninety-one surgical procedures were performed. There were 63 (69 per cent) retroperitoneal lymph node dissections, 16 (18 per cent) thoracotomies, three (3 per cent) hepatic resections, three (3 per cent) craniotomies, five (5 per cent) delayed orchidectomies and one anterolateral decompression of the vertebral column. Nine (13 per cent) patients required a repeat retroperitoneal node dissection and one patient needed a repeat thoracotomy to remove recurrent metastatic deposits during the period of follow-up. Multivisceral resections and vascular reconstruction procedures were required in 20 (30 per cent) patients undergoing retroperitoneal node dissection. Fifty-five (82 per cent) patients remain in complete remission with a mean follow-up period of 49.6 months (range 2-121 months). Nine (13 per cent) patients died with metastatic disease between 2 months to 4 years after operation. There were three deaths in the perioperative period (4 per cent). The histology of the resected metastases revealed undifferentiated active tumour in 20 (30 per cent) patients, differentiated mature teratoma in 29 (43 per cent) patients and fibrosis/necrosis in 18 (27 per cent) patients. Twelve (60 per cent) patients with undifferentiated elements and 15 patients (60 per cent) with raised preoperative tumour markers (poor prognostic categories) are in complete remission. Cytoreductive surgery in patients with metastatic germ cell tumours offers the best chance of remission following chemotherapy even in poor prognostic group categories.

  3. Neoadjuvant Chemotherapy in Locally Advanced and Borderline Resectable Nonsquamous Sinonasal Tumors (Esthesioneuroblastoma and Sinonasal Tumor with Neuroendocrine Differentiation

    Directory of Open Access Journals (Sweden)

    Vijay M. Patil

    2016-01-01

    Full Text Available Introduction. Sinonasal tumors are chemotherapy responsive which frequently present in advanced stages making NACT a promising option for improving resection and local control in borderline resectable and locally advanced tumours. Here we reviewed the results of 25 such cases treated with NACT. Materials and Methods. Sinonasal tumor patients treated with NACT were selected for this analysis. These patients received NACT with platinum and etoposide for 2 cycles. Patients who responded and were amenable for gross total resection underwent surgical resection and adjuvant CTRT. Those who responded but were not amenable for resection received radical CTRT. Patients who progressed on NACT received either radical CTRT or palliative radiotherapy. Results. The median age of the cohort was 42 years (IQR 37–47 years. Grades 3-4 toxicity with NACT were seen in 19 patients (76%. The response rate to NACT was 80%. Post-NACT surgery was done in 12 (48% patients and radical chemoradiation in 9 (36% patients. The 2-year progression free survival and overall survival were 75% and 78.5%, respectively. Conclusion. NACT in sinonasal tumours has a response rate of 80%. The protocol of NACT followed by local treatment is associated with improvement in outcomes as compared to our historical cohort.

  4. Granular cell tumour of the neurohypophysis: a rare sellar tumour with specific radiological and operative features.

    LENUS (Irish Health Repository)

    Aquilina, K

    2012-02-03

    Symptomatic granular cell tumours of the neurohypophysis are rare sellar lesions. Preoperative prediction of the diagnosis on the basis of radiological appearance is useful as these tumours carry specific surgical difficulties. This is possible when the tumour arises from the pituitary stalk, rostral to a normal pituitary gland. This has not been emphasized previously.

  5. Block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder. Surgical technique and a report of 11 cases.

    Science.gov (United States)

    Mimura, H; Takakura, N; Kim, H; Hamazaki, K; Tsuge, H; Ochiai, Y

    1991-12-01

    Carcinoma of the bile duct and gallbladder often infiltrates the entire hepatoduodenal ligament. Therefore radical resection should include block resection of the hepatoduodenal ligament. Over the last two years, block resection of the hepatoduodenal ligament for carcinoma of the bile duct and gallbladder was performed in 11 patients. When the carcinoma was located in the hilar bile duct, a combination of hemihepatectomy including the caudate lobe and ligamentetomy, "hepato-ligamentectomy", was performed (six cases). When the carcinoma was in the lower bile duct, a combination of pancreatico-duodenectomy and ligamentectomy, "ligamento-pancreatectomy", was performed (three cases). In two extremely advanced cases a combination of both hepatectomy and pancreatectomy with ligamentectomy, "hepato-ligamento-pancreatectomy", was performed. To accomplish these procedures safely, double catheter bypass of the portal circulation, devised by the authors in 1986, proved very effective in maintaining sufficient hepatic circulation and preventing portal congestion during block resection of the hepatoduodenal ligament. Histological evidence of invasion of the carcinoma cells into the hepatoduodenal ligament was detected in 10 cases, and in half of them the hepatic artery or portal vein was involved. As of April 1988, five cases in whom curative resection was performed are still alive, the longest survival period being 18 months. Four cases died in the early postoperative period, three of the deaths being due to sepsis and one to respirator malfunction.

  6. Malignant triton tumour of the sinonasal tract: Case report and literature review

    Directory of Open Access Journals (Sweden)

    Abdulmajeed Zakzouk

    2014-01-01

    CONCLUSION: Malignant triton tumour is a rare malignancy of the sinonasal tract. Otolaryngologists should be aware of this disease. The optimal treatment should include radical resection of the tumour.

  7. Mediastino-hepato-renal cystic lymphangiomas—diagnostic and surgical considerations

    Science.gov (United States)

    Vad, Henrik; Christensen, Thomas D.

    2014-01-01

    Cystic lymphangiomas or hygromas are rare benign vascular tumours, caused by congenital malformation of the lymphatic vessels. It appears as a progressive swelling in the head or neck of children during 2-5 years of life, yet rarely seen in the mediastinum or abdomen. Symptomatic mediastinal cystic lymphangiomas provide symptoms such as chest pain, breathlessness, cough, and dysphagia, making it difficult to differentiate from other mediastinal tumours. The tumour can become larger due to infections, inflammations, obstructions and bleedings. Chest X-ray, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) provide helpful information but the diagnosis appears merely after surgical resection and histological examination. Only a few cases have been reported. Hence, we report the first case of a mediastinal and asymptomatic renal and multiple hepatic cystic lymphangiomas in a 71-year-old male with respiratory symptoms and sever reduction in lung capacity. The symptoms regressed fully after surgical excision and lung diffusions capacity increased significantly. PMID:25276391

  8. Mediastino-hepato-renal cystic lymphangiomas-diagnostic and surgical considerations.

    Science.gov (United States)

    Ahmad, Khalil; Vad, Henrik; Christensen, Thomas D

    2014-09-01

    Cystic lymphangiomas or hygromas are rare benign vascular tumours, caused by congenital malformation of the lymphatic vessels. It appears as a progressive swelling in the head or neck of children during 2-5 years of life, yet rarely seen in the mediastinum or abdomen. Symptomatic mediastinal cystic lymphangiomas provide symptoms such as chest pain, breathlessness, cough, and dysphagia, making it difficult to differentiate from other mediastinal tumours. The tumour can become larger due to infections, inflammations, obstructions and bleedings. Chest X-ray, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) provide helpful information but the diagnosis appears merely after surgical resection and histological examination. Only a few cases have been reported. Hence, we report the first case of a mediastinal and asymptomatic renal and multiple hepatic cystic lymphangiomas in a 71-year-old male with respiratory symptoms and sever reduction in lung capacity. The symptoms regressed fully after surgical excision and lung diffusions capacity increased significantly.

  9. 神经导航系统在成人幕上胶质瘤切除手术中的应用及其对神经功能的保护作用%Reactions of the application of neuronavigation system on surgical resection of adult supratentorial glioma and the neuroprotective function

    Institute of Scientific and Technical Information of China (English)

    高之宪; 王忠诚; 张懋植; 王采云

    2004-01-01

    BACKGROUND: The extent of surgical resection of glioma is closely relating with the prognosis.Neuronavigation system could trace and direct dimensionally to improve the surgical quality of carcinoma excision by clearing the accurate imaging anatomic position of the surgical field for the operator.OBJECTIVE: To apply nerve navigation system in the operation of total resection of adult supratentorial glioma and the function of neural protection.SETTINGS and PARTICIPANTS: Settings: Department of neurosurgery of Beijing Tiantan Hospital. Participants: 85 cases of supratentorial glioma admitted from December 1997 to June 2000, in which there were 51 males and 34females aged from 17 to 56 years old with a diameter of tumour of 1.8 -7.0cm, were selected.INTERVENTIONS: All authors were intervenors. Total resection was operated in all patients under the instruction and the surveillance of navigation system.the limb motor function and language function in postoperative patients.RESULTS: There were 76 cases with total resection, 5 cases with nearlytotal resection and 4 cases with resection in most of the part of the tumour. There were 49 cases had obvious postoperative nerve impairment,which manifested with different extent of limb paralysis and/or languageimpairment and incomplete hemianopia; however, all cases were recoveredwithin 2 months with no permanent nerve impairments. The symptoms significantly improved within short periods after the surgery in all 8 cases withpreoperative hemiplegia, which all were able to walk, and the Karnofaky(KPS) score increased from preoperative 60-70 points to postoperative80 - 90 points.CONCLUSION: From the imaging point of view, it could totally resectgliomas on different sites of cerebral hemisphere in most of the patient byapplying neuronavigation system and moreover, no permanent postoperativenerve impairment would be induced as well.%背景:肿瘤的切除程度与患者的预后密切相关.神经导航系统可空间追踪立体定

  10. Malignant Peripheral Nerve Sheath Tumour of the Maxilla

    Directory of Open Access Journals (Sweden)

    Puja Sahai

    2014-01-01

    Full Text Available A 38-year-old man was diagnosed with malignant peripheral nerve sheath tumour of the maxilla. He was treated with total maxillectomy. Histopathological examination of the resected specimen revealed a close resection margin. The tumour was of high grade with an MIB-1 labelling index of almost 60%. At six weeks following the surgery, he developed local tumour relapse. The patient succumbed to the disease at five months from the time of diagnosis. The present report underlines the locally aggressive nature of malignant peripheral nerve sheath tumour of the maxilla which necessitates an early therapeutic intervention. A complete resection with clear margins is the most important prognostic factor for malignant peripheral nerve sheath tumour in the head and neck region. Adjuvant radiotherapy may be considered to improve the local control. Future research may demarcate the role of targeted therapy for patients with malignant peripheral nerve sheath tumour.

  11. En bloc resection of huge cemento-ossifying fibroma of mandible: avoiding lower lip split incision.

    Science.gov (United States)

    Ayub, Tahera; Katpar, Shahjahan; Shafique, Salman; Mirza, Talat

    2011-05-01

    Cemento-ossifying Fibroma (COF) is an osteogenic benign neoplasm affecting the jaws and other craniofacial bones. It commonly presents as a progressively slow growing pathology, which can sometimes attain an enormous size, causing facial deformity. A case of a huge cemento-ossifying fibroma, appearing as a mandibular dumbell tumour in a male patient is documented, which caused massive bone destruction and deformity. It was surgically removed by performing en bloc resection of mandible avoiding the splitting of lower lip incision technique, thereby maintaining his normal facial appearance.

  12. Limb Amputation after Multiple Treatments of Tenosynovial Giant Cell Tumour: Series of 4 Dutch Cases

    Directory of Open Access Journals (Sweden)

    Monique J. L. Mastboom

    2017-01-01

    Full Text Available In Tenosynovial Giant Cell Tumours (TGCT, previously named Pigmented Villonodular Synovitis (PVNS, a distinction is made between a single nodule (localized-type and multiple nodules (diffuse-type. Diffuse-type is considered locally aggressive. Onset and extermination of this orphan disease remain unclear. Surgical resection is the most commonly performed treatment. Unfortunately, recurrences often occur (up to 92%, necessitating reoperations and adjuvant treatments. Once all treatments fail or if severe complications occur, limb amputation may become unavoidable. We describe four cases of above-knee amputation after TGCT diagnosis.

  13. Microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach

    Institute of Scientific and Technical Information of China (English)

    XU Jian-guo; YOU Chao; CAI Bo-wen; JIANG Shu; SUN Hong; GUO Fu-you; YANG Yong-bo; WU Bo

    2005-01-01

    Background Craniopharyngioma of the third ventricle is difficult to treat and its therapeutic regimens and operative approaches have been controversial. This study was undertaken to probe indications for microsurgical resection of craniopharyngioma of the third ventricle via an improved transventricular approach, its surgical procedures and therapeutic effects, and prevention of postoperative complications.Methods Fifty-one patients with craniopharyngioma of the third ventricle were treated from January 2000 to October 2004 by an improved transventricular approach for removing the tumor via the interventricular foramen,the intermedius of the septum pellucidum or choroid fissure. Symptoms and signs of the patients, and results of imaging, operation, and follow-up were analyzed. Results Of the 51 patients who had received the improved transventricular resection, 4 underwent a combined approach with an entrance of the pterion. Forty patients (78.43%) underwent total resection and others subtotal resection, without an operative death. Epileptic seizures were found in 3 patients (5.88%) and subdural effusion in the operative field in 4 (7.84%). All patients showed good general conditions after operation, and follow-up for an average of 27.52 months showed relapse of the tumour in 8 patients (15.69%).Conclusions Microsurgical resection of craniopharyngioma of the third ventricle by an improved transventricular approach has advantages of operative safety and efficacy, lower mortality and disability, and less complications.

  14. Extent of Surgery and Implications of Transection Margin Status after Resection of IPMNs

    Directory of Open Access Journals (Sweden)

    Marina Paini

    2014-01-01

    Full Text Available Appropriate surgical strategies for management of intraductal papillary mucinous neoplasms (IPMNs of the pancreas are a matter of debate. Preoperative and intraoperative evaluation of malignant potential of IPMN and of patient’s comorbidities is of paramount importance to balance potential complications of surgery with tumors’ risk of being or becoming malignant; the decision about the extent of pancreatic resection and the eventual total pancreatectomy needs to be determined on individual basis. The analysis of frozen-section margin of pancreas during operation is mandatory. The goal should be the complete resection of IPMN reaching negative margin, although there is still no agreed definition of “negative margin.” Of note, the presence of deepithelization is often wrongly interpreted as absence of neoplasia. Management of resection margin status and stratification of surveillance of the remnant pancreas, based on characteristics of primary tumour, are of crucial importance in the management of IPMNs in order to decrease the risk of tumor recurrence after resection. Although risk of local and distant recurrence for invasive IPMNs is increased even in case of total pancreatectomy, also local recurrence after complete resection of noninvasive IPMNs is not negligible. Therefore, a long-term/life-time follow-up monitoring is of paramount importance to detect eventual recurrences.

  15. POMB/ACE chemotherapy for mediastinal germ cell tumours.

    Science.gov (United States)

    Bower, M; Brock, C; Holden, L; Nelstrop, A; Makey, A R; Rustin, G J; Newlands, E S

    1997-05-01

    Mediastinal germ cell tumours (MGCT) are rare and most published series reflect the experiences of individual institutions over many years. Since 1979, we have treated 16 men (12 non-seminomatous germ cell tumours and 4 seminomas) with newly diagnosed primary MGCT with POMB/ACE chemotherapy and elective surgical resection of residual masses. This approach yielded complete remissions in 15/16 (94%) patients. The median follow-up was 6.0 years and no relapses occurred more than 2 years after treatment. The 5 year overall survival in the non-seminomatous germ cell tumours (NSGCT) is 73% (95% confidence interval 43-90%). One patient with NSGCT developed drug-resistant disease and died without achieving remission and 2 patients died of relapsed disease. In addition, 4 patients with bulky and/or metastatic seminoma were treated with POMB/ACE. One died of treatment-related neutropenic sepsis in complete remission and one died of relapsed disease. Finally, 4 patients (2 NSGCT and 2 seminomas) referred at relapse were treated with POMB/ACE and one was successfully salvaged. The combination of POMB/ACE chemotherapy and surgery is effective management for MGCT producing high long-term survival rates.

  16. Chronic unlimited recording electrocorticography-guided resective epilepsy surgery: technology-enabled enhanced fidelity in seizure focus localization with improved surgical efficacy.

    Science.gov (United States)

    DiLorenzo, Daniel J; Mangubat, Erwin Z; Rossi, Marvin A; Byrne, Richard W

    2014-06-01

    Epilepsy surgery is at the cusp of a transformation due to the convergence of advancements in multiple technologies. Emerging neuromodulatory therapies offer the promise of functionally correcting neural instability and obviating the need for resective or ablative surgery in select cases. Chronic implanted neurological monitoring technology, delivered as part of a neuromodulatory therapeutic device or as a stand-alone monitoring system, offers the potential to monitor patients chronically in their normal ambulatory setting with outpatient medication regimens. This overcomes significant temporal limitations, pharmacological perturbations, and infection risks inherent in the present technology comprising subacute percutaneous inpatient monitoring of presurgical candidates in an epilepsy monitoring unit. As part of the pivotal study for the NeuroPace Responsive Neurostimulation (RNS) System, the authors assessed the efficacy of the RNS System to control seizures in a group of patients with medically refractory epilepsy. Prior to RNS System implantation, these patients were not candidates for further resective surgery because they had temporal lobe epilepsy with bilateral temporal sources, frontal lobe reflex epilepsy with involvement of primary motor cortex, and occipital lobe epilepsy with substantial involvement of eloquent visual cortex. Without interfering with and beyond the scope of the therapeutic aspect of the RNS System study, the authors were able to monitor seizure and epileptiform activity from chronically implanted subdural and depth electrodes in these patients, and, in doing so, they were able to more accurately localize the seizure source. In 5 of these study patients, in whom the RNS System was not effective, the notion of resective surgery was revisited and considered in light of the additional information gleaned from the chronic intracranial recordings obtained from various permutations of electrodes monitoring sources in the frontal, temporal

  17. Angiogenic Response to Major Lung Resection for Non-Small Cell Lung Cancer with Video-Assisted Thoracic Surgical and Open Access

    Directory of Open Access Journals (Sweden)

    Calvin S. H. Ng

    2012-01-01

    Full Text Available Background. Angiogenic factors following oncological surgery is important in tumor recurrence. Vascular endothelial growth factor (VEGF, angiopoietin 1 (Ang-1, Ang-2, soluble VEGF-receptor 1 (sVEGFR1 and sVEGFR2 may influence angiogenesis. This prospective study examined the influence of open and video-assisted thoracic surgery (VATS lung resections for early stage non-small cell lung cancer (NSCLC on postoperative circulating angiogenic factors. Methods. Forty-three consecutive patients underwent major lung resection through either VATS (=23 or Open thoracotomy (=20 over an 8-month period. Blood samples were collected preoperatively and postoperatively on days (POD 1 and 3 for enzyme linked immunosorbent assay determination of angiogenic factors. Results. Patient demographics were comparable. For all patients undergoing major lung resection, postoperative Ang-1 and sVEGFR2 levels were significantly decreased, while Ang-2 and sVEGFR1 levels markedly increased. No significant peri-operative changes in VEGF levels were observed. Compared with open group, VATS had significantly lower plasma levels of VEGF (VATS 170±93 pg/mL; Open 486±641 pg/mL; =0.04 and Ang-2 (VATS 2484±1119 pg/mL; Open 3379±1287 pg/mL; =0.026 on POD3. Conclusions. Major lung resection for early stage NSCLC leads to a pro-angiogenic status, with increased Ang-2 and decreased Ang-1 productions. VATS is associated with an attenuated angiogenic response with lower circulating VEGF and Ang-2 levels compared with open. Such differences in angiogenic factors may be important in lung cancer biology and recurrence following surgery.

  18. Targeted imaging of α(v)β(3) expressing sarcoma tumor cells in vivo in pre-operative setting using near infrared: a potential tool to reduce incomplete surgical resection.

    Science.gov (United States)

    Dutour, Aurelie; Josserand, Veronique; Jury, Delphine; Guillermet, Stephanie; Decouvelaere, Anne Valerie; Chotel, Franck; Pointecouteau, Thomas; Rizo, Philippe; Coll, Jean Luc; Blay, Jean Yves

    2014-05-01

    Tumor size and location along with efficacy of pre-operative imaging are limiting factors for optimal surgical excision for osteosarcoma. Our general hypothesis is that targeting αvβ3 integrin-rich osteosarcoma neoangiogenesis should provide improved delivery of diagnostic compounds and assist surgeons intra operatively using near-infrared imaging techniques. We evaluated in an orthotopic metastatic osteosarcoma in rats the potential of AngioStamp™ targeting αvβ3 integrins and detected intra operatively by near infrared (NIR) illumination (Fluobeam™) as a novel, intra operative imaging technique. To determine the potential of this association in improving tumor and metastasis detection, we compared the quality and sensitivity of tumor/metastasis margin delineation and tumor resection using intra-operative NIR imaging to the ones guided by pre-operative imaging (i.e., MRI subsequently confirmed by histopathological analysis). Chemotherapy being essential in osteosarcoma treatment, we evaluated the capacity of AngioStamp™ to specifically localize to the tumor after chemotherapy treatment. We showed a significantly lesser extent of healthy tissue resection after surgical excision when assessing tumor margin intra operatively using AngioStamp™/Fluobeam™ association compared to pre-operative MRI post-operatively confirmed by histopathological analysis (plungs revealed more metastases than were detected by CT Scan or under intra-operative white light examination (plung metastasis excision. Based on these promising results, we now propose to evaluate this approach as a mean to improve surgical excision while maintaining tumor control in other sarcoma or tumors overexpressing αvβ3 integrins. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Intermittent exotropia: comparative surgical results of lateral recti-recession and monocular recess-resect Exotropia intermitente: comparação dos resultados cirúrgicos entre retrocesso dos retos laterais e retrocesso-ressecção monocular

    Directory of Open Access Journals (Sweden)

    Vanessa Macedo Batista Fiorelli

    2007-06-01

    Full Text Available PURPOSE: To compare the results between recession of the lateral recti and monocular recess-resect procedure for the correction of the basic type of intermittent exotropia. METHODS: 115 patients with intermittent exotropia were submitted to surgery. The patients were divided into 4 groups, according to the magnitude of preoperative deviation and the surgical procedure was subsequently performed. Well compensated orthophoria or exo-or esophoria were considered surgical success, with minimum of 1 year follow-up after the operation. RESULTS: Success was obtained in 69% of the patients submitted to recession of the lateral recti, and in 77% submitted to monocular recess-resect. In the groups with deviations between 12 PD and 25 PD, surgical success was observed in 74% of the patients submitted to recession of the lateral recti and in 78% of the patients submitted to monocular recess-resect. (p=0.564. In the group with deviations between 26 PD and 35 PD, surgical success was observed in 65% out of the patients submitted to recession of the lateral recti and in 75% of the patients submitted to monocular recess-resect. (p=0.266. CONCLUSION: recession of lateral recti and monocular recess-resect were equally effective in correcting basic type intermittent exotropia according to its preoperative deviation in primary position.OBJETIVO: Comparar os resultados entre o retrocesso dos retos laterais e retrocesso-ressecção monocular, para correção de exotropia intermitente do tipo básico. MÉTODOS: Foram selecionados 115 prontuários de pacientes portadores de exotropia intermitente do tipo básico submetidos a cirurgia no período entre janeiro de 1991 e dezembro de 2001. Os planejamentos cirúrgicos seguiram orientação do setor de Motilidade Extrínseca Ocular da Clínica Oftalmológica da Santa Casa de São Paulo e basearam-se na magnitude do desvio na posição primária do olhar. Os pacientes foram divididos em 4 grupos, de acordo com a magnitude

  20. Tumour eosinophilia combined with an immunohistochemistry panel is useful in the differentiation of type B3 thymoma from thymic carcinoma

    Science.gov (United States)

    Khoury, Thaer; Chandrasekhar, Rameela; Wilding, Gregory; Tan, Dongfeng; Cheney, Richard T

    2011-01-01

    It is sometimes difficult to differentiate between type B3 thymoma from thymic carcinoma histologically. Given the rarity of these tumours, studies have been limited. A series of 66 thymic neoplasms were reviewed and classified according to the World Health Organization (WHO) scheme. We performed a tissue microarray analysis of surgically resected thymic tumour specimens including 12 thymic carcinomas, 17 type B3 thymomas and 37 thymomas of other types. Percentage and staining intensity of immunohistochemical markers were recorded. Tumour eosinophilia was recorded positive if at least one eosinophilic cell identified. Positive staining of the following markers significantly differentiated type B3 thymoma from thymic carcinoma: cytokeratin 5/6 (15 vs. 3), Mesothelin (0 vs. 5), cytoplasmic androgen receptor (10 vs. 0), CD57 (9 vs. 0), CD5 (0 vs. 7), TdT (lymphocytic) (14 vs. 1), CD1a (lymphocytic) (14 vs. 2), CD117 (1 vs. 9), MOC31 (2 vs. 6), p21 (2 vs. 8), cytoplasmic Survivin (0 vs. 4), and tumour eosinophilia (1 vs. 11). Combining two or three markers was able to differentiate these two tumours with area under the curve percentage of at least 92%. Tumour eosinophilia combined with a panel of immunohistochemistry could differentiate type B3 thymoma from thymic carcinoma. PMID:21044186

  1. Development of a positron probe for localization and excision of brain tumours during surgery

    Energy Technology Data Exchange (ETDEWEB)

    Bogalhas, F; Charon, Y; Duval, M-A; Lefebvre, F; Pinot, L; Siebert, R; Menard, L [Laboratoire Imagerie et Modelisation en Neurobiologie et Cancerologie (UMR 8165), Campus d' Orsay, 91406 Orsay Cedex (France); Palfi, S [Service de neurochirurgie, CHU Henri Mondor, 94010 Creteil Cedex (France) and URA CEA-CNRS 2210, 4 Place du General Leclerc, 91401 Orsay Cedex (France)], E-mail: menard@imnc.in2p3.fr

    2009-07-21

    The survival outcome of patients suffering from gliomas is directly linked to the complete surgical resection of the tumour. To help the surgeons to delineate precisely the boundaries of the tumour, we developed an intraoperative positron probe with background noise rejection capability. The probe was designed to be directly coupled to the excision tool such that detection and removal of the radiolabelled tumours could be simultaneous. The device consists of two exchangeable detection heads composed of clear and plastic scintillating fibres. Each head is coupled to an optic fibre bundle that exports the scintillating light to a photodetection and processing electronic module placed outside the operative wound. The background rejection method is based on a real-time subtraction technique. The measured probe sensitivity for {sup 18}F was 1.1 cps kBq{sup -1} ml{sup -1} for the small head and 3.4 cps kBq{sup -1} ml{sup -1} for the large head. The mean spatial resolution was 1.6 mm FWHM on the detector surface. The {gamma}-ray rejection efficiency measured by realistic brain phantom modelling of the surgical cavity was 99.4%. This phantom also demonstrated the ability of the probe to detect tumour discs as small as 5 mm in diameter (20 mg) for tumour-to-background ratios higher than 3:1 and with an acquisition time around 4 s at each scanning step. These results indicate that our detector could be a useful complement to existing techniques for the accurate excision of brain tumour tissue and more generally to improve the efficiency of radio-guided cancer surgery.

  2. Functional outcome of en bloc resection of a giant cell tumour of the distal radius and arthrodesis of the wrist and distal ulna using an ipsilateral double barrel segmental ulna bone graft combined with a modified Sauve-Kapandji procedure.

    Science.gov (United States)

    Zhang, W; Zhong, J; Li, D; Sun, C; Zhao, H; Gao, Y

    2017-05-01

    Giant cell tumour of the distal radius is a locally aggressive lesion. In this study, we performed a wrist arthrodesis reconstruction with an ipsilateral double barrel segmental ulnar bone graft combined with a modified Sauve-Kapandji procedure for a giant cell tumour of the distal radius. From January 2007 to September 2013, we followed eight patients for a mean duration of 36 months. One patient developed a recurrence and was treated by amputation; the other seven patients achieved radiological union in about 8 months. There was no wrist instability, deformation or dislocation; the mean range of motion of the forearm achieved 75° of supination and 70° of pronation. The patients could recover reasonable grip strength. This new operative procedure can excise the tumour with a low rate of recurrence, fewer functional deficits and fewer complications than reported for other procedures. IV, therapeutic.

  3. High dose level radiation therapy for local tumour control in esthesioneuroblastoma

    Energy Technology Data Exchange (ETDEWEB)

    Guedea, F. [Universidad Autonoma de Barcelona (Spain); Limbergen, E. Van; Bogaert, W. Van Den [University Hospital, Leuven (Belgium). Dept. of Radiotherapy

    1994-12-31

    Esthesioneuroblastoma is an uncommon tumour of neural crest origin arising in the nasal cavity. This paper is a retrospective review of 7 patients with esthesioneuroblastoma treated at a single institution from May 1974 to July 1990. 5 patients were treated with radiation therapy alone and 2 patients were irradiated after surgical resection. No local or regional occurrence was observed in any patient at 6 months, or at 1, 3, 6, 11.5 and 12 years following treatment. One patient died of intercurrent disease 6 years after radiation therapy, 2 patients died of disease, 1 of distant metastasis at 6 months and the other patient of meningeal carcinomatosis and distant metastases 1 year after treatment. One patient is alive with distant metastases 1 year after treatment. None of the patients experienced significant complications of irradiation. High-dose irradiation (60 Gy or more) alone or in combination with resection is an effective local treatment modality for esthesioneuroblastoma. (author).

  4. Preoperative shunts in thalamic tumours.

    Directory of Open Access Journals (Sweden)

    Goel A

    2000-10-01

    Full Text Available Thirty one patients with thalamic glioma underwent a pre-tumour resection shunt surgery. The procedure was uneventful in 23 patients with relief from symptoms of increased intracranial pressure. Eight patients worsened after the procedure. The level of sensorium worsened from excessively drowsy state to unconsciousness in seven patients. Three patients developed hemiparesis, 4 developed paresis of extra-ocular muscles and altered pupillary reflexes, and 1 developed incontinence of urine and persistent vomiting. Alteration in the delicately balanced intracranial pressure and movements in the tumour and vital adjacent brain areas could be the probable cause of the worsening in the neurological state in these 8 patients. On the basis of these observations and on review of literature, it is postulated that the ventricular dilatation following an obstruction in the path of the cerebrospinal fluid flow by a tumour could be a natural defense phenomenon of the brain.

  5. Combination short-course preoperative irradiation, surgical resection, and reduced-field high-dose postoperative irradiation in the treatment of tumors involving the bone.

    Science.gov (United States)

    Wagner, Timothy D; Kobayashi, Wendy; Dean, Susan; Goldberg, Saveli I; Kirsch, David G; Suit, Herman D; Hornicek, Francis J; Pedlow, Francis X; Raskin, Kevin A; Springfield, Dempsey S; Yoon, Sam S; Gebhardt, Marc C; Mankin, Henry J; Delaney, Thomas F

    2009-01-01

    To assess the feasibility and outcomes of combination short-course preoperative radiation, resection, and reduced-field (tumor bed without operative field coverage) high-dose postoperative radiation for patients with solid tumors mainly involving the spine and pelvis. Between 1982 and 2006, a total of 48 patients were treated using this treatment strategy for solid tumors involving bone. Radiation treatments used both photons and protons. Of those treated, 52% had chordoma, 31% had chondrosarcoma, 8% had osteosarcoma, and 4% had Ewing's sarcoma, with 71% involving the pelvis/sacrum and 21% elsewhere in the spine. Median preoperative dose was 20 Gy, with a median of 50.4 Gy postoperatively. With 31.8-month median follow-up, the 5-year overall survival (OS) rate is 65%; 5-year disease-free survival (DFS) rate, 53.8%; and 5-year local control (LC) rate, 72%. There were no significant differences in OS, DFS, and LC according to histologic characteristics. Between primary and recurrent disease, there was no significant difference in OS rates (74.4% vs. 51.4%, respectively; p = 0.128), in contrast to DFS (71.5% vs. 18.3%; p = 0.0014) and LC rates (88.9% vs. 30.9%; p = 0.0011) favoring primary disease. After resection, 10 patients experienced delayed wound healing that did not significantly impact on OS, DFS, or LC. This approach is promising for patients with bone sarcomas in which resection will likely yield close/positive margins. It appears to inhibit tumor seeding with an acceptable rate of wound-healing complications. Dose escalation is accomplished without high-dose preoperative radiation (likely associated with higher rates of acute wound healing delays) or large-field postoperative radiation only (likely associated with late normal tissue toxicity). The LC and DFS rates are substantially better for patients with primary than recurrent sarcomas.

  6. Xanthogranulomatous Cystitis Treated by Transurethral Resection

    Directory of Open Access Journals (Sweden)

    Sachi Yamamoto

    2015-09-01

    Full Text Available Xanthogranulomatous cystitis (XC is a rare benign chronic inflammatory disease of unknown etiology. Curative treatment of XC requires surgical resection, and most of reported cases were treated by partial cystectomy. Here we describe a case with XC that was treated using transurethral resection.

  7. Liver resection over the last decade

    DEFF Research Database (Denmark)

    Wettergren, A.; Larsen, P.N.; Rasmussen, A.;

    2008-01-01

    of hepatic metastases from colorectal cancer and hepatocellular carcinoma in our institution. MATERIALS AND METHODS: The patients who underwent their primary liver resection from 1.1.1995-31.12.2004 in our institution were included. The surgical outcome was reviewed retrospectively and the five-year survival...... after resection of hepatic metastases from colorectal cancer and hepatocellular carcinoma was estimated. RESULTS: 141 patients (71M/70F), median age 58 years (1-78), underwent a liver resection in the ten-year period. The number of resections increased from two in 1995 to 32 in 2004. Median hospital......AIMS: The results after liver resection have improved over the last decade with an operative mortality rate of less than 5% in high-volume centres. The aim of the present study was to assess the perioperative outcome after hepatic resection and to assess the long-term survival after liver resection...

  8. The impact of radiotherapy in the treatment of desmoid tumours. An international survey of 110 patients. A study of the Rare Cancer Network

    Directory of Open Access Journals (Sweden)

    Maurer Robert

    2007-03-01

    Full Text Available Abstract Purpose A multi-centre study to assess the value of combined surgical resection and radiotherapy for the treatment of desmoid tumours. Patients and methods One hundred and ten patients from several European countries qualified for this study. Pathology slides of all patients were reviewed by an independent pathologist. Sixty-eight patients received post-operative radiotherapy and 42 surgery only. Median follow-up was 6 years (1 to 44. The progression-free survival time (PFS and prognostic factors were analysed. Results The combined treatment with radiotherapy showed a significantly longer progression-free survival than surgical resection alone (p smaller than 0.001. Extremities could be preserved in all patients treated with combined surgery and radiotherapy for tumours located in the limb, whereas amputation was necessary for 23% of patients treated with surgery alone. A comparison of PFS for tumour locations proved the abdominal wall to be a positive prognostic factor and a localization in the extremities to be a negative prognostic factor. Additional irradiation, a fraction size larger than or equal to 2 Gy and a total dose larger than 50 Gy to the tumour were found to be positive prognostic factors with a significantly lower risk for a recurrence in the univariate analysis. This analysis revealed radiotherapy at recurrence as a significantly worse prognostic factor compared with adjuvant radiotherapy. The addition of radiotherapy to the treatment concept was a positive prognostic factor in the multivariate analysis. Conclusion Postoperative radiotherapy significantly improved the PFS compared to surgery alone. Therefore it should always be considered after a non-radical tumour resection and should be given preferably in an adjuvant setting. It is effective in limb preservation and for preserving the function of joints in situations where surgery alone would result in deficits, which is especially important in young patients.

  9. The influence of circumferential resection margins on survival following rectal cancer surgery.

    Science.gov (United States)

    Mois, Emil; Graur, Florin; Hajjar, Nadim Al; Puia, Cosmin; Cote, Adrian; Zaharie, Florin; Bartos, Adrian; Momani, Noemi Al; Pop, Flaviu; Neagos, Horatiu; Ciorogar, George; Iancu, Cornel

    2017-01-01

    A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival. Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the tumor and the resection margin. The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of the rectum. Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors. Abdomino-perineal resection, Circumferential resection margins, Local recurrence, Rectal cancer, Overall survival.

  10. Surgical Management of Juvenile Nasopharyngeal Angiofibroma Without Angiographic Embolization

    Directory of Open Access Journals (Sweden)

    Raja Ahmad

    2008-10-01

    Full Text Available Juvenile nasopharyngeal angiofibroma (JNA is a rare benign neoplasm that occurs almost exclusively in the nasopharynx of adolescent males. Surgery remains the primary treatment of choice. JNA has always presented a management challenge to surgeons because of its vascular nature, site of occurrence, and local tissue destruction. The surgical approaches are either standard open method which include external or intraoral incisions, or the recent advanced approach, i.e. via using the endonasal endoscope. It is widely accepted that the use of preoperative angiographic embolization reduces the occurrence of intraoperative bleeding and facilitates tumour removal. However, angiographic embolization is not available at all centres. The purpose of this article is to present our experience with five patients diagnosed with JNA who were resected without embolization, using various surgical approaches. Two tumours were removed via endonasal endoscopic surgery. None of the tumours were embolized prior to surgery. We highlight the preoperative evaluation of tumour extent, using both computed tomography (CT and magnetic resonance angiography, and the importance of temporary clamping of the external carotid artery intraoperatively. Our results suggest that the latter procedure is a safe and effective means of facilitating surgery and reducing intraoperative bleeding.

  11. Can a one-day practical lesson in surgical skills encourage medical students to consider a surgical career?

    Science.gov (United States)

    Bauer, Florian; Rommel, Niklas; Koerdt, Steffen; Fichter, Andreas; Wolff, Klaus-Dietrich; Kesting, Marco R

    2016-05-01

    Interest in a surgical career is declining among medical students, and many more need to commit themselves to becoming surgeons to cope with this. We have therefore developed a one-day practical lesson in surgical skills to find out whether a short course such as this can make students more enthusiastic about surgery, and about subsequently pursuing a career in one of its subspecialties. Fifty-four randomly-selected medical students did a one-day practical course in the skills required for maxillofacial surgical specialties. The 4 subdivisions involved - traumatology, resection of a tumour (cancer surgery), plastic surgery (microsurgery), and cleft lip and palate surgery. All students took written tests and completed an evaluation form about their interest in a surgical career before and after training. There was a significant increase in test scores in almost all categories at the end of the course, and significantly more students were prepared to consider a surgical career or a career in maxillofacial surgery after the training. This study shows that a one-day training course in surgical skills can significantly improve medical students' surgical knowledge, and might encourage them to enter a surgical career. We recommend the integration of a short training course such as this into the medical school curriculum. Only time and further evaluation will tell whether this increased exposure to surgical techniques can be transformed into additional surgeons.

  12. Choice of Surgical Procedure for Patients With Non-Small-Cell Lung Cancer ≤ 1 cm or > 1 to 2 cm Among Lobectomy, Segmentectomy, and Wedge Resection

    DEFF Research Database (Denmark)

    Dai, Chenyang; Shen, Jianfei; Ren, Yijiu

    2016-01-01

    PURPOSE: According to the lung cancer staging project, T1a (≤ 2 cm) non-small-cell lung cancer (NSCLC) should be additionally classified into ≤ 1 cm and > 1 to 2 cm groups. This study aimed to investigate the surgical procedure for NSCLC ≤ 1 cm and > 1 to 2 cm. METHODS: We identified 15,760 patie...

  13. Causes and surgical treatment of anastomotic stenosis after colorectal cancer resection:a report of 14 cases%直肠癌切除术后吻合口狭窄14例分析

    Institute of Scientific and Technical Information of China (English)

    李光焰; 张安平; 王祥峰; 刘宝华

    2016-01-01

    Objective To investigate causes and surgical treatment of anastomotic stenosis after resection of rectal carcinoma. Methods There were 14 cases of postoperative anastomotic stenosis,inclu-ding 11 cases of dissection for anastomotic stenosis ring,1 case of urethral dilatation,1 case of transab-dominal resection of anastomotic stenosis ring and ileostomy,and 1 case of sigmoidostomy with anastomotic stoma compressed by carcinoma recurrence in pelvic. Results The 11 cases with stenosis ring dissection received following anal dilatation by fingers and there was no recurrence. The patient with urethral dilata-tion received protective ileal colostomy at the 20th day after surgery,and then was able to defecate loose stool. Conclusion The causes of anastomotic stenosis are protective ileostomy,anastomotic leakage,anas-tomotic infection,tumor recurrence,postoperative pelvic radiotherapy and anastomosis skill. Surgical treat-ments mainly include dissection of anastomotic stenosis ring,urethra dilatation and transabdominal resec-tion of anastomotic stenosis ring.%目的分析直肠癌切除术后吻合口狭窄的原因。方法直肠癌切除术后吻合口狭窄患者14例,11例行吻合口狭窄环切开术,1例行尿道探条扩张术2次,1例行经腹直肠吻合口狭窄环切除、回肠造口术,1例肿瘤盆腔复发压迫吻合口,行乙状结肠造口术。结果11例吻合口狭窄环切开术患者术后继续手指扩肛,无直肠吻合口狭窄症状。尿道探条扩张术的患者,术后20天行回肠保护性造口还纳术,能够排出稀便。结论吻合口狭窄原因为保护性回肠造口术、吻合口感染和吻合口漏、肿瘤复发、术后盆腔放疗、吻合技术。手术方法主要是吻合口狭窄环切开术、尿道探条扩张术和经腹直肠吻合口狭窄环切除术。

  14. Five-year survival analysis of surgically resected gastric cancer cases in Japan: a retrospective analysis of more than 100,000 patients from the nationwide registry of the Japanese Gastric Cancer Association (2001-2007).

    Science.gov (United States)

    Katai, Hitoshi; Ishikawa, Takashi; Akazawa, Kohei; Isobe, Yoh; Miyashiro, Isao; Oda, Ichiro; Tsujitani, Shunichi; Ono, Hiroyuki; Tanabe, Satoshi; Fukagawa, Takeo; Nunobe, Souya; Kakeji, Yoshihiro; Nashimoto, Atsushi

    2017-04-17

    The aim of this retrospective study was to investigate the tumor characteristics, surgical details, and survival distribution of surgically resected cases of gastric cancer from the nationwide registry of the Japanese Gastric Cancer Association. Data from 118,367 patients with primary gastric carcinoma who underwent resection between 2001 and 2007 were included in the survival analyses. The 5-year survival rates were calculated for various subsets of prognostic factors. The median age of the patients was 67 years. The proportions of patients with pathological stage (Japanese Gastric Cancer Association) IA, IB, II, IIIA, IIIB, and IV disease were 44.0%, 14.7%, 11.7%, 9.5%, 5.0%, and 12.4% respectively. The death rate within 30 days of operation was 0.5%. The 5-year overall survival rate in the 118,367 patients who were treated by resection was 71.1%. The 5-year overall survival rates of patients with pathological stage IA, IB, II, IIIA, IIIB, and IV disease were 91.5%, 83.6%, 70.6%, 53.6%, 34.8%, and 16.4% respectively. The 5-year disease-specific survival rates in the patients with pT1 (mucosa) disease after D1+ dissection of lymph node station no. 7 (D1 + α), D1+ dissection of lymph node station nos. 7, 8, and 9 (D1+ β), and D2 lymphadenectomy were 99.4%, 99.6%, and 99.1% respectively. The 5-year disease-specific survival rates in the patients with pT1 (submucosa) disease after D1 + α, D1 + β, and D2 lymphadenectomy were 97.3%, 98.1%, and 96.9% respectively. Detailed analyses of the data from more than 100,000 patients show the recent trends of the outcomes of gastric cancer treatment in Japan and provide baseline information for use by medical communities around world.

  15. [A Case of Advanced Rectal Cancer in Which Combined Prostate Removal and ISR Using the da Vinci Surgical System with Preoperative Chemotherapy Allowed Curative Resection].

    Science.gov (United States)

    Kawakita, Hideaki; Katsumata, Kenji; Kasahara, Kenta; Kuwabara, Hiroshi; Shigoka, Masatoshi; Matsudo, Takaaki; Enomoto, Masanobu; Ishizaki, Tetsuo; Hisada, Masayuki; Kasuya, Kazuhiko; Tsuchida, Akihiko

    2016-11-01

    A 53-year-old male presented with a chief complaint of dyschezia.Lower gastrointestinal endoscopy confirmed the presence of a type II tumor in the lower part of the rectum, and a biopsy detected a well-differentiated adenocarcinoma.As invasion of the prostate and levator muscle of the anus was suspected on diagnostic imaging, surgery was performed after preoperative chemotherapy.With no clear postoperative complications, the patient was discharged 26 days after surgery. After 24 months, the number of urination ranged from 1 to 6, with a Wexner score of 6 and a mild desire to urinate in the absence of incontinence.At present, the patient is alive without recurrence.When combined with chemotherapy, robotassisted surgery allows the curative resection of extensive rectal cancer involving the suspected invasion of other organs.In this respect, it is likely to be a useful method to conserve anal and bladder function.

  16. Varying recurrence rates and risk factors associated with different definitions of local recurrence in patients with surgically resected, stage I nonsmall cell lung cancer.

    Science.gov (United States)

    Varlotto, John M; Recht, Abram; Flickinger, John C; Medford-Davis, Laura N; Dyer, Anne-Marie; DeCamp, Malcolm M

    2010-05-15

    The objective of this study was to examine the effects of different definitions of local recurrence on the reported patterns of failure and associated risk factors in patients who undergo potentially curative resection for stage I nonsmall cell lung cancer (NSCLC). The study included 306 consecutive patients who were treated from 2000 to 2005 without radiotherapy. Local recurrence was defined either as 'radiation' (r-LR) (according to previously defined postoperative radiotherapy fields), including the bronchial stump, staple line, ipsilateral hilum, and ipsilateral mediastinum; or as 'comprehensive' (c-LR), including the same sites plus the ipsilateral lung and contralateral mediastinal and hilar lymph nodes. All recurrences that were not classified as "local" were considered to be distal. The median follow-up was 33 months. The proportions of c-LR and r-LR at 2 years, 3 years, and 5 years were 14%, 21%, and 29%, respectively, and 7%, 12%, and 16%, respectively. Significant risk factors for c-LR on multivariate analysis were diabetes, lymphatic vascular invasion, and tumor size; and significant factors for r-LR were resection of less than a lobe and lymphatic vascular invasion. The proportions of distant (non-local) recurrence using these definitions at 2 years, 3 years, and 5 years were 10%, 12%, and 18%, respectively, and 14%, 19%, and 29%, respectively. Significant risk factors for distant failure were histology when using the c-LR definition and tumor size when using the r-LR definition. Local recurrence increased nearly 2-fold when a broad definition was used instead of a narrow definition. The definition also affected which factors were associated significantly with both local and distant failure on multivariate analysis. Comparable definitions must be used when analyzing different series. (c) 2010 American Cancer Society.

  17. A prospective study of tumor suppressor gene methylation as a prognostic biomarker in surgically-resected stage I-IIIA non-small cell lung cancers

    Science.gov (United States)

    Drilon, Alexander; Sugita, Hirofumi; Sima, Camelia S.; Zauderer, Marjorie; Rudin, Charles M.; Kris, Mark G.; Rusch, Valerie W.; Azzoli, Christopher G.

    2014-01-01

    Introduction While retrospective analyses support an association between early tumor recurrence and tumor suppressor gene (TSG) promoter methylation in early-stage non-small cell lung cancers (NSCLCs), few studies have investigated this question prospectively. Methods Primary tumor tissue from patients with resected pathologic stage I-IIIA NSCLCs was collected at the time of surgery and analyzed for promoter methylation via methylation-specific reverse-transcriptase polymerase chain reaction (MethyLight). The primary objective was to determine an association between promoter methylation of 10 individual TSGs (CDKN2A, CDH13, RASSF1, APC, MGMT, GSTP1, DAPK1, WIF1, SOCS3, and ADAMTS8) and recurrence-free survival (RFS), with the secondary objectives of determining association with overall survival (OS), and relation to clinical or pathologic features. Results 107 patients had sufficient tumor tissue for successful promoter methylation analysis. Majority of patients were former/current smokers (88%) with lung adenocarcinoma (78%) and pathologic stage I disease (66%). Median follow-up was 4 years. When controlled for pathologic stage, promoter methylation of the individual genes CDKN2A, CDH13, RASSF1, APC, MGMT, GSTP1, DAPK1, WIF1, and ADAMTS8 was not associated with RFS. Promoter methylation of the same genes was not associated with OS except for DAPK1 which was associated with improved OS (p=0.03). The total number of genes with methylated promoters did not correlate with RFS (p=0.89) or OS (p=0.55). Conclusions Contrary to data established by previous retrospective series, TSG promoter methylation (CDKN2A, CDH13, RASSF1,APC, MGMT, GSTP1, DAPK1, WIF1, and ADAMTS8) was not prognostic for early tumor recurrence in this prospective study of resected NSCLCs. PMID:25122424

  18. Prolongation of survival of dogs with oral malignant melanoma treated by en bloc surgical resection and adjuvant CSPG4-antigen electrovaccination.

    Science.gov (United States)

    Piras, L A; Riccardo, F; Iussich, S; Maniscalco, L; Gattino, F; Martano, M; Morello, E; Lorda Mayayo, S; Rolih, V; Garavaglia, F; De Maria, R; Lardone, E; Collivignarelli, F; Mignacca, D; Giacobino, D; Ferrone, S; Cavallo, F; Buracco, P

    2016-05-04

    Reported post-surgery 1-year survival rate for oral canine malignant melanoma (cMM) is around 30%; novel treatments are needed as the role of adjuvant chemotherapy is unclear. This prospective study regards adjuvant electrovaccination with human chondroitin sulfate proteoglycan-4 (hCSPG4)-encoded plasmid in 23 dogs with resected II/III-staged CSPG4-positive oral cMM compared with 19 dogs with resected only II/III-staged CSPG4-positive oral cMM. Vaccination resulted in 6-, 12-, 18- and 24-month survival rate of 95.6, 73.9, 47.8 and 30.4%, respectively [median survival time (MST) 684 days, range 78-1694, 8 of 23 dogs alive] and 6-, 12-, 18- and 24-month disease-free interval (DFI) rate of 82.6, 47.8, 26.1 and 17.4%, respectively (DFI 477 days, range 50-1694). Non-vaccinated dogs showed 6-, 12-, 18- and 24-month survival rate of 63.2, 26.3, 15.8 and 5.3%, respectively (MST 200 days, range 75-1507, 1 of 19 dogs alive) and 6-, 12-, 18- and 24-month DFI rate of 52.6, 26.3, 10.5 and 5.3%, respectively (DFI 180 days, range 38-1250). Overall survival and DFI of vaccinated dogs was longer in those <20 kg. In vaccinated and non-vaccinated dogs local recurrence rate was 34.8 and 42%, respectively while lung metastatic rate was 39 and 79%, respectively.

  19. Increased levels of deleted in malignant brain tumours 1 (DMBT1) in active bacteria-related appendicitis

    DEFF Research Database (Denmark)

    Kaemmerer, Elke; Schneider, Ursula; Klaus, Christina

    2012-01-01

    Kaemmerer E, Schneider U, Klaus C, Plum P, Reinartz A, Adolf M, Renner M, Wolfs T G A M, Kramer B W, Wagner N, Mollenhauer J & Gassler N (2012) Histopathology Increased levels of deleted in malignant brain tumours 1 (DMBT1) in active bacteria-related appendicitis Aims:  Deleted in malignant brain...... in bacteria-related active intestinal inflammation such as appendicitis. Methods and results:  mRNA and protein levels of DMBT1 were analysed in surgical resections of 50 appendices (active inflammation: n = 25). In non-actively inflamed appendices, inter-individual differences in basal DMBT1 levels...

  20. [Hydatidosis simulating a cardiac tumour with pulmonary metastases].

    Science.gov (United States)

    Martín-Izquierdo, Marta; Martín-Trenor, Alejandro

    2016-01-01

    The presence of multiple symptomatic pulmonary nodules and one cardiac tumour in a child requires urgent diagnosis and treatment. Until a few decades ago, the diagnosis of a cardiac tumour was difficult and was based on a high index of suspicion from indirect signs, and required angiocardiography for confirmation. Echocardiography and other imaging techniques have also helped in the detection of cardiac neoplasms. However, it is not always easy to make the correct diagnosis. The case is presented of a 12 year-old boy with pulmonary symptoms, and diagnosed with a cardiac tumour with lung metastases. The presence of numerous pulmonary nodules was confirmed in our hospital. The echocardiogram detected a solid cardiac nodule in the right ventricle. Magnetic resonance imaging confirmed the findings and the diagnosis. Puncture-aspiration of a lung nodule gave the diagnosis of hydatidosis. He underwent open-heart surgery with cardiac cyst resection and treated with anthelmintics. The lung cysts were then excised, and he recovered uneventfully. This child had multiple pulmonary nodules and a solid cardiac nodule, and was suspected of having a cardiac tumour with pulmonary metastases. However, given the clinical history, background and morphology of pulmonary nodules, another possible aetiology for consideration is echinococcosis. The clinical picture of cardiac hydatidosis and its complications is highly variable. The clinical history is essential in these cases, as well as having a high index of suspicion. Hydatidosis should be included in the differential diagnosis of a solid, echogenic, cardiac nodule. The treatment for cardiopulmonary hydatid cysts is surgical, followed by anthelmintics. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  1. Gastrointestinal stromal tumour presenting as gastroduodenal intussusception.

    LENUS (Irish Health Repository)

    Wilson, Mark H

    2012-08-01

    Gastroduodenal intussusception secondary to gastrointestinal stromal tumour is a very rare cause for intestinal obstruction. The diagnosis of this condition can be challenging, as symptoms are often non-specific and intermittent. This article reports a case where the diagnosis was made preoperatively with abdominal imaging and was treated by a combination of endoscopic reduction and laparoscopic resection.

  2. Adrenohepatic fusion: Adhesion or invasion in primary virilizant giant adrenal carcinoma? Implications for surgical resection. Two case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Antonio Alastrué Vidal

    2016-01-01

    Conclusion: We report two consecutive rare cases of adrenohepatic fusion in giant right adrenocortical carcinoma, not detectable by imaging, what has important implications for the surgical decision-making. As radical surgery is the best choice to offer a curative treatment, it has to be performed by a multidisciplinary well-assembled team, counting with endocrine and liver surgeons, and transplant surgeons in case of vena cava involvement, in order to maximize the disease-free survival.

  3. Surgical treatment of congenital thoracolumbar spondyloptosis in a 2-year-old child with vertebral column resection and posterior-only circumferential reconstruction of the spine column: case report.

    Science.gov (United States)

    Gressot, Loyola V; Mata, Javier A; Luerssen, Thomas G; Jea, Andrew

    2015-02-01

    Spondyloptosis refers to complete dislocation of a vertebral body onto another. The L5-S1 level is frequently affected. As this condition is rare, few published reports describing its clinical features and surgical outcomes exist, especially in the pediatric patient population. The authors report the presentation, pathological findings, and radiographic studies of a 2-year-old girl who presented to Texas Children's Hospital with a history since birth of progressive spastic paraparesis. Preoperative CT and MRI showed severe spinal cord compression associated with T11-12 spondyloptosis. The patient underwent a single-stage posterior approach for complete resection of the dysplastic vertebral bodies at the apex of the spinal deformity with reconstruction and stabilization of the vertebral column using a titanium expandable cage and pedicle screws. At the 12-month follow-up, the patient remained neurologically stable without any radiographic evidence of instrumentation failure or loss of alignment. To the best of the authors' knowledge, there have been only 2 other children with congenital thoracolumbar spondyloptosis treated with the above-described strategy. The authors describe their case and review the literature to discuss the aggregate clinical features, surgical strategies, and operative outcomes for congenital thoracolumbar spondyloptosis.

  4. Lower limb salvage surgery: modular endoprosthesis in bone tumour treatment.

    Science.gov (United States)

    Orlic, D; Smerdelj, M; Kolundzic, R; Bergovec, M

    2006-12-01

    We retrospectively analysed 90 patients who underwent "en bloc" resection and modular endoprosthesis reconstruction in the lower limbs between 1987-2003. After proximal femur resection, reconstruction was performed with a modular endoprosthesis by Howmedica (KFTR, designed by Kotz) and modular revision endoprosthesis by W. Link or Lima-Lto (Revision system, designed by Wagner). The knee joint was reconstructed with a modular endoprosthesis (Howmedica, KFTR designed by Kotz) after distal femur or proximal tibia resection. Malignant bone tumours were present in 58 patients (64.5%), benign tumours in 16 (17.8%), metastases in 8 (8.9%), tumour-like lesions in 4 (4.4 %) and non-tumour-related destruction of the femur in 4 patients (4.4%). High-grade tumours were found in the majority of malignant bone tumours (70.7%). Treatment complications, which occurred in 26 patients, were: local recurrence of the tumour, deep infection, acetabular destruction following hemiarthroplasty, recurrent dislocations of endoprosthesis, periprosthetic fracture and hardware problems. In total, 23 patients (25.6%) died due to tumours. Endoprostheses should be considered as a treatment of choice for bone tumours in the hip and knee joint region. Advances in limb salvage surgery are, and will long continue to be, a great challenge for orthopaedic oncologists of the 21st century.

  5. A comparison of surgical outcomes of perineal urethrostomy plus penile resection and perineal urethrostomy in twelve calves with perineal or prescrotal urethral dilatation

    Directory of Open Access Journals (Sweden)

    M.A. Marzok

    2013-10-01

    Full Text Available The clinical diagnosis, ultrasonographic findings, surgical management, outcome, and survival rate of perineal or prescrotal urethral dilatation in 12 male calves are described. All calves were crossbred and intact males. The most noticeable clinical presentations were perineal (n= 10 or prescrotal (n= 2 swellings and micturition problems. The main ultrasonographic findings were oval shaped dilatation of the urethra in all animals with dimensions of 40-75 X 30-62 mm. The calves with perineal urethral dilatation were treated by perineal urethrostomy (n= 4 and partial penile transection including the dilated urethra and urethral fistulation (n= 6. Prescrotal urethral dilatations were treated by penile transection proximal to the dilatation site (n= 2. Cystitis and stricture of the urethra were recorded postoperatively for two of the calves that underwent perineal urethrostomy. Nine animals were slaughtered at normal body weight approximately 6-8 months after the surgical treatment. Three animals were slaughtered after approximately three to four months, two of them having gained insufficient body weight. Our study shows that ultrasonography is a useful tool for the diagnosis of urethral dilatation in bovine calves. Our study also shows that the partial penile transection may be a suitable and satisfactory choice of surgical treatment for correcting the urethral dilatation in bovine calves.

  6. Step-by-step isolated resection of segment 1 of the liver using the hanging maneuver.

    Science.gov (United States)

    López-Andújar, Rafael; Montalvá, Eva; Bruna, Marcos; Jiménez-Fuertes, Montiel; Moya, Angel; Pareja, Eugenia; Mir, Jose

    2009-09-01

    The caudate lobe can be the origin of primary liver tumours or the sole site of liver metastases. This lobe is anatomically divided into 3 parts: Spiegel's lobe (Couinaud's segment 1), paracaval portion (Couinaud's segment 9), and the caudate process. In this series of 4 cases, we provide a step-by-step description of a surgical technique variation that can be applied to resections of lesions localized in segment 1. We believe that other than size, lesion removal in this hepatic anatomic area, which is difficult to perform, can be done more easily using this new approach because it requires minimal mobilization without unnecessary parenchyma transection of other liver parts. Therefore, it reduces the risk of lesions in the inferior vena cava and the middle hepatic vein and respects adequate margins without the use of clamping maneuvers and in an acceptable surgical time.

  7. Performance characteristics of a conformal ultra-wideband multilayer applicator (CUMLA) for hyperthermia in veterinary patients: a pilot evaluation of its use in the adjuvant treatment of non-resectable tumours.

    Science.gov (United States)

    Smrkovski, O A; Koo, Y; Kazemi, R; Lembcke, L M; Fathy, A; Liu, Q; Phillips, J C

    2013-03-01

    Performance and clinical characteristics of a novel hyperthermia antenna operating at 434 MHz were evaluated for the adjuvant treatment of locally advanced superficial tumours in cats, dogs and horses. Electromagnetic simulations were performed to determine electric field characteristics and compared to simulations for a flat microwave antenna with similar dimensions. Simulation results show a reduced skin surface and backfield irradiation and improved directional irradiation (at broadside) compared to a flat antenna. Radiated power and penetration is notably increased with a penetration depth of 4.59 cm compared to 2.74 cm for the flat antenna. Clinical use of the antenna was then evaluated in six animals with locoregionally advanced solid tumours receiving adjuvant chemotherapy. During clinical applications, therapeutic temperatures were achieved at depths ≥4 cm. Objective responses were seen in all patients; tissue toxicity in one case limited further therapy. This antenna provides compact, efficient, focused and deep-penetrating clinical hyperthermia for the treatment of solid tumours in veterinary patients.

  8. Treatment of Adenoid Hypertrophy in Children by Plasma Ablation Combined With Surgical Resection%等离子消融合并手术切除治疗儿童腺样体肥大

    Institute of Scientific and Technical Information of China (English)

    卢新丰; 张国顺; 郭自奇; 黄晓阳

    2015-01-01

    Objective To investigate the clinical effect of plasma ablation combined with surgical resection for the hypertrophy of adenoid hypertrophy in children. Methods In our hospital, 140 cases of adenoid hypertrophy children were randomly divided into observation group and control group, 70 cases in each group. Two groups of patients were treated by surgical treatment, on this basis, the observation group combined with plasma ablation treatment. Results In the observation group treatment effective rate was 91.43%, LSaO2 for (91.76±4.59)%, AHI (7.78±2.56) times / h; the control group treatment effective rate is 78.57%, lsao2 for (81.28±4.47)%, AHI (16.54±3.66) times / h. The indexes of the observation group were significantly better than those of the control group (P<0.05). Conclusion The clinical effect of plasma ablation combined with surgical resection for adenoid hypertrophy in children is remarkable, and the improvement of the indexes is obvious.%目的:分析并探讨等离子消融合并手术切除治疗儿童腺样体肥大的临床效果。方法选取在我院接受治疗的腺样体肥大儿童140例,将其随机分为观察组与对照组,每组70例。两组患者均采用手术治疗,在此基础上,观察组联合等离子消融治疗。结果观察组治疗有效率为91.43%,LSaO2为(91.76±4.59)%,AHI 为(7.78±2.56)次/h ;对照组治疗有效率为78.57%,LSaO2为(81.28±4.47)%,AHI 为(16.54±3.66)次/h。观察组各项指标均明显优于对照组(P <0.05)。结论等离子消融合并手术切除治疗儿童腺样体肥大临床效果显著,且各项指标改善明显。

  9. 桥小脑角区小型占位致继发性三叉神经痛的手术疗效分析%Surgical outcome after resection of small cerebellopontine angle lesions resulted in secondary trigeminal neuralgia

    Institute of Scientific and Technical Information of China (English)

    陶传元; 魏攀; 庄进学; 陈登奎; 程宏炜; 宋朝理; 李海龙; 薛峰; 张炜; 郑小强

    2011-01-01

    目的 评估桥小脑角区(CPA)小型占位致继发性三叉神经痛的手术疗效.方法 回顾分析我科自2005年1月~2010年12月期间该类患者的临床资料,包括年龄、症状及体征、影像学表现、手术方式、疗效及并发症.结果 6年期间手术治疗三叉神经痛372例,其中CPA区小型病变(最大直径<3cm)致继发性三叉神经痛23例,约占6.2%;病种包括胆脂瘤12例、神经鞘瘤6例、脑膜瘤3例、蛛网膜囊肿2例;所有患者行乙状窦后入路显微镜下切除病变,3例另行三叉神经感觉根部分切断术;术后疼痛消失20例,面部麻木3例;术后并发症包括无菌性脑膜炎、脑脊液漏、颅内感染、短暂耳鸣及面瘫,均恢复,无死亡.随访1~5年,无疼痛复发.结论 CPA区小型占位所致继发性三叉神经痛患者由于病变小、易于全切,加之镜下暴露充分,手术疗效满意;术中若发现病变与三叉神经无确切关系,则需行微血管减压或三叉神经部分感觉根切断术.%Objective To evaluate the surgical outcome after resection of small cerebel-lopontine angle lesions resulted in secondary trigeminal neuralgia (TN). Methods Clinical data including age, symptom and sign, image manifestation, surgical modality, surgical outcome and complications in patients diagnosed secondary TN resulted from small cerebellopontine angle lesions are analyzed retrospectively between 2005. 1 and 2010. 12. Results Of 6 years duration, 372 cases of TN underwent operations. There were 23 cases of such kind (the largest diameter less than 3cm) accounting for 6. 2% among them which involved 12 cholesteatomas, 6 schwanno-mas, 3 meningiomas and 2 arachnoid cysts. All lesions were resected under microscope through retrosigmoid approach and additional partial sensory rhizotomy was performed in 3 cases. After operation, 20 cases got complete pain relief and the rest had facial numbness. Postoperative complications included aseptic

  10. Anaesthetic techniques for risk of malignant tumour recurrence.

    Science.gov (United States)

    Cakmakkaya, Ozlem S; Kolodzie, Kerstin; Apfel, Christian C; Pace, Nathan Leon

    2014-11-07

    Surgery remains a mainstay of treatment for malignant tumours; however, surgical manipulation leads to a significant systemic release of tumour cells. Whether these cells lead to metastases is largely dependent on the balance between aggressiveness of the tumour cells and resilience of the body. Surgical stress per se, anaesthetic agents and administration of opioid analgesics perioperatively can compromise immune function and might shift the balance towards progression of minimal residual disease. Regional anaesthesia techniques provide perioperative pain relief; they therefore reduce the quantity of systemic opioids and of anaesthetic agents used. Additionally, regional anaesthesia techniques are known to prevent or attenuate the surgical stress response. In recent years, the potential benefit of regional anaesthesia techniques for tumour recurrence has received major attention and has been discussed many times in the literature. In preparing this review, we aimed to summarize the current evidence systematically and comprehensively. To establish whether anaesthetic technique (general anaesthesia versus regional anaesthesia or a combination of the two techniques) influences the long-term prognosis for individuals with malignant tumours. We searched The Cochrane Library (2013, Issue 12), PubMed (1950 to 15 December 2013), EMBASE (1974 to 15 December 2013), BIOSIS (1926 to 15 December 2013) and Web of Science (1965 to 15 December 2013). We handsearched relevant websites and conference proceedings and reference lists of cited articles. We applied no language restrictions. We included all randomized controlled trials or controlled clinical trials that investigated the effects of general versus regional anaesthesia on the risk of malignant tumour recurrence in patients undergoing resection of primary malignant tumours. Comparisons of interventions consisted of (1) general anaesthesia alone versus general anaesthesia combined with one or more regional anaesthetic

  11. Usefulness of Color Coding Resected Samples from a Pancreaticoduodenectomy with Tissue Marking Dyes for a Detailed Examination of Surgical Margin Surrounding the Uncinate Process of the Pancreas.

    Science.gov (United States)

    Mizutani, Satoshi; Suzuki, Hideyuki; Aimoto, Takayuki; Yamagishi, Seiji; Mishima, Keisuke; Watanabe, Masanori; Kitayama, Yasuhiko; Motoda, Norio; Isshiki, Saiko; Uchida, Eiji

    2017-01-01

    Characteristics of a cancer-positive margin around a resected uncinate process of the pancreas (MUP) due to a pancreticoduodenectomy are difficult to understand by standardized evaluation because of its complex anatomy. The purposes of this study were to subclassify the MUP with tissue marking dyes of different colors and to identify the characteristics of sites that showed positivity for cancer cells in patients with pancreatic head carcinoma who underwent circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Results of this evaluation were used to review operation procedures and perioperative methods. We divided the MUP into 4 sections and stained each section with a different color. These sections were the pancreatic head nerve plexus margin (Area A), portal vein groove margin (Area B), superior mesenteric artery margin (Area C), and left of the superior mesenteric artery margin (Area D). The subjects evaluated were 45 patients who had carcinoma of the pancreatic head and were treated with circumferential superior mesenteric arterial nerve plexus-preserving pancreaticoduodenectomy. Of the 45 patients, nine cases (90%) of incomplete resection showed cancer-positivity in the MUP. Among the 4 sections of the MUP, the most cases of positive results [MUP (+) ] were found in Area B, with Area A (+), 0 case; Area B (+), 6 cases; Area C (+), 2 cases; and Area D (+), 3 cases (total, 11 sites in 9 patients). Relapse occurred in 7 of the 9 patients with MUP (+). Local recurrence was observed as initial relapse in all 3 patients with Area D (+). In contrast, the most common site of recurrence other than that in patients with Area D (+) was the liver. By subclassifying the MUP with tissue marking dyes of different colors, we could confirm regional characteristics of MUP (+). As a result, circumferential superior mesenteric arterial nerve plexus-preserving pancreticoduodenectomy was able to be performed in R0 operations in selected

  12. Post-recurrence survival of elderly patients 75 years of age or older with surgically resected non-small cell lung cancer.

    Science.gov (United States)

    Takenaka, Tomoyoshi; Inamasu, Eiko; Yoshida, Tsukihisa; Toyokawa, Gouji; Nosaki, Kaname; Hirai, Fumihiko; Yamaguchi, Masafumi; Seto, Takashi; Takenoyama, Mitsuhiro; Ichinose, Yukito

    2016-04-01

    The purpose of this study was to evaluate the outcomes of elderly patients 75 years of age or older with recurrent non-small cell lung cancer (NSCLC). A total of 1237 consecutive patients with NSCLC underwent pulmonary resection at our institution. Of these patients, 280 experienced postoperative recurrence. The rate of the post-recurrence survival and predictors were analyzed independently in a group of younger patients (recurrence. The median post-recurrence survival time and the five-year survival rate of all cases were 25 months and 20.8%, respectively. There were no significant survival differences between the younger and elderly groups (p = 0.20). A univariate analysis determined that gender, Eastern Cooperative Oncology Group performance status, smoking status, histological type and epithelial growth factor receptor (EGFR) mutation status were factors influencing the post-recurrence survival among the elderly patients. In addition, a multivariate analysis determined the EGFR mutation status to be an independent prognostic factor for the post-recurrence survival. Elderly patients 75 years of age or older in this study achieved satisfactory long-term outcomes.

  13. Enteroclysis CT and PEG-CT in patients with previous small-bowel surgical resection for Crohn's disease: CT findings and correlation with endoscopy

    Energy Technology Data Exchange (ETDEWEB)

    Minordi, Laura Maria; Vecchioli, Amorino; Poloni, Giuliana; Bonomo, Lorenzo [Radiology Institute, UCSC, Department of Bio-Imaging and Radiological Sciences, Rome (Italy); Guidi, Luisa; De Vitis, Italo [Catholic University (UCSC), Gastrointestinal Department, Complesso Integrato Columbus, Rome (Italy)

    2009-10-15

    The aim of this study was to evaluate the accuracy of multidetector CT in patients with Crohn's disease (CD) relapse after ileocolic resection compared with endoscopy. Thirty-four patients were studied by endoscopy and multidetector CT, after oral administration of polyethylene glycol solution (n = 21) or after administration of methylcellulose via nasojejunal tube (n = 13). In CT examinations we evaluated the presence of mural thickening, target sign, perienteric stranding, comb sign, fibrofatty proliferation and complications. Endoscopic results were classified in accordance with Rutgeerts score (from 0 to 4). The statistical evaluations were carried out by using Fisher's exact text and {chi} {sup 2} testing (p < 0.05, statistically significant difference). Sensitivity, specificity and accuracy of the CT were 96.9%, 100% and 97%, respectively. We found a statistically significant correlation between an endoscopic score of 4 and the CT signs of target sign, perienteric stranding, comb sign and fibrofatty proliferation, and between scores 1 and 2 and mucosal hyperdensity without or with mural thickening, respectively (p < 0.05). Moreover, only CT identified the presence of jejunal and proximal ileum disease in two and three patients, respectively, and fistulas in three patients. CT is a reliable method in the diagnosis of CD relapse and shows agreement with the approved endoscopic Rutgeerts score. (orig.)

  14. Endoscopic resection of esthesioneuroblastoma.

    Science.gov (United States)

    Gallia, Gary L; Reh, Douglas D; Lane, Andrew P; Higgins, Thomas S; Koch, Wayne; Ishii, Masaru

    2012-11-01

    Esthesioneuroblastoma, or olfactory neuroblastoma, is an uncommon malignant tumor arising in the upper nasal cavity. Surgical approaches to this and other sinonasal malignancies involving the anterior skull base have traditionally involved craniofacial resections. Over the past 10 years to 15 years, there have been advances in endoscopic approaches to skull base pathologies, including malignant tumors. In this study, we review our experience with purely endoscopic approaches to esthesioneuroblastomas. Between January 2005 and February 2012, 11 patients (seven men and four women, average age 53.3 years) with esthesioneuroblastoma were treated endoscopically. Nine patients presented with newly diagnosed disease and two were treated for tumor recurrence. The modified Kadish staging was: A, two patients (18.2%); B, two patients (18.2%); C, five patients (45.5%); and D, two patients (18.2%). All patients had a complete resection with negative intraoperative margins. Three patients had 2-deoxy-2-((18)F)fluoro-d-glucose avid neck nodes on their preoperative positron emission tomography-CT scan. These patients underwent neck dissections; two had positive neck nodes. Perioperative complications included an intraoperative hypertensive urgency and pneumocephalus in two different patients. Mean follow-up was over 28 months and all patients were free of disease. This series adds to the growing experience of purely endoscopic surgical approaches in the treatment of skull base tumors including esthesioneuroblastoma. Longer follow-up on larger numbers of patients is required to clarify the utility of purely endoscopic approaches in the management of this malignant tumor.

  15. Juvenile aggressive cemento-ossifying fibroma of the sphenoid sinus with proptosis: a surgical dilemma.

    Science.gov (United States)

    Singh, Rohit; Ramaswamy, Balakrishnan; Hazarika, Manali

    2013-11-27

    The term fibro-osseous lesion has currently grown in popularity as an overall designation for a number of rare, histologically benign head and neck lesions that are made up of bone, fibrous tissue and cementum. Cemento-ossifying fibroma is a variant of cementifying fibroma and is a fibro-osseous disease. They are usually small innocuous lesions which follow a slow benign course and are commonly seen in the skull bone rather than the sphenoid. It is rare for these tumours to attain large size, behave aggressively, destroy bone and require a radical surgery. One such rapidly growing juvenile cemento-ossifying lesion of sphenoid in our 10-year-old young patient causing proptosis and impaired vision is reported here because of its uncommon nature and its surgical dilemma. Selection of surgical approach to resect this tumour becomes difficult because it is deeply seated and needs a multidisciplinary approach.

  16. Application status of robotic surgical system resection for colorectal cancer%机器人手术系统在结直肠癌手术临床应用现状

    Institute of Scientific and Technical Information of China (English)

    许平平; 许剑民

    2016-01-01

    机器人手术系统的优点是三维图像清晰和操作稳定灵活,缺点是力反馈缺失、费用昂贵和手术时间延长。其可安全应用于结直肠癌手术,具有创伤小和术后恢复快的特点。机器人结肠癌手术的安全性和有效性已得到肯定,但关于长期生存的研究证据仍不够。目前,与腹腔镜手术比较,机器人直肠癌手术并未在肿瘤短期和长期结局方面显现出优势。机器人手术系统在结直肠癌手术中的合理应用还需进一步的前瞻性随机对照研究。随着第4代达芬奇Xi手术系统面世和外科技术的不断进步,机器人手术系统将在结直肠癌手术中发挥更重要的作用。%The outstanding advantages of robotic surgical system include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of force feedback,high cost and prolonged surgery time. It was reported that robotic surgery for colorectal cancer was safe and feasible and it was associated with less trauma stress and faster recovery. Safety and efficacy of robotic colectomy was confirmed,but long-term survival benefit was still unclear. Currently, when compared to laparoscopic surgery, robotic rectal surgery has no short-term or long-term survival advantage. Above all, randomized controlled trials are necessarily conducted to convince the application of da Vinci surgical system resection for colorectal cancer. The latest da Vinci Xi surgical system may make up for the deficiencies through new technologies. With the advantage of more advanced surgical technique,robotic surgical system will play a more important role in the treatment of colorectal cancer.

  17. The evolution of surgical procedures in the management of duodenal and gastric ulcers.

    Science.gov (United States)

    Ajao, O G; Ugwu, B T

    2013-01-01

    Surgical procedures for the surgical management of duodenal ulcer had evolved through many stages, over the years. It started with gastroenterostomy alone, then followed by subtotal gastrectomy, vagotomy alone, vagotomy and gastro-jejunostomy, vagotomy and pyloroplasty, and highly selective vagotomy - all which started as open surgical procedures. Now unless there are complications the treatment is essentially medical following the work of Marshall and Warren. Currently, even when surgery is indicated, minimal invasive procedures are preferred. Four main types of pyloroplasties are well known. They are Weinberg, Heinecke-Mikulicz, Finney and Jaboulay. Vagotomy can be truncal, selective, and highly selective. Accepted surgical treatment for gastric ulcer is the distal gastric resection to include the ulcerated area, but not resecting more than 50-60% of the stomach. In the uncommon cases of Zollinger-Ellison syndrome, aggressive gastric surgery, the use of drugs, and the resection of the tumour have all been recommended in appropriate cases. With the discovery of Helicobacter pylori and its effective medical treatment, surgery has little role in the initial management of peptic ulcer disease. The place of the history of the surgical procedures employed earlier in the treatment of this disease would remain relevant.

  18. Nephron-sparing surgery for bilateral Wilms′ tumours: A single-centre experience with 23 cases

    Directory of Open Access Journals (Sweden)

    Millar AJW

    2011-01-01

    Full Text Available Introduction: The challenge of management with bilateral Wilms′ tumours is the eradication of the neoplasm, while at the same time preserving renal function. Surgical management with a variety of nephron-sparing techniques, combined with chemotherapy and occasionally supplemented by transplantation has evolved over the last 30 years to achieve remarkable success. We document the experience of a single centre in a developing country. Material and Methods: Twenty-three bilateral Wilms′ tumours were seen in our service between 1981 and 2007. Treatment was, in most cases, according to National Wilms′ Tumour Study Group protocols, with initial bilateral biopsy, neoadjuvant chemotherapy, and tumourectomy. Technique of nephrectomy included full mobilization of the tumour-involved kidney, topical cooling with slush ice, vascular exclusion, tumour resection and reconstruction of the remnant kidney. Results: Twelve patients are alive and free of disease one to 15 years after treatment, all with well-preserved renal function (lowest glomerular filtration rate was 65 ml/min per (1.73 m 2 . None of the survivors have hypertension. Eleven have died (two of unrelated disease including six of the seven with spread outside the kidney. All three with unfavourable histology are alive. Four of the five metachronous presentations are alive, as are eight of 12 patients with synchronous bilateral tumours who presented since 2000. Conclusions: Appropriat