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Sakhrekar R, Iorio C, Yoon S, Monjardino MP, Lewis S, Gray R. Philosophies And Surgical Techniques for Ewing's Sarcoma of Spine with Review of Literature. J Orthop Case Rep 2024; 14:168-175. [PMID: 38560320 PMCID: PMC10976549 DOI: 10.13107/jocr.2024.v14.i03.4330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/12/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Ewing sarcoma (ES) is a malignant and aggressive bony tumor affecting the most common age group of 5-20 years. It constitutes 10%-15% of all bone sarcomas and is the second most common primary malignant bone tumor after osteosarcoma. It usually presents with pain, which is typically constant and progressive in nature. The primary source of pain is due to the instability of the spine to support the weight of the body, the vertebral body's expanding cortices due to the growing mass, compression of nerve roots due to tumour mass, pathologic fractures, spinal cord compression, and invasion of tissue by the tumour mass. Methods We reviewed the literature on Ewing's Sarcoma of the spine to evaluate its etiology, clinical presentations, differential diagnosis, imaging modalities and management with chemotherapy, radiotherapy, and surgical management. PubMed, EMBASE, Google Scholar and Cochrane key articles were searched. Keywords like 'Ewing's Sarcoma,' 'Spine,' 'etiology,' 'treatment,' 'surgical management,' and 'en bloc resection' were used. Discussion The current management of Ewing's sarcoma of the spine usually involves three primary modalities: combination chemotherapy, surgery and/or radiotherapy. Recent improvements in combination chemotherapy (vincristine, doxorubicin, cyclophosphamide +/- Ifosfamide and etoposide) are among the most significant factors for improving survival. Also, recent advancements in radiotherapy, instrumentation, and fusion techniques in surgical management have been demonstrated to improve local disease control and overall survival. Conclusion Primary Ewing sarcoma of the spine is a rare condition affecting the most common age group of 5-20 years, accounting for 1-3 cases/million/year. About 5 % of cases have spine involvement. Recent improvements in combination chemotherapy have improved the overall survival rates. Enbloc resection and/or radiotherapy have improved local control of the disease.
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Affiliation(s)
- Rajendra Sakhrekar
- Department of Spine Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Carlo Iorio
- Department of Spine Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Samuel Yoon
- Department of Spine Surgery, The Hospital for Sick Children, Toronto, Canada
| | | | - Stephen Lewis
- Department of Spine Surgery, The Hospital for Sick Children, Toronto, Canada
| | - Randolph Gray
- Department of Spine Surgery, The Hospital for Sick Children, Toronto, Canada
- Children Hospital Westmead, Sydney, Australia
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Gomez Cifuentes JD, Berger S, Caskey K, Jove A, Sealock RJ, Hair C, Velez M, Jarbrink-Sehgal M, Thrift AP, da Costa W, Gyanprakash K. Evolution of endoscopic mucosal resection (EMR) technique and the reduced recurrence of large colonic polyps from 2012 to 2020. Scand J Gastroenterol 2023; 58:435-440. [PMID: 36254785 DOI: 10.1080/00365521.2022.2134734] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic mucosal resection (EMR) is an effective method for removing non-pedunculated polyps ≥ 20 mm. We aimed to examine changes in EMR techniques over a 9-year period and evaluate frequency of histologic-confirmed recurrence. METHODS We identified patients who underwent EMR of non-pedunculated polyps ≥ 20 mm at a safety net and the Veteran's Affairs (VA) hospital in Houston, Texas between 2012 and 2020. Odds ratios (ORs) and 95% confidence intervals (CI) for associations with recurrence risk were estimated using multivariable logistic regression. RESULTS 461 unique patients were included. The histologic-confirmed recurrence was 29.0% at 15.6 months median follow up (IQR 12.3 - 17.4). Polyps removed between 2018 and 2020 had a 0.43 decreased odds of recurrence vs. polyps removed between 2012 and 2014. The use of viscous lifting agents increased over time (from 0 to 54%), and the use of saline was associated with increased risk of recurrence (OR 2.28 [CI 1.33 - 3.31]). CONCLUSIONS Histologic-confirmed recurrence after EMR for non-pedunculated polyps ≥ 20 mm decreased over the seven year-period. Saline was associated with a higher risk of recurrence and the use of more viscous agents increased over time.
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Affiliation(s)
| | - Scott Berger
- Internal Medicine Department, Baylor College of Medicine, Houston, TX, USA
| | | | - Andre Jove
- Baylor College of Medicine, Houston, TX, USA
| | - Robert J Sealock
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | - Clark Hair
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | - Maria Velez
- Gastroenterology Department, Baylor College of Medicine, Houston, TX, USA
| | | | - Aaron P Thrift
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Wilson da Costa
- Department of Medicine, Epidemiology and Population Sciences, Baylor College of Medicine, Houston, TX, USA
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Schwendner M, Ille S, Kirschke JS, Bernhardt D, Combs SE, Meyer B, Krieg SM. Clinical evaluation of vertebral body replacement of carbon fiber-reinforced polyetheretherketone in patients with tumor manifestation of the thoracic and lumbar spine. Acta Neurochir (Wien) 2023. [PMID: 36820888 DOI: 10.1007/s00701-023-05502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE Radiolucent anterior and posterior implants by carbon fiber-reinforced polyetheretherketone (CFR PEEK) aim to improve treatment of primary and secondary tumors of the spine during the last years. The aim of this study was to evaluate clinical and radiological outcomes after dorsoventral instrumentation using a CFR PEEK implant in a cohort of patients representing clinical reality. METHODS A total of 25 patients with tumor manifestation of the thoracic and lumbar spine underwent vertebral body replacement (VBR) using an expandable CFR PEEK implant between January 2021 and January 2022. Patient outcome, complications, and radiographic follow-up were analyzed. RESULTS A consecutive series aged 65.8 ± 14.7 (27.6-91.2) years were treated at 37 vertebrae of tumor manifestation, including two cases (8.0%) of primary tumor as well as 23 cases (92.0%) of spinal metastases. Overall, 26 cages covering a median of 1 level (1-4) were implanted. Duration of surgery was 134 ± 104 (65-576) min, with a blood loss of 792 ± 785 (100-4000) ml. No intraoperative cage revision was required. Surgical complications were reported in three (12.0%) cases including hemothorax in two cases (one intraoperative, one postoperative) and atrophic wound healing disorder in one case. In two cases (8.0%), revision surgery was performed (fracture of the adjacent tumorous vertebrae, progressive construct failure regarding cage subsidence). No implant failure was observed. CONCLUSION VBR using CFR PEEK cages represents a legitimate surgical strategy which opens a variety of improvements-especially in patients in need of postoperative radiotherapy of the spine and MRI-based follow-up examinations.
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Gomez Ruiz M, Ballestero Diego R, Tejedor P, Cagigas Fernandez C, Cristobal Poch L, Suarez Pazos N, Castillo Diego J. Robotic surgery for locally advanced T4 rectal cancer: feasibility and oncological quality. Updates Surg 2023; 75:589-597. [PMID: 36763301 DOI: 10.1007/s13304-023-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 02/03/2023] [Indexed: 02/11/2023]
Abstract
For T4 rectal tumours and local recurrences (LR) of rectal cancer, a radical resection beyond TME, sometimes by multi-visceral resection, is important to obtain safe margins and improve survival. The use of the laparoscopic approach (LA) for these cases is still controversial and associated with a high rate of conversion. However, robotic surgery might offer some advantages that can overcome some of the limitations of LA. Therefore, we aimed to analyse the postoperative outcomes and medium-term oncological results of robotic surgery for locally advanced rectal cancer (pathological T4) and LR. A retrospective analysis was performed including patients who had undergone robotic rectal resection in a single institution over an 11-year period, and had a T4 tumour confirmed in the pathological report. Primary endpoint was to analyse postoperative complications (30-day) and the rate of conversion. Secondary endpoints include pathological assessment of the quality of the specimen, local recurrence and survival [2-year disease-free survival (DFS) and overall survival (OS)]. A total of 41 patients were analysed, including a total of 24 patients (60%) that required a multivisceral resection. The median distance from the tumour to the anorectal junction was 7 (4-12) cm. Conversion to open surgery was necessary in 2 cases (5%). The overall morbidity rate was 78% (n = 32), with 37% of major complications, most of them urinary (n = 7). Median length of hospital stay (LOS) was 13 (7-27) days. The 30-day mortality rate was 7% (n = 3). An R0 resection was achieved in 85.4% of the cases (n = 35) due to 6 cases of the positive circumferential resection margin. 2-year disease-free survival (DFS) and overall survival (OS) for the T4 tumours were 72% and 85%, respectively. There were 8 cases of local recurrence (22.2%); 6 of them met the selection criteria for salvage surgery. Robotic surgery for locally advanced T4 rectal cancer and multi-visceral resections is safe and feasible, with a low rate of conversion and an acceptable rate of postoperative morbidity in this subgroup of patients. Oncological results have shown to be comparable with the laparoscopic series published, preserving a good quality of the resected specimen. However, comparative studies and a longer follow-up period is needed to confirm the oncologic findings and to support the general adoption of the robotic system for these complex interventions.
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Affiliation(s)
- Marcos Gomez Ruiz
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Roberto Ballestero Diego
- Urology, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Patricia Tejedor
- Colorectal Surgery Unit, General Surgery Department, Gregorio Marañón University Hospital, Madrid, Spain.
| | - Carmen Cagigas Fernandez
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Lidia Cristobal Poch
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Natalia Suarez Pazos
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
| | - Julio Castillo Diego
- Colorectal Surgery Unit, General Surgery Department, Marqués de Valdecilla University Hospital, 39008, Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39010, Santander, Spain
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Koucheki R, Gazendam A, Perera J, Griffin A, Ferguson P, Wunder J, Tsoi K. Management of giant cell tumors of the distal radius: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 2022; 33:759-772. [PMID: 35377078 DOI: 10.1007/s00590-022-03252-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/09/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE The treatment of giant cell tumors (GCT) of the distal radius remains challenging, with no consensus on the optimal surgical management. Surgical management remains the mainstay of treatment with options including intralesional curettage and en-bloc resection with reconstruction. The objective of this systematic review and meta-analysis was to evaluate and compare the outcomes of these two procedures. METHODS Using OVID-Medline and Embase databases, a systematic literature search was performed. Comparative studies, assessing intralesional curettage and en-bloc resection in patients with GCTs of the distal radius, were included. Data regarding rates of local recurrence, metastasis, overall complications, and functional outcomes, were collected and analyzed. The ROBINS-I tool was utilized for risk of bias appraisal within each study outcome. RESULTS Thirteen studies (n = 373 patients) reporting on 191 intralesional curettage procedures and 182 en-bloc resections were included in the analysis. The average age of participants was 31.9 (SD ± 2.4) years and average follow-up was 7.1 (SD ± 3.6) years. Patients that underwent intralesional curettage were more likely to develop local recurrence (Risk Ratio (RR) 3.3, 95% CI, [2.1, 5.4], p < 0.00001) when compared to patients that underwent en-bloc resection. In Campanacci grade 3 lesions, the risk for local recurrence was 5.9 (95% CI, [2.2, 16.3], p = 0.0006) times higher in patients that received intralesional curettage. Patients that underwent intralesional curettage showed an 84% reduction in the relative risk of developing overall complications compared to en-bloc resection (95% CI, [0.1, 0.4], p < 0.00001), and a larger decrease in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores (p < 0.00001). Risk ratio for developing a local recurrence, with PMMA versus bone graft following an intralesional procedure was not significant (RR 1.2, 95% CI, [0.6, 2.6], p = 0.62). CONCLUSIONS In the surgical management of GCT of the distal radius, intralesional curettage increased local recurrence compared to en-bloc resection with reconstruction, particularly in grade 3 tumors. However, it led to significantly fewer operative complications, lower pain scores, and improved functional outcomes compared to en-bloc resection. Both treatment options remain relevant in the contemporary management of GCTs of the distal radius. Surgical decision making should include both patient and tumor factors when determining the optimal treatment strategy for these patients. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.
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Affiliation(s)
- Robert Koucheki
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Institute of Biomedical Engineering, Toronto, ON, Canada.
| | - Aaron Gazendam
- Division of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada.,Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Jonathan Perera
- Royal National Orthopaedic Hospital NHS Trust, Greater London, UK
| | - Anthony Griffin
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada
| | - Peter Ferguson
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Jay Wunder
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
| | - Kim Tsoi
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,Division of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada
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Louati A, Dukan R, Masmejean EH. Primary digital localization of extra-axial extra-osseous soft-tissue chordoma: A case report. Hand Surg Rehabil 2021:S2468-1229(21)00192-4. [PMID: 34375728 DOI: 10.1016/j.hansur.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/19/2021] [Accepted: 08/05/2021] [Indexed: 11/24/2022]
Abstract
We report a case of digital extra-axial extra-osseous soft-tissue chordoma located in a flexor synovial sheath of the little finger of the left hand. Histology-immunohistochemistry (brachyury) analysis after broad en-bloc resection confirmed the diagnosis. Exhaustive MRI assessment of the entire spine, skull and pelvis found no other locations. No recurrence was reported at last follow-up. Hand surgeons should be aware of the diagnosis and treatment of brachyury-positive extra-axial soft-tissue chordomas, whence the importance of recognizing its typical and differential characteristics to guide optimal therapeutic strategy.
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Girolami M, Sartori M, Monopoli-Forleo D, Ghermandi R, Tedesco G, Evangelisti G, Pipola V, Pesce E, Falzetti L, Fini M, Gasbarrini A. Histological examination of a retrieved custom-made 3D-printed titanium vertebra : Do the fine details obtained by additive manufacturing really promote osteointegration? Eur Spine J 2021; 30:2775-2781. [PMID: 34279722 DOI: 10.1007/s00586-021-06926-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/19/2021] [Accepted: 07/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE In the present report it is described the design, the manufacturing and the successful surgical implant of one of the first 3D custom titanium vertebra realized with Additive Manufacturing technique and its use for the spinal reconstruction after en-bloc resection for primary osteogenic sarcoma. METHODS Clinical case presentation and the design of the 3D custom titanium vertebra was reported. It was also described the complex procedures adopted to evaluate the retrieved device from the histological point of view, as a tumor relapse hit the patient, one year after the reconstruction procedure. RESULTS The histological evaluation confirmed that the resection technique exerts an important role in promoting bone formation: vertebral body osteotomies favored the reconstruction procedure and maximized the contact area between host bone/vertebral prosthesis thus favoring the bone tissue penetration and device colonization. CONCLUSION The sharing of these results is very important as they represent the starting point for improving the knowledge starting from the evidence obtained in a challenging clinical condition and with post-operative treatments that could be never reproduced in preclinical model.
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Affiliation(s)
- Marco Girolami
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Maria Sartori
- Surgical Sciences and Technologies Complex Structure, IRCCS - Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy.
| | | | - Riccardo Ghermandi
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Giuseppe Tedesco
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Gisberto Evangelisti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Valerio Pipola
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Eleonora Pesce
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Luigi Falzetti
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
| | - Milena Fini
- Surgical Sciences and Technologies Complex Structure, IRCCS - Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy
| | - Alessandro Gasbarrini
- Department of Oncologic and Degenerative Spine Surgery, IRCCS - Istituto Ortopedico Rizzoli, via G.C.Pupilli, 1, 40136, Bologna, Italy
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Solichin I, Martika W, Wikanjaya R. Giant cell tumor of distal ulna treated using en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization: A case report. Int J Surg Case Rep 2021; 79:362-367. [PMID: 33516051 PMCID: PMC7847819 DOI: 10.1016/j.ijscr.2021.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 01/16/2021] [Accepted: 01/16/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Giant Cell Tumor (GCT) is a form of bone tumor which is rare, benign, and locally invasive. To date, there have not been many case reports regarding cases of GCTs on the distal ulna which made the optimum strategy in management remain controversial. In some reported cases, the patient was treated with wide excision followed by reconstructive procedure resulting in ulnar translation of the carpal bones and dynamic convergence of the ulna towards the radius. PRESENTATION OF CASE We documented a case of 29-year-old male with distal ulna GCT, treated with en-bloc resection combined with extensor carpi ulnaris and flexor carpi ulnaris tendon stabilization. The key objectives of GCT treatments are to avoid local recurrence with sufficient resection and to maintain the function of the limbs. Specific treatment options have been suggested for en-bloc resection with or without the need for ulnar reconstruction or stabilization, even prothesis. In this case, we excised the distal portion of the ulna with some soft tissue procedure for added stability. CLINICAL DISCUSSION Three weeks after the surgery, the patient was able to perform wrist flexion and extension, fingers abduction, adduction, and opposition with slight limitation. The DASH and PRWE score had improved gradually within 3 weeks and 6 months after the surgery. CONCLUSION In the subsequent evaluation after six months of the surgery, the patient achieved full restoration of forearm function without any limitation.
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Affiliation(s)
- Iman Solichin
- Department of Orthopaedics and Traumatology, Purwokerto Orthopaedics Hospital, Purwokerto, Central Java, Indonesia
| | - Windi Martika
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo National Central General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
| | - Rio Wikanjaya
- Department of Orthopaedic and Traumatology, Dr. Cipto Mangunkusumo National Central General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Abstract
Chordomas are malignant bone tumours with a reported annual incidence of 0.08 per 100,000 cases. They show a notochordal differentiation and are characterised by their nuclear expression of brachyury (TBXT). Chordomas are localised in the axial skeleton, where they occur from the clivus to the sacrococcygeal region. They are slow growing, locally destructive tumours, and are often not diagnosed until they have reached an advanced stage. Putative precursor-lesions are benign notochordal cell lesions, which are microscopically small and intraosseous. Different histological chordoma subtypes exist, which differ in their prognosis. To date, there are no known recurrent genetic drivers for this disease. Brachyury seems to play a key role in the pathogenesis of chordoma, though the detailed mechanism still needs to be elucidated. Surgical en bloc resection with negative margins is the only curative treatment for this disease. High-dose irradiation, particularly with protons and carbon ions, is a therapeutic alternative in cases of inoperable tumours. Currently, there is no approved medical treatment for chordoma. Clinical trials exploring additional therapeutic modalities are ongoing.
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Affiliation(s)
- Susanne Scheipl
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich.
| | - Jasminka Igrec
- Univ.-Klinik für Radiologie, Medizinische Universität Graz, Auenbruggerplatz 9, 8036, Graz, Österreich
| | - Andreas Leithner
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - Maria Smolle
- Univ.-Klinik für Orthopädie und Traumatologie, Medizinische Universität Graz, Auenbruggerplatz 5, 8036, Graz, Österreich
| | - Johannes Haybäck
- Institut für Pathologie, Neuropathologie und Molekularpathologie, Medizinische Universität Innsbruck, Müllerstraße 44, 6020, Innsbruck, Österreich
- Institut für Pathologie, Univ.-Klinikum Magdeburg A.ö.R., Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120, Magdeburg, Deutschland
- Diagnostik- und Forschungsinstitut für Pathologie, Medizinische Universität Graz, Neue Stiftingtalstraße 6, 8010, Graz, Österreich
| | - Bernadette Liegl
- Diagnostik- und Forschungsinstitut für Pathologie, Medizinische Universität Graz, Neue Stiftingtalstraße 6, 8010, Graz, Österreich
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Roland D, Rahmi G, Pérez-Cuadrado-Robles E, Perrod G, Jacques J, Barret M, Leblanc S, Berger A, Albouys J, Chaussade S, Cellier C. Endoscopic submucosal dissection in rectal tumors extending or not to the dentate line: A comparative analysis. Dig Liver Dis 2020; 52:296-300. [PMID: 31744774 DOI: 10.1016/j.dld.2019.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The feasibility of endoscopic submucosal dissection (ESD) in rectal tumors extending to the dentate line (RTDL) is unclear. AIMS To analyze the outcomes of ESD in RTDL compared to non-RTDL, with a special focus on the lower rectum location. METHODS Observational multicenter retrospective study. All patients with a rectal tumor who underwent ESD in 2013-2017 were included. A comparative analysis between RTDL and non-RTDL groups was done. RESULTS Two-hundred and twenty-eight patients (median age: 69 years, range: 33-89, 51.3% male) with RTDL (n = 65, 28.5%) and non-RTDL lesions (n = 163, 71.5%) were included. There were no significant differences between the en-bloc (89.2% vs. 90.8%, p = 0.718), complete (60% vs. 71.8%, p = 0.084) and curative resection rates (58.5% vs. 68.7%, p = 0.141). The overall complication rate (4.6% vs. 8%, p = 0.370) was not different, independently of the rectal location. Local recurrence was higher in RTDL (7.3% vs. 1.5%, p = 0.065). The indication for surgery due to non-curative resections in the lower rectum was lower in RTDL (9.2% vs. 14.6%, p = 0.378). CONCLUSION The safety, effectiveness and long-term impact of ESD in RTDL and non-RTDLs is comparable. Local recurrence in the lower rectum may be higher in RTDL.
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Affiliation(s)
- Déborah Roland
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Gabriel Rahmi
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France.
| | | | - Guillaume Perrod
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Jacques
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Sarah Leblanc
- Department of Gastroenterology, Cochin Hospital, Paris, France
| | - Arthur Berger
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
| | - Jérémie Albouys
- Department of Gastroenterology, Dupuytren University Hospital, Limoges, France
| | | | - Christophe Cellier
- Department of Gastroenterology and Endoscopy, Georges-Pompidou European Hospital, Paris, France
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El-Khoury M, Bohlok A, Sleiman YA, Loi P, Coppens E, Demetter P, El Nakadi I. A rare presentation of small diaphragmatic epidermoid cyst with extremely elevated serum CA19-9 level. Ann R Coll Surg Engl 2019; 102:e23-e25. [PMID: 31508987 DOI: 10.1308/rcsann.2019.0110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Epidermoid cysts are rare lesions that can occur anywhere in the body. They are associated with elevated serum levels of CA 19-9. The spleen represents the most common site of intra-abdominal localisation. Only two cases of diaphragmatic epidermoid cyst are reported in the literature. We present the case of a 61-year-old woman with a small suprasplenic subdiaphragmatic cyst discovered during the investigation of left flank pain. The establishment of an adequate diagnosis was challenging due to the difficulty in specifying the exact localisation of the cyst, the extremely elevated CA 19-9 level of 19,000 and the high uptake on 18-fluoro-2-deoxy-D-glucose positron emission tomography. The definitive diagnosis followed complete surgical excision. Intra-abdominal epidermoid cysts are usually discovered incidentally on imaging for another reason. The cyst is lined by squamous epithelium responsible for the secretion of CA 19-9. The elevation of serum CA 19-9 is due to small rupture or increased intraluminal pressure followed by diffusion to the bloodstream. Surgery with en-bloc resection represents the optimal treatment to avoid any risk of recurrence. The definitive diagnosis is established by demonstrating positive immunohistopathological staining of epithelial cell to CA 19.9.
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Affiliation(s)
- M El-Khoury
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Bohlok
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Y A Sleiman
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Loi
- Department of Gastrointestinal Surgery, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - E Coppens
- Department of Medical Imaging, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - P Demetter
- Department of Pathology, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - I El Nakadi
- Department of Surgery, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Department of Gastrointestinal Surgery, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Hayashida Y, Miyata Y, Matsuo T, Ohba K, Sakai H, Taba M, Naito S, Taniguchi K. A pilot study to assess the safety and usefulness of combined transurethral endoscopic mucosal resection and en-bloc resection for non-muscle invasive bladder cancer. BMC Urol 2019; 19:56. [PMID: 31234817 PMCID: PMC6591831 DOI: 10.1186/s12894-019-0486-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Background Transurethral resection (TUR) is the standard operation used for non-muscle invasive bladder cancer (NMIBC). Although most solid tumors are principally removed via single block resection without incising the mass, disruption of the lesion is unavoidable in traditional TUR. Furthermore, pathological diagnosis is often difficult due to heat-related denaturation of tissues in TUR. Although transurethral en-bloc resection is useful for judging tumor invasion, it is associated with a prolonged operative duration. We attempted to show the safety and usefulness of combined endoscopic mucosal resection (EMR) and en-bloc resection in NMIBC patients. Methods We investigated 39 patients with clinical NMIBC who were treated using our original EMR + en-bloc resection technique, which involved removal of the tumor mass that protruded from the mucosa, using a polypectomy snare similar to that used for EMR. The residual lesion was removed using en-bloc resection. The operative period, duration of hospitalization, and recurrence rates were compared with those of conventional TUR (n = 31). Results The mean (standard deviation, range) time interval for EMR and total operative duration were 1.6 (1.1, 1–5) min and 18.3 (10.5, 3–48) min, respectively. The total operative duration was comparable to that of TUR (17.3 min, p = 0.691). The mean duration of catheterization in the EMR + en-bloc resection group (4.2 days) was also similar to that in the TUR group (3.7 days; p = 0.285). No severe complications were observed with EMR + en-bloc resection. The pathologists were able to determine tumor invasiveness with considerable certainty in all specimens obtained via the EMR + en-bloc procedure than via TUR, and the difference in the ease of diagnosis was statistically significant (p = 0.016). Recurrence rates were comparable (p = 0.662) between the EMR + en-bloc (15.4%) and TUR groups (19.4%). Conclusions Our results demonstrated that the EMR + en-bloc resection technique is feasible, safe, and useful for treating patients with NMIBC. Furthermore, this technique helps provide a more accurate pathological diagnosis.
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Affiliation(s)
- Yasushi Hayashida
- Department of Urology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Yasuyoshi Miyata
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Tomohiro Matsuo
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kojiro Ohba
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Hideki Sakai
- Department of Urology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Mitsuru Taba
- Department of Pathology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Shinji Naito
- Department of Pathology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
| | - Keisuke Taniguchi
- Department of Urology, National Hospital Organization Ureshino Medical Center, 2436 Shimosyuku, Ureshino, 843-0393, Japan
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Mellado-Romero MA, Vilá-Rico J, Gallego-Herrero C, Sánchez-Herraéz S, Casas-Ramos P, Santos-Sánchez JA, Ramos-Pascua LR. Diagnosis and treatment of hindfoot osteoid osteoma: A therapeutic method for each case. Rev Esp Cir Ortop Traumatol (Engl Ed) 2019; 63:165-72. [PMID: 30922598 DOI: 10.1016/j.recot.2019.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/05/2018] [Accepted: 01/07/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES 1) to set a reminder of the diagnostic approach to osteoid osteomas (OOs) of the foot; 2) to define the indications of treatment for hindfoot OOs. MATERIAL AND METHOD 5 OOs were checked (3 cases located in the talus and two cases in calcaneus). The diagnosis was established by clinical and imaging data. In all cases, a calcified nidus was identified on CT, perilesional bone oedema on MRI and focal scintigraphic uptake. Two cases were treated with radiofrequency ablation (RFA) and 3 cases with surgical resections: two open surgeries and one arthroscopic surgery. Clinical and oncological outcomes were evaluated at the end of the follow-up. RESULTS No complications were reported. The clinical outcome was excellent in all cases. One patient was initially treated with open surgery and then subsequently with RFA due to failure of the procedure. There were no recurrences after an average follow-up time of 4 years and 8 months (range, 1-12 years). DISCUSSION Hindfoot OOs are uncommon and their diagnosis is based on clinical data in conjunction with characteristic imaging findings. Their treatment choices depend on the location of the nidus and relationships with nearby anatomical structures. CONCLUSIONS The diagnosis of an OO of the hindfoot can be ensured when the epidemiological, clinical and imaging data are compatible with this pathological entity. RFA is indicated for intracortical or cancellous cases in which the nidus is more than 1cm off the skin and significant neurovascular structures. For all other cases an open surgical resection or arthroscopic resection would be the first choice.
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Abstract
BACKGROUND Multivisceral resections seem to be naturally associated with an elevated morbidity rate. Data regarding the impact of multivisceral resections on progression-free and overall survival are only available in insufficient quantities. OBJECTIVE Data on multivisceral resections in cancer surgery are presented exemplified by gastric cancer, colorectal cancer and peritoneal metastases, focusing on overall and progression-free survival as well as morbidity and mortality. MATERIAL AND METHODS A PubMed search was carried out including the following terms: multivisceral resection, peritoneal metastases, cytoreduction, morbidity, HIPEC (hyperthermic intraperitoneal chemotherapy) RESULTS: Multivisceral resections should only be performed if an R0 status can be achieved for all tumor entities. Preoperative performance of an FDG-PET-CT scan (fluorodeoxyglucose positron emission tomography computed tomography scan) can help in the selection of appropriate patients. In gastric cancer, extensive lymphatic metastases are associated with a poor overall survival despite multivisceral resection. Recurrent rectal cancer shows elevated morbidity rates and also decreased overall survival rates. Maximum cytoreductive surgery can be conducted for peritoneal metastasized appendiceal neoplasms and colorectal cancer with acceptable morbidity and without an increased risk for reduced overall survival. CONCLUSION After adequate patient selection and exclusion of stage IV distant metastatic disease, multivisceral resections can be offered to patients with the goal of an R0 resection.
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Affiliation(s)
- P Horvath
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland
| | - A Königsrainer
- Klinik für Allgemeine, Viszeral- und Transplantationschirurgie, Universitätsklinikum Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Deutschland.
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15
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Zhang KY, Xing JC, Li W, Wu Z, Chen B, Bai DY. A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection. World J Surg Oncol 2017; 15:125. [PMID: 28683751 PMCID: PMC5501371 DOI: 10.1186/s12957-017-1192-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/22/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Transurethral resection of bladder tumor (TURBT) is the standard approach to bladder tumors but suffers from several disadvantages. The aim of this study was to evaluate the safety and efficacy of a novel procedure of retrograde en bloc resection of bladder tumor (RERBT) with conventional monopolar resection electrode for the treatment of superficial bladder tumors. METHODS RERBT and conventional TURBT (C-TURBT) were conducted, respectively, in 40 and 50 patients diagnosed with superficial papillary bladder tumors. In the RERBT group, the tumors were en bloc removed retrogradely under direct vision using a conventional monopolar electrode. Patients' clinicopathological, intraoperative, and postoperative data were compared retrospectively between the RERBT and C-TURBT groups. RESULTS Of the 90 patients, 40 underwent RERBT and 50 underwent C-TURBT. Both groups were comparable in clinicopathological characteristic. RERBT could be performed as safely and effectively as C-TURBT. There were no significant differences in operative time and surgical complications. The cumulative recurrence rates between groups were similar during up to 18 months follow-up. The detrusor muscle could be identified pathologically in 100% of RERBT tumor specimens and the biopsy of tumor bases, but only in 54 and 70%, respectively, of C-TURBT samples (P < 0.01). CONCLUSIONS The RERBT technique is feasible and safe for superficial bladder tumors using conventional monopolar resection setting, with the advantages of adequate tumor resection and the ability to collect good quality tumor specimens for pathological diagnosis and staging compared to conventional TURBT.
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Affiliation(s)
- Kai-Yan Zhang
- Department of Urology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China
| | - Jin-Chun Xing
- Department of Urology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China.
| | - Wei Li
- Department of Urology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China
| | - Zhun Wu
- Department of Urology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China
| | - Bin Chen
- Department of Urology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China
| | - Dong-Yu Bai
- Department of Pathology, Xiamen University Affiliated First Hospital, 55 Zhenhai Road, Siming District, Xiamen, 361003, China
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Qi DW, Wang P, Ye ZM, Yu XC, Hu YC, Zhang GC, Yan XB, Zheng K, Zhao LM, Zhang HL. Clinical and Radiographic Results of Reconstruction with Fibular Autograft for Distal Radius Giant Cell Tumor. Orthop Surg 2017; 8:196-204. [PMID: 27384728 DOI: 10.1111/os.12242] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 02/07/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the result of en bloc resection and reconstruction of the distal radius with a non-vascularized fibular autograft for giant cell tumor (GCT) of bone. METHODS Between 2005 and 2015, 12 eligible patients (seven males, five females, mean age 31.3 years) with grade III GCT of the distal radius were treated by en bloc resection and reconstruction with non-vascularized proximal fibular autografts in four Chinese institutions (members of Giant Cell Tumor Team of China). The patients had a clinical and radiographic review every 6 months for the first 2 years then annually thereafter. The functional, oncologic and radiological outcomes of the patients were analyzed. RESULTS The mean duration of follow-up was 39.6 months. Bony union was achieved in all cases. None of the patients were dissatisfied with the shape and appearance of the wrist. The mean MSTS score was 25.23 ± 2.38 (range, 22-29). The mean DASH score was 13.0 (range, 6.7-33.3). The average range of motion of the wrist was: 35.8° ± 14.5° of extension, 14.0° ± 8.4° of flexion, 15.5° ± 6.7° of radial deviation, 19.4° ± 10.1° of ulnar deviation, 57.2° ±18.9° of pronation and 44.0° ± 24.8° of supination. The average percentage of grip strength was 55.2% ± 29.0% compared with that of the contralateral side. One localized soft tissue recurrence occurred; it was successfully managed by excision. Lung metastases developed postoperatively in one case and were treated by gamma knife radiotherapy. There was radiographic evidence of radiocarpal arthritis in eleven patients, bone resorption in ten, distal radioulnar joint diastasis in six, ulnar deviation of the wrist in seven, subluxation of the carpal bone in three and dislocation of the carpal bone in one patient. CONCLUSIONS Reconstruction with a non-vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone.
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Affiliation(s)
- Dian-Wen Qi
- Department of Musculoskeletal Tumor, Key Biomechanical Laboratory of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Peng Wang
- Graduate School, Hebei Medical University, Tianjin, China
| | - Zhao-Ming Ye
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Yong-Cheng Hu
- Department of Bone Oncology, Tianjin Hospital, Tianjin, China
| | - Guo-Chuan Zhang
- Department of Musculoskeletal Tumor, Key Biomechanical Laboratory of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiao-Bo Yan
- Department of Orthopaedics, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Kai Zheng
- Department of Orthopaedics, General Hospital of Jinan Military Region, Jinan, China
| | - Li-Ming Zhao
- Graduate School, Tianjin Medical University, Tianjin, China
| | - Hui-Lin Zhang
- Graduate School, Tianjin Medical University, Tianjin, China
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Yang YF, Wang JW, Huang P, Xu ZH. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord 2016; 17:346. [PMID: 27530935 PMCID: PMC4987985 DOI: 10.1186/s12891-016-1211-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/10/2016] [Indexed: 11/15/2022] Open
Abstract
Background Giant cell tumors (GCTs) located in the distal radius are likely to recur, and the treatment of such recurrent tumors is very difficult. Here, we report our clinical experience in distal radius reconstruction with vascularized proximal fibular autografts after en-bloc excision of the entire distal radius in 17 patients with recurrent GCT (RGCT) of the distal radius. Methods All 17 patients with RGCT in distal radius underwent plain radiography and/or magnetic resonance imaging (MRI) of the distal radius as the initial evaluation after hospitalization. Then the distal radius were replaced by vascularized proximal fibular autografts after en-bloc RGCT resection. We assessed all patients by using clinical examinations, plain radiography of the wrist and chest, and Mayo wrist scores in the follow-ups. Results After an average follow-up of 4.3 years (range: 1.5–10.0 years), no lung metastasis or local recurrence was detected in any of the 17 patients. In total, 14 patients had excellent or good functional wrist scores, 16 were pain free or had occasional pain, and 15 patients returned to work. The mean range of motion of the wrist was 101° (flexion-extension), and the mean grip strength was 77.2 % of the contralateral normal hand. Conclusion En-bloc excision of the entire distal radius and distal radius reconstruction with a vascularized proximal fibular autograft can effectively achieve local tumor control and preserve wrist function in patients with RGCT of the distal radius.
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Affiliation(s)
- Yun-Fa Yang
- Division of Orthopaedic Trauma and Hand Surgery, Department of Orthopaedic Surgery, Guangzhou First people's Hospital, Guangzhou Medical University, 1 Panfu Road, Guangzhou, Guangdong, 510180, People's Republic of China.
| | - Jian-Wei Wang
- Division of Orthopaedic Trauma and Hand Surgery, Department of Orthopaedic Surgery, Guangzhou First people's Hospital, Guangzhou Medical University, 1 Panfu Road, Guangzhou, Guangdong, 510180, People's Republic of China
| | - Pin Huang
- Department of Orthopaedic Surgery, Liwang Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510170, People's Republic of China
| | - Zhong-He Xu
- Division of Orthopaedic Trauma and Hand Surgery, Department of Orthopaedic Surgery, Guangzhou First people's Hospital, Guangzhou Medical University, 1 Panfu Road, Guangzhou, Guangdong, 510180, People's Republic of China
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Tozzi R, Gubbala K, Majd HS, Campanile RG. Interval Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) in patients with stage IIIC-IV ovarian cancer: Description of the technique and surgical outcomes. Gynecol Oncol 2016; 142:477-83. [PMID: 27450637 DOI: 10.1016/j.ygyno.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/30/2016] [Accepted: 07/03/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To describe the technique and evaluate the feasibility, efficacy and morbidity of the Laparoscopic En-Bloc Resection of the Pelvis (L-EnBRP) during Visceral-Peritoneal Debulking (VPD) at time of interval surgery. METHODS This report is part of a prospective non randomized study (service evaluation protocol) on the feasibility and safety of laparoscopy in patients with stage IIIC-IV ovarian cancer and gross residual disease following neoadjuvant chemotherapy. Primary endpoints of this part of the study were the feasibility (rate of patients in whom the surgery could be completed by laparoscopy), efficacy (rate of patients ended with a complete resection) and morbidity (number of patients that suffered complications specifically associated to the procedure) of L-EnBRP. The results were compared between patients in group 1 (L-EnBRP+L-VPD), group 2 (L-EnBRP+VPD) and group 3 (VPD). RESULTS Eighteen patients were in group 1, 8 in group 2 and 32 in group 3. Feasibility of L-EnBRP was 45% (26 patients out of 58), efficacy was 100% of the pelvic disease (94.4% overall disease) and morbidity was 5.5%. Main cause for conversion to laparotomy was high tumor load on diaphragm and/or mesentery. All but one patient had a complete resection (CR) of the disease. Group 1 patients had significantly earlier hospital discharge, lower blood loss and reduced overall morbidity than group 2 and 3. CONCLUSION L-EnBRP was feasible in almost half of the patients. In these patients a CR was achieved with a low morbidity rate. The latter was significantly decreased when compared to the patients who had a laparotomy.
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Affiliation(s)
- Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK.
| | - Kumar Gubbala
- Department of Gynaecologic Oncology, Oxford University Hospital, Oxford, UK
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Sakata K, Maeda A, Rikimaru H, Ono T, Koga N, Takeshige N, Tokutomi T, Umeno H, Kiyokawa K, Morioka M. Advantage of Extended Craniofacial Resection for Advanced Malignant Tumors of the Nasal Cavity and Paranasal Sinuses: Long-Term Outcome and Surgical Management. World Neurosurg 2016; 89:240-54. [PMID: 26875653 DOI: 10.1016/j.wneu.2016.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 02/03/2016] [Accepted: 02/04/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Craniofacial resection (CFR) for advanced sinonasal malignant tumors (SNMTs) is mandatory for radical resection. Surgeons must be aware of perioperative complications and long-term outcome because this procedure is extremely invasive, especially when the tumor involves the anterior skull base. METHODS Thirty-eight consecutive surgical patients with advanced SNMT of T4 stage or Kadish stage C (31 men and 7 women; mean age, 55 years; range: 19-76 years) treated with CFR in the past 28 years were followed up for 59.4 months. In cases of unilateral orbital extension, en-bloc resection was achieved using several neurosurgical techniques (extended CFR) from 2005 onwards. Herein, we evaluated the safety and effectiveness of surgery by comparing survival data between 2 time periods (first stage: 1984-2004, second stage: 2005-2012). RESULTS Squamous cell carcinoma was the most common histological type observed (65.8%), followed by esthesioneuroblastoma (15.8%). Using a combination of adjuvant radiation therapy, the 5-year overall survival and the 5-year disease-specific survival rates were 55.5% and 59.4%, respectively. Sarcomatous histology was a poor prognostic factor. The 5-year disease-specific survival rate was 48.9% in the first stage and improved to 82.1% in the second stage (P = 0.057); this was related to improvements in local control rate. CONCLUSIONS CFR and postoperative radiotherapy are safe and effective for treating advanced SNMTs. Extended CFR, including radical orbital exenteration, may contribute to good long-term outcomes. A diverse surgical team may help perform radical resection and reconstruction in patients with advanced tumors.
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Affiliation(s)
- Kiyohiko Sakata
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan.
| | - Akiteru Maeda
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Hideaki Rikimaru
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Takeharu Ono
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Noriyuki Koga
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Nobuyuki Takeshige
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
| | | | - Hirohito Umeno
- Department of Otolaryngology Head and Neck Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Kensuke Kiyokawa
- Department of Plastic, Reconstructive and Maxillofacial Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine, Fukuoka, Japan
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Agarwal S, Chawla S, Agarwal S, Agarwal P. Giant cell tumour 2nd metatarsal-Result with en-bloc excision and autologous fibular grafting. Foot (Edinb) 2015; 25:265-9. [PMID: 26441038 DOI: 10.1016/j.foot.2015.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 02/01/2015] [Accepted: 07/25/2015] [Indexed: 02/04/2023]
Abstract
Giant cell tumour (GCT) of the small bones is relatively uncommon tumour. It occurs most commonly in the distal portions of femur and radius and proximal end of tibia. GCT of small bones presents at advanced stages with major bony destruction. These tumours represent more aggressive course; associated with increased local recurrence rates (40%) and metastasis. Various treatment modalities like en-bloc resection, cryosurgery, intralesional curettage with burring/phenolization or bone cement are available. In our case en-bloc resection with reconstruction using nonvascular autogenous fibular strut graft was used in patient of 2nd metatarsal GCT and a favourable functional outcome was observed.
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Affiliation(s)
| | - Sumit Chawla
- Maharani Laxmi Bai Medical College, Jhansi, UP, India
| | - Sippy Agarwal
- Maharani Laxmi Bai Medical College, Jhansi, UP, India
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Zhou B, Li W. A case of gastrocolic fistula secondary to adenocarcinoma of the colon. Int J Surg Case Rep 2015; 15:46-9. [PMID: 26318125 PMCID: PMC4601962 DOI: 10.1016/j.ijscr.2015.08.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Gastrocolic fistula secondary to colon carcinoma is a rare entity. The common cause of gastrocolic fistula is different between eastern and western countries. Gastrocolic fistula may present many manifestations. PRESENTATION OF CASE We present a case report of gastrocolic fistula in a 59-year-old male patient with colon adenocarcinoma, diagnosed on digestive endoscopy, CT scanning and barium enema. Radical en-bloc surgery was undertaken based on patient's symptom, the size and the nature of the tumor. DISCUSSION The typical symptoms of gastrocolic fistula include abdominal pain, vomiting, diarrhea, emaciation, anemia, hypoaluminemia, weight loss and ascites. There are many methods to diagnose gastrocolic fistula, but barium enema is the most accepted way nowadays. CONCLUSION It is rare for gastrocolic fistula case to be caused by colon adenocarcinoma, and has been rarely reported inside China. The best therapy of gastrocolic fistula remains radical en-bloc surgery.
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Affiliation(s)
- BiaoHuan Zhou
- Department of Surgical oncology, Fujian Medical University (Fujian Provincial Hospital), Fu Zhou, China.
| | - WeiHua Li
- Department of Surgical oncology, Fujian Provincial Hospital, Fu Zhou, China.
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Abstract
Bronchogenic carcinomas involving the chest wall include tumors invading the ribs and spine, as well as Pancoast tumors. In the past, such neoplasms were considered to be incurable, but with new multimodality regimens, including induction chemoradiation followed by surgery, they can now be completely resected and patients can benefit from prolonged survival. The most important prognostic factors are the completeness of resection and the pathologic nodal status.
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Affiliation(s)
- Jean Deslauriers
- Division of Thoracic Surgery, Institut universitaire de cardiologie et de pneumologie de Québec (IUCPQ), Laval University, 2725 chemin Sainte-Foy, L-3540, Quebec City, Quebec G1V 4G5, Canada.
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Hasegawa F, Kiyozaki H, Takata O, Tokai K, Uehara T, Yoshida Y, Nokubi M, Konishi F. Lymphatic invasion in small differentiated-type mucosal gastric cancer. Clin J Gastroenterol 2012; 5:234-8. [PMID: 26182327 DOI: 10.1007/s12328-012-0308-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Accepted: 04/22/2012] [Indexed: 02/01/2023]
Abstract
Endoscopic resection for early gastric cancer is indicated for patients who are at negligible risk of lymph node metastasis. A 71-year-old female underwent endoscopic resection for a 15-mm differentiated-type mucosal gastric tumor, as recommended in the Japanese treatment guidelines. A histological examination revealed lymphatic invasion. Therefore, we performed laparoscopy-assisted distal gastrectomy and D1+ lymph node dissection. A histological examination detected no.3 lymph node metastasis, but no residual cancer cells were observed at the site of the endoscopic resection. This case is rare as lymphatic invasion and lymph node metastasis are highly unusual in small differentiated-type mucosal gastric cancer. Having experienced this case, we consider that en-bloc endoscopic resection of such lesions is extremely important, as it allows precise histological examinations to be performed, which can determine the necessity of additional treatment.
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Affiliation(s)
- Fumi Hasegawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan.
| | - Hirokazu Kiyozaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Osamu Takata
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Koichi Tokai
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Takeshi Uehara
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Yukio Yoshida
- Department of Gastroenterology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Mitsuhiro Nokubi
- Department of Pathology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
| | - Fumio Konishi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama, 330-8503, Japan
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