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Kramer SP, Tonelli C, Luchette FA, Swanson J, Abdelsattar Z, Cohn T, Baker MS. Locally advanced pancreatic cancer: Is surgical palliation associated with improved clinical outcome relative to medical palliation? Am J Surg 2024; 230:73-77. [PMID: 38350746 DOI: 10.1016/j.amjsurg.2024.01.017] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/15/2024]
Abstract
BACKGROUND The value of palliative surgery in pancreatic cancer is not well-defined. METHODS We queried the National Cancer Database for patients undergoing curative-intent resection, palliative surgery or medical palliation for clinical stage cT4N0-2M0 pancreatic cancer. Cohorts were 1:1:1 propensity-score-matched for comorbidities and stage. Kaplan-Meier method was used to compare overall survival for matched cohorts. RESULTS 9,107 patients met inclusion criteria: 3,567 (39 %) underwent curative intent surgery, 1608 (18 %) surgical palliation, 3932 (43 %) medical palliation. Patients undergoing resection and surgical palliation had significant hospitalizations (11.0 ± 0.4 vs. 10.0 ± 0.3 days; p = 0.821) and rates of readmission (8.1 % vs. 2.0 %; p < 0.001). Patients undergoing surgical palliation demonstrated marginal increases in survival relative to those undergoing medical palliation (8.54 vs. 7.36 months; p < 0.0001). CONCLUSION In patients undergoing care for locally advanced pancreatic cancer, palliative surgery is associated with marginal improvement in survival but significant lengths of hospitalization and risk of readmission.
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Affiliation(s)
- Sarah P Kramer
- Department of Surgery, NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, USA; Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| | - Celsa Tonelli
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Fred A Luchette
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
| | - James Swanson
- Loyola University Chicago, Stritch School of Medicine, Maywood, IL, USA.
| | - Zaid Abdelsattar
- Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA.
| | - Tyler Cohn
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, Edward Hines Jr. Veterans Affairs Hospital, Hines, IL, USA.
| | - Marshall S Baker
- Department of Surgery, Loyola University Medical Center, Maywood, IL, USA; Department of Surgery, University of Utah, Salt Lake City, UT, USA.
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Koob S, Kohlhof H, Randau TM, Wirtz DC. [Acetabular metastatic defect reconstruction using the modular revision support cup MRS-C]. Oper Orthop Traumatol 2024; 36:145-156. [PMID: 37921888 PMCID: PMC11014813 DOI: 10.1007/s00064-023-00834-6] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/24/2023] [Accepted: 03/22/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVE Stabilization of metastatic acetabular defects with a bone cement-augmented revision support cup for remobilization of oncological patients in advanced cancer stages. INDICATIONS Metastatic acetabular defects (Metastatic Acetabular Classification, MAC 2-4) in patients with a prognostic medium or long-term survival. CONTRAINDICATIONS Highly limited survival due to metastatic disease (< 6 weeks). Local bone or soft tissue infection. Primary bone tumor with curative treatment option. Advanced pelvic discontinuity. Recent wound compromising systemic therapy. SURGICAL TECHNIQUE Standard hip approach. Curettage of the metastatic defect and careful reaming of the acetabulum before insertion of the cup. Predrilling of the dome und flange screws before application of the bone cement through the center hole of the implant and filling of the acetabular defect. Complete insertion of the screws for compound osteosynthesis. Implant of a modular inlay or dual mobility system. POSTOPERATIVE MANAGEMENT Full weight bearing or mobilization with two crutches according to the level of pain. Adjuvant local radiation therapy after wound consolidation. Continuation of systemic therapy according to tumor board decision. RESULTS Between 2012 and 2019, we treated 14 patients with metastatic acetabular defects using the modular revision support cup "MRS-TITAN® Comfort", MRS-C, Peter Brehm GmbH, Weisendorf, Germany) at our institution. Mean Harris Hip Score improvement was 23.2 with a mean patient's survival of 9.7 months due to the reduced cancer-related prognosis; 13 of the 14 implants endured the patient's prognosis. One implant had to be removed due soft tissue defect-related periprosthetic joint infection.
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Affiliation(s)
- S Koob
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland.
| | - H Kohlhof
- Unfall‑, Hand- und Orthopädische Chirurgie, St. Antonius Krankenhaus Köln, Köln, Deutschland
| | - T M Randau
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
| | - D C Wirtz
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland
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Ng IAT, Thiagarajan S, Ong WS, Wong SMJ. Predicted and actual survival in patients undergoing palliative oncologic surgery: Are surgeons overly optimistic? Asian J Surg 2023; 46:6051-6052. [PMID: 37723038 DOI: 10.1016/j.asjsur.2023.09.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023] Open
Affiliation(s)
- Irene A T Ng
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Sasinthiran Thiagarajan
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore
| | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore
| | - Si Min Jolene Wong
- Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore; Department of Sarcoma, Peritoneal and Rare Tumours (SPRinT), Division of Surgery and Surgical Oncology, Singapore General Hospital, Singapore; SingHealth Duke-NUS Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore; SingHealth Duke-NUS Surgery Academic Clinical Program, Duke-NUS Medical School, Singapore.
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4
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Koob S, Plöger MM, Schmolling JS, Lehmann RP, Alex D, Kohlhof H. Intramedullary nailing versus plate compound osteosynthesis in subtrochanteric and diaphyseal pathologic femoral fractures: a retrospective cohort study. Eur J Orthop Surg Traumatol 2023; 33:3597-3601. [PMID: 37246990 PMCID: PMC10651703 DOI: 10.1007/s00590-023-03599-7] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/30/2023]
Abstract
PURPOSE Pathologic fractures of the extremities due to carcinoma metastases require individual and patient prognosis-related stabilization procedures. Quick remobilization of the patient to restore the quality of life is of high importance, especially in the case of subtrochanteric and diaphyseal femoral fractures. In our retrospective cohort study, we evaluated intraoperative blood loss, length of operation, complication rate, and regain of lower extremity function in plate compound osteosynthesis (PCO) versus intramedullary nailing (IM) for subtrochanteric and diaphyseal pathologic fractures of the femur. METHODS Between January 2010 and July 2021, we retrospectively reviewed 49 patients who were treated at our institution for pathologic fractures of the subtrochanteric and diaphyseal femurs for group differences in terms of blood loss, length of operation, implant survival, and Musculoskeletal Tumor Society (MSTS) score. RESULTS We included 49 stabilization procedures of the lower extremity due to pathologic fractures of the proximal or diaphyseal femur, with a mean follow-up of 17.7 months. IM (n = 29) had a significantly shorter operation time than PCO (n = 20) (112.4 ± 9.4 and 163.3 ± 15.96 min, respectively). We did not detect any significant differences in terms of blood loss, complication rate, implant survival, or MSTS score. CONCLUSION Based on our data, pathologic subtrochanteric and diaphyseal fractures of the femur can be stabilized with IM, which has a shorter operation time than PCO, but the complication rate, implant survival, and blood loss remain unaffected.
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Affiliation(s)
- Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Milena Maria Plöger
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Johanna Sophie Schmolling
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Ramona Pia Lehmann
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Dana Alex
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Hendrik Kohlhof
- Department of Emergency, Hand and Orthopaedic Surgery, St. Antonius Hospital, Cologne, Germany
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Schaefer G, Regier D, Stout C. Palliative Emergency General Surgery. Surg Clin North Am 2023; 103:1283-1296. [PMID: 37838468 DOI: 10.1016/j.suc.2023.06.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
Acute care surgeons encounter patients experiencing surgical emergencies related to advanced malignancy, catastrophic vascular events, or associated with multisystem organ failure. The acute nature is a factor in establishing a relationship between surgeon, patient, and family. Surgeons must use effective communication skills, empathy, and a knowledge of legal and ethical foundations. Training in palliative care principles is limited in many medical school and residency curricula. We offer examples of clinical situations facing acute care surgeons and discuss evidence-based recommendations to facilitate successful treatment and outcomes.
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Affiliation(s)
- Gregory Schaefer
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Surgical Critical Care, J.W. Ruby Memorial Hospital, West Virginia University Medicine, West Virginia University, Morgantown, WV, USA; Division of Military Medicine, J.W. Ruby Memorial Hospital, West Virginia University Medicine, West Virginia University, Morgantown, WV, USA; Department of Surgery, West Virginia University, Morgantown, WV, USA.
| | - Daniel Regier
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Conley Stout
- Department of Surgery, West Virginia University, Morgantown, WV, USA
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Fan Y, Zhang B, Guo L, Yao W. Long bone shaft metastasis: a comparative study between cement filling and intercalary prosthesis. World J Surg Oncol 2023; 21:374. [PMID: 38037167 PMCID: PMC10687828 DOI: 10.1186/s12957-023-03242-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Metastatic bone lesions in the extremities can cause severe pain and pathological fractures, significantly affecting patients' quality of life. Timely intervention and effective management of long bone metastases can positively influence patient outcomes, including survival rates and subsequent treatment options. OBJECTIVE The objective of this study is to compare the efficacy and associated complications of two surgical reconstruction techniques and propose a more effective limb reconstruction approach for long bone metastases. METHODS A retrospective study was conducted on 28 patients with complete clinical data who underwent a surgical procedure for long bone metastases of the extremities in our department between January 2017 and June 2022. The patients were divided into two groups based on their surgical methods. In group 1, the affected bones were curetted and filled with cement, then secured with plates or intramedullary nails. In group 2, the affected bone segments were completely removed and replaced with custom intercalary prostheses. Various factors, including general patient information, surgical details, surgical effectiveness, and common complications, were compared and analyzed. RESULTS There were no significant differences in general patient information between the two groups, including age, gender, surgical site, and primary tumor type. The operative times were 115.37 min for group 1 and 108.90 min for group 2, respectively (p > 0.05). However, intraoperative blood loss differed significantly between the groups, with 769 ml in group 1 and 521 ml in group 2 (p < 0.05). The postoperative MSTS scores were 91% for group 1 and 92% for group 2 (p > 0.05). Postoperative complications included two cases of internal fixation failure and three cases of tumor recurrence in group 1, resulting in a 33% incidence rate, while group 2 experienced a 15% incidence rate with two cases of internal fixation failure. CONCLUSION The results of this study suggest that both surgical techniques are effective for the treatment of long bone metastases of the extremities. However, the custom intercalary prostheses technique in group 2 showed a lower incidence of complications and less intraoperative blood loss. Therefore, it may be a more effective limb reconstruction approach for long bone metastases. Further studies with larger sample sizes are needed to confirm these findings.
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Affiliation(s)
- Yichao Fan
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, China
| | - Boya Zhang
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, China
| | - Liangyv Guo
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, China
| | - Weitao Yao
- Department of Bone and Soft Tissue Cancer, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, China.
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Xu Q, Hou K, Lv B, Xing Q, Chen R. Application of Foley balloon catheter in palliative surgery for pulmonary atresia with an intact ventricular septem, with additional cases of pulmonary atresia with ventricular septal defect and tetralogy of Fallot. BMC Cardiovasc Disord 2023; 23:547. [PMID: 37940877 PMCID: PMC10634058 DOI: 10.1186/s12872-023-03587-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/29/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pulmonary atresia and tetralogy of Fallot can require palliative surgery in the neonatal period due to severe hypoxia; however, limitations of established techniques include high failure rate and need for cardiopulmonary bypass. Herein, right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter is described. METHODS A retrospective review of patients who underwent right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter at our institution between September 2018 and March 2022 was completed. During the procedure, a Foley balloon catheter was used to occlude the blood from the right ventricular inflow tract. RESULTS Eight patients with pulmonary atresia and intact ventricular septum underwent an off-pump right ventricular outflow tract reconstruction. One patient with pulmonary atresia and ventricular septal defect, and two patients with tetralogy of Fallot underwent an on-pump right ventricular outflow tract reconstruction on a beating heart. The procedures were successful in all patients. Patent ductus arteriosus ligation without modified Blalock-Taussig shunt placement was performed in three patients with pulmonary atresia with intact ventricular septum and two patients with tetralogy of Fallot, ductus arteriosus was left open in four patients with pulmonary atresia with intact ventricular septum. All patients remained clinically well without serious complications. CONCLUSIONS Right ventricular outflow tract reconstruction on a beating heart using a Foley balloon catheter for pulmonary atresia and tetralogy of Fallot is a feasible alternative to catheter-based interventions or traditional surgical treatment, especially in patients with muscular infundibular stenosis or hypoplastic pulmonary annulus. Further studies with more cases are needed to verify feasibility and superiority of this approach.
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Affiliation(s)
- Qiteng Xu
- Medical College, Qingdao University, Qingdao, China
| | - Kefeng Hou
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Bei Lv
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Quansheng Xing
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China
| | - Rui Chen
- Heart Center, Qingdao Women and Children's hospital, 6 Tongfu Road , Qingdao, 266000, China.
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Papadakis M. Sculpting dignity: the art of palliative reconstructive surgery※※Special series on Palliative Reconstructive Surgery. Ann Palliat Med 2023; 12:1134-1135. [PMID: 38062931 DOI: 10.21037/apm-23-561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/28/2023] [Indexed: 12/18/2023]
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Chrastina J, Horák O, Ryzí M, Brázdil M, Novák Z, Zeman T, Danhofer P. Single-center long-term results of vagus nerve stimulation for pediatric epilepsy: a 10-17-year follow-up study. Childs Nerv Syst 2023; 39:3215-3224. [PMID: 37219617 DOI: 10.1007/s00381-023-05992-3] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/06/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE A retrospective study, based on a prospectively built database, presents the results of long-term follow-up care of pediatric vagus nerve stimulation (VNS) patients in terms of seizure outcome, surgical aspects, the potential impact of maturation, and medication changes. METHODS From a prospectively built database, 16 VNS patients (median age 12.0 years, range 6.0 to 16.0 years; median seizure duration 6.5 years, range 2.0 to 15.5 years) followed for at least 10 years were graded as non-responder - NR (seizure frequency reduction < 50%), responder - R (reduction ≥ 50% and < 80%), and 80% responder - 80R (reduction ≥ 80%). Data about surgical aspects (battery replacement, system complications), seizure dynamics, and medication changes were taken from the database. RESULTS The early percentages of good results (80R + R) were 43.8% (year 1), 50.0% (year 2), and 43.8% (year 3). These percentages remained stable between years 10 and 12 (50% year 10; 46.7% year 11; 50% year 12) and increased in years 16 (60%) and 17 (75%). Depleted batteries were replaced in ten patients, six of whom were either R or 80R. In the four NR, the indication for replacement was improved quality of life. Three patients had VNS explanted or switched off-one had repeated asystolia and two were NR. The effect of hormonal changes in menarche on seizure was not proven. During the study, antiseizure medication was changed in all patients. CONCLUSIONS The study proved the efficacy and safety of VNS in pediatric patients over an exceptionally long follow-up period. The demand for battery replacements indicates a positive treatment effect.
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Affiliation(s)
- J Chrastina
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic.
| | - O Horák
- Department of Pediatric Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - M Ryzí
- Department of Pediatric Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - M Brázdil
- Brno Epilepsy Center, First Department of Neurology, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic
| | - Z Novák
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - T Zeman
- Department of Neurosurgery, Faculty of Medicine, St. Anne's University Hospital, Masaryk University, Pekařská 53, 656 91, Brno, Czech Republic
| | - P Danhofer
- Department of Pediatric Neurology, Faculty of Medicine, Masaryk University and University Hospital Brno, Brno, Czech Republic
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Echalier C, Teboul F, Goubier JN. Tendon transfer from a re-innervated triceps to the biceps for restoration of elbow flexion in total brachial plexus palsy. Hand Surg Rehabil 2023; 42:442-445. [PMID: 37474021 DOI: 10.1016/j.hansur.2023.07.003] [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] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES This study aimed to evaluate the outcomes of the tendon transfer from a reinnervated triceps to biceps in the context of total brachial plexus palsy. METHODS We conducted a retrospective study. Patients had reinnervation of the triceps either by spontaneous recovery or by nerve transfer. Functional results were assessed by strength and range of motion. The level of patient satisfaction was measured on a scale from 0 to 10. RESULTS Six patients (6 transfers) were included. Two triceps had spontaneous reinnervation and the other four through neurotization of intercostal nerves. All patients recovered strength to M4 in flexion with an average secondary deficit of 10° (5°-15°). The mean level of satisfaction was measured at 7/10 (6-8). CONCLUSIONS This tendon transfer is a reliable and simple solution for supportive restoration of elbow flexion. Systematic reinnervation of active extension of the elbow should be proposed for the gain in function that it represents but also for the supportive therapeutic opportunity that it offers should nerve surgery for elbow flexion fail. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Camille Echalier
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France; Clinique Nollet Paris, 23 rue Brochant, 75017 Paris, France
| | - Frédéric Teboul
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France
| | - Jean-Noël Goubier
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France.
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Ho UC, Lai DM, Xiao FR, Yang SH, Chen CM, Tsuang FY. Metastatic spinal cord compression as the first manifestation of malignancy: A retrospective study of surgical outcome from single institution. Asian J Surg 2023:S1015-9584(23)01334-9. [PMID: 37689519 DOI: 10.1016/j.asjsur.2023.08.159] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/04/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Given the limited studies addressing the issue about the effect of different surgical modalities for metastatic spinal cord compression (MSCC) as the first malignancy manifestation, we conducted a retrospective case-control study to evaluate the surgical outcome of MSCC as the first malignancy manifestation. METHODS A total of 128 patients who were suspected of having metastatic spinal cord compression and underwent surgery from 2008 to 2021 were enrolled in the study. All patients were categorized into either 'debulking group' or 'palliative group'. RESULTS The primary outcome was progression-free survival (PFS). The secondary outcomes were overall survival (OS), Frankel scale, and Karnofsky scores. All the outcomes were analyzed with a data cutoff of December 31, 2021. There was a significant difference between groups in progression-free survival (PFS) (p = 0.0094). However, there was no significant difference between groups in the overall survival (OS) (p = 0.0746). Age of onset, gender, duration of symptoms, and location of spinal metastasis, initial Frankel, initial Tomita scores, and initial Karnofsky performance scale showed no significant differences between groups. CONCLUSION In conclusion, debulking surgery was shown to provide better neurological recoveries and could be considered first in patients with metastatic spinal cord compression as the first malignancy manifestation.
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Affiliation(s)
- Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Dar-Ming Lai
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Fu-Ren Xiao
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Shih-Hung Yang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chang-Mu Chen
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
| | - Fon-Yih Tsuang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan; Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan; Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan.
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Jorgensen J, Redman R, Jusufbegovic M. The Ethics of Palliative Surgery for Locally Advanced Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2023; 169:738-740. [PMID: 37210609 DOI: 10.1002/ohn.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/29/2023] [Indexed: 05/22/2023]
Affiliation(s)
| | - Rebecca Redman
- Department of Medicine, Division of Medical Oncology, University of Louisville Hospital, Kentucky, Louisville, USA
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Cattermole TC, Schimmel ML, Carpenter RL, Callas PW, Gramling R, Bertges DJ, Ferranti KM. Integration of palliative care consultation into the management of patients with chronic limb-threatening ischemia. J Vasc Surg 2023; 78:454-463. [PMID: 37088444 DOI: 10.1016/j.jvs.2022.12.069] [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: 08/29/2022] [Revised: 11/21/2022] [Accepted: 12/06/2022] [Indexed: 04/25/2023]
Abstract
OBJECTIVE We assessed the feasibility of integrating palliative care consultation into the routine management of patients with chronic limb-threatening ischemia (CLTI). Additionally, we sought to describe patient-reported outcomes from the palliative care and vascular literature in patients with CLTI receiving a palliative care consultation at our institution. METHODS This was a single-institution, prospective, observational study that aimed to assess feasibility of incorporating palliative care consultation into the management of patients admitted to our tertiary academic medical center with CLTI by looking at utilization of palliative care before and after implementation of a protocol-based palliative care referral system. A survey comprised of patient-reported outcomes from the palliative care literature was administered to patients before and after palliative consultation. Length of stay and mortality were compared between our study cohort and a historic cohort of patients admitted with CLTI. RESULTS Over a 14-month enrollment period, 44% of patients (n = 39) with CLTI (rest pain, 36%; tissue loss, 64%) admitted to the vascular service received palliative care consultation, compared with 5% of patients (n = 4) who would have met criteria over the preceding 14 months before our protocol was instituted. The mean age was 69 years, 23% were female, 92% were white, and 49% were able to ambulate independently. Revascularization included bypass (46%), peripheral vascular intervention (23%), and femoral endarterectomy (21%). Additional procedures included minor amputation or wound debridement (26%) and major amputation (15%). No patients received medical management alone. After receiving palliative care consultation, patients reported experiencing less emotional distress than before consultation (P = .03). They also reported being less bothered by uncertainty regarding what to expect from the course of their illness (P = .002). Fewer patients reported being unsure of the purpose of their medical care after palliative care consultation (8%) vs before (18%), although this was not statistically significant (P = .10). Median length of stay was longer in the study group compared with the historic cohort (8 vs 7 days; P = .02). There was no difference in 30-day mortality (3% vs 8%; P = .42) between the study group and the historic cohort (n = 77). CONCLUSIONS Integrating inpatient palliative care consultation into the routine management of patients with CLTI is feasible and may improve emotional domains of health-related quality of life. This study laid the foundation for future studies on longer term outcomes of patients with CLTI undergoing palliative care consultation as well as the benefit of outpatient palliative care consultation in patients with CLTI.
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Affiliation(s)
| | | | | | - Peter W Callas
- University of Vermont College of Medicine, Burlington, VT
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Shinkai M, Imano M, Kohda M, Nakanishi T, Hiraki Y, Hagi T, Kato H, Shiraishi O, Yasuda A, Tsubaki M, Nishida S, Yasuda T. Efficacy of palliative surgery for gastric cancer patients with peritoneal metastasis who still have residual peritoneal dissemination after chemotherapy. Langenbecks Arch Surg 2023; 408:291. [PMID: 37523006 DOI: 10.1007/s00423-023-03028-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/23/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE Gastric cancer patients with peritoneal metastasis (PM) are generally treated with systemic chemotherapy. When PM has disappeared because of chemotherapy, radical gastrectomy (so-called conversion surgery) is usually performed. We have previously reported the efficacy of conversion surgery, but there are no reports examining the efficacy of palliative gastrectomy for patients with residual PM after chemotherapy. The purpose of this study was to investigate the efficacy of palliative surgery for gastric cancer patients with PM who still have residual peritoneal dissemination after chemotherapy. METHODS Twenty-five gastric cancer patients with PM confirmed by laparoscopy and who had received chemotherapy but who still had residual PM were included in this study. Among the 25 patients, palliative surgery was performed in 20 patients (PS group) and chemotherapy was continued in 5 patients (CTx group), and their therapeutic outcomes were compared. RESULTS In the PS group, total and distal gastrectomies were performed. Clavien-Dindo grade I postoperative complications occurred in two patients (10%). There were no treatment-related deaths. Postoperative chemotherapy was performed all cases. In the PS group, the median survival time (MST) reached 22.5 months, with 1- and 2-year overall survival (OS) rates of 95% and 45%, respectively, whereas in the CTx group, the MST was 15.8 months, and the 1- and 2-year OS rates were 60% and 0%, respectively. The PS group had significantly longer OS than the CTx group (P=0.044). CONCLUSIONS Palliative surgery is safe and may prolong survival in gastric cancer patients with residual PM after chemotherapy.
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Affiliation(s)
- Masayuki Shinkai
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Motohiro Imano
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Masashi Kohda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Tomoya Nakanishi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoko Hiraki
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takaomi Hagi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroaki Kato
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Atsushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masanobu Tsubaki
- Division of Pharmacotherapy, Faculty of Pharmacy, Kindai University, Higashiosaka, Japan
| | - Shozo Nishida
- Division of Pharmacotherapy, Faculty of Pharmacy, Kindai University, Higashiosaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
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Son K, Shindo K, Ouchida K, Moriyama T, Tamura K, Nagayoshi K, Mizuuchi Y, Ikenaga N, Nakata K, Nakamura M. Endoscopic stent placement with laparoscopic stent fixation in a patient with obstruction at a gastrojejunostomy anastomosis site. Surg Case Rep 2023; 9:121. [PMID: 37382836 DOI: 10.1186/s40792-023-01699-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Palliative endoscopic stent placement may be considered in patients with malignant gastrointestinal obstruction. Stent migration is a potential complication, particularly for those placed at a surgical anastomosis or across a stricture caused by extra-alimentary tract factors. We report a patient with left renal pelvis cancer and gastrojejunostomy obstruction who underwent endoscopic stent placement and laparoscopic stent fixation. CASE PRESENTATION A 60-year-old male with peritoneal dissemination of a left renal pelvis cancer was admitted for treatment of upper gastrointestinal obstruction. A laparoscopic gastrojejunostomy had been previously performed for cancer invasion of the duodenum. Imaging showed gastroduodenal dilation and impaired passage of contrast medium through the efferent loop of the gastrojejunostomy. Gastrojejunostomy anastomosis site obstruction due to dissemination of left renal pelvis cancer was diagnosed. Conservative treatment failed and endoscopic stent placement with laparoscopic stent fixation was performed. After surgery, the patient was able to tolerate oral intake and he was discharged without complications. The patient gained weight and was able to resume chemotherapy, indicating the procedure was effective. CONCLUSIONS Endoscopic stent placement with laparoscopic stent fixation for malignant upper gastrointestinal obstruction appears effective in patients with a high risk of stent migration.
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Affiliation(s)
- Kiwa Son
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Shindo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Kenoki Ouchida
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taiki Moriyama
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Tamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kinuko Nagayoshi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yusuke Mizuuchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Suvithayasiri S, Kim YJ, Liu Y, Trathitephun W, Asawasaksaku A, Quillo-Olvera J, Kotheeranurak V, Chagas H, Valencia CC, Serra MV, Isseldyk FV, Lee LH, Chen CM, Lokhande P, Park SM, Jitpakdee K, Patel KK, Kim JH, Mahatthanatrakul A, Luksanapruksa P, Wilartratsami S, Kim JS. The Role and Clinical Outcomes of Endoscopic Spine Surgery of Treating Spinal Metastases; Outcomes of 29 Cases From 8 Countries. Neurospine 2023; 20:608-619. [PMID: 37401080 PMCID: PMC10323327 DOI: 10.14245/ns.2346274.137] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 07/05/2023] Open
Abstract
OBJECTIVE We aim to report the outcomes and feasibility of endoscopic spine surgery used to treat symptomatic spinal metastases patients. This is the most extensive series of spinal metastases patients who underwent endoscopic spine surgery. METHODS A worldwide collaborative network group of endoscopic spine surgeons, named 'ESSSORG,' was established. Patients diagnosed with spinal metastases who underwent endoscopic spine surgery from 2012 to 2022 were retrospectively reviewed. All related patient data and clinical outcomes were gathered and analyzed before the surgery and the followtime period of 2 weeks, 1 month, 3 months, and 6 months. RESULTS A total of 29 patients from South Korea, Thailand, Taiwan, Mexico, Brazil, Argentina, Chile, and India, were included. The mean age was 59.59 years, and 11 of them were female. The total number of decompressed levels was 40. The technique was relatively equal (15 uniportal; 14 biportal). The average length of admission was 4.41 days. Of all patients with an American Spinal Injury Association Impairment Scale of D or lower before surgery, 62.06% reported having at least one recovery grade after the surgery. Almost all clinical outcomes parameters statistically significantly improved and maintained from 2 weeks to 6 months after the surgery. Few surgical-related complications (4 cases) were reported. CONCLUSION Endoscopic spine surgery is a valid option for treating spinal metastases patients as it could yield comparable results to other minimally invasive spine surgery techniques. As the aim is to improve the quality of life, this procedure is valuable and holds value in palliative oncologic spine surgery.
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Affiliation(s)
- Siravich Suvithayasiri
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | - Young-Jin Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yanting Liu
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Warayos Trathitephun
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Javier Quillo-Olvera
- The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Hospital H+, Queretaro City, Mexico
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Haroldo Chagas
- Department of Neurosurgery, Hospital Federal da Lagoa, Rio de Janeiro, Brazil
| | | | | | | | - Lung-Hsing Lee
- Department of Orthopedics, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chien-Min Chen
- Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Pramod Lokhande
- Department of Orthopaedics, Smt. Kashibai Navale Medical College and General Hospital, Pune, India
| | - Sang-Min Park
- Spine Center, Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul ational University Bundang Hospital, Seongnam, Korea
| | - Khanathip Jitpakdee
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Kandarpkumar K. Patel
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung-Hoon Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - Panya Luksanapruksa
- Division of Spine Surgery, Department of Orthopaedics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirichai Wilartratsami
- Division of Spine Surgery, Department of Orthopaedics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Hara H, Kawamoto T, Fukase N, Sawada R, Fujiwara S, Yahiro S, Miyamoto T, Terakawa T, Mifune Y, Hoshino Y, Kakutani K, Matsumoto T, Matsushita T, Niikura T, Kuroda R, Akisue T. Outcomes of palliative surgery for bone metastasis of metastatic renal cell carcinoma in the era of targeted therapy. Eur J Surg Oncol 2023; 49:928-933. [PMID: 36463006 DOI: 10.1016/j.ejso.2022.11.094] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 11/08/2022] [Accepted: 11/14/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The introduction of tyrosine kinase inhibitors has revolutionized treatment strategies for metastatic renal cell carcinoma (RCC) and has improved survival rates. The number of patients with bone metastases from RCC requiring surgery will increase as survival rates improve. However, there is insufficient evidence to standardize the treatment of bone metastases after the introduction of targeted therapy for metastatic RCC. We aimed to determine the outcomes of palliative surgical treatment of bone metastases in the extremities of patients with metastatic RCC. MATERIALS AND METHODS We retrospectively reviewed 26 lesions from 17 patients who underwent surgery for extremity and acetabular bone metastases and were treated with targeted therapies for advanced RCC between 2008 and 2020. The median follow-up duration was 19 months (range, 4-76). We assessed the patients' activities of daily living, quality of life, and pain and analyzed their postoperative values relative to preoperative values. Postoperative overall survival (OS), local progression-free survival (LPFS), and the factors affecting them were evaluated using the Kaplan-Meier method and log-rank test. RESULTS The 5-year OS and LPFS rates were 39.5% and 65.6%, respectively. The factors affecting OS were sex, Katagiri score, visceral metastases, and preoperative targeted therapy, while the factors affecting LPFS were pathologic fractures and surgical technique. CONCLUSION In this study, the postoperative outcomes of palliative surgery for bone metastases from metastatic RCC were good. We suggest that systemic treatment should be prioritized over local control for advanced bone metastasis in RCC and surgery before pathological fracture should be performed for local control.
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Affiliation(s)
- Hitomi Hara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Teruya Kawamoto
- Division of Orthopaedic Surgery, Kobe University Hospital International Clinical Cancer Research Center, 1-5-1 Minatojimaminami-cho, Chuo-ku, Kobe, 650-0047, Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryoko Sawada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shuichi Fujiwara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shunsuke Yahiro
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomohiro Miyamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Terakawa
- Division of Urology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toshihiro Akisue
- Department of Rehabilitation Science, Kobe University Graduate School of Health Science, 7-10-2 Tomogaoka, Suma-ku, Kobe, 654-0142, Japan
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18
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Dondorf F, Rohland O, Deeb AA, Ardelt M, Settmacher U, Rauchfuss F. Value of palliative surgery in perihilar cholangiocarcinoma. Langenbecks Arch Surg 2023; 408:128. [PMID: 36977835 PMCID: PMC10049926 DOI: 10.1007/s00423-023-02854-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/02/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE The survival rate of patients with irresectable perihilar cholangiocarcinoma is remarkably poor. An essential part of palliation is treatment of obstructive cholestasis caused by the tumor. Currently, this is mainly performed endoscopically by stent or via PTBD, requiring frequent changes of the stents and limiting health-related quality of life due to the multiple hospital stays needed. The aim of this study was to evaluate surgical palliation via extrahepatic bile duct resection as an option for palliative treatment. METHODS Between 2005 and 2016, we treated 120 pCCC patients with primary palliative care. Three treatment strategies were retrospectively considered: extrahepatic bile duct resection (EBR), exploratory laparotomy (EL), and primary palliative (PP) therapy. RESULTS The EBR group required significantly less stenting postoperatively, and the overall morbidity was 29.4% (EBR). After the surgical procedure, fewer subsequent endoscopic treatments for stenting or PTBD were necessary in the EBR group over time. The 30-day mortality was 5.9% (EBR) and 3.4% (EL). The median overall survival averaged 570 (EBR), 392 (EL), and 247 (PP) days. CONCLUSIONS In selected pCCC patients, palliative extrahepatic bile duct resection is a feasible option for treatment of obstructive cholestasis and should be reconsidered as a therapy option for these patients even in a palliative setting.
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Affiliation(s)
- Felix Dondorf
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Oliver Rohland
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Aladdin Ali Deeb
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Ardelt
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Utz Settmacher
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Falk Rauchfuss
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
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Alcasid NJ, Banks KC, Sun A, Velotta JB. Case report on the role of aggressive palliative surgery in lung NUT carcinoma after induction chemoimmunotherapy. Int J Surg Case Rep 2023; 105:108015. [PMID: 36948057 PMCID: PMC10040693 DOI: 10.1016/j.ijscr.2023.108015] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 03/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE NUT (nuclear protein in testis) carcinoma of the lung is an aggressive, poorly differentiated squamous cell carcinoma that has a poor prognosis. Currently, there are no recommended guidelines with limited literature regarding the management of primary NUT carcinoma of the lung. CASE PRESENTATION A 28-year-old male presented with 2 weeks of intractable chest pain and shortness of breath and was found to have Stage IV pleural NUT carcinoma. After 2 cycles of chemoimmunotherapy, the patient's symptoms persisted with worsening functional status. Palliative surgery was performed via an extrapleural pneumonectomy with significant improvement in symptoms and activities of daily living. CLINICAL DISCUSSION With no current treatment guidelines, we demonstrate the benefit of surgical resection of advanced pleural NUT carcinoma to improve quality of life. Prognosis is poor with a median survival around 7 months and 3 months with an associated mass. The patient presented pre-operatively with intractable pleuritic chest pain and shortness of breath, limiting activities of daily living that persisted despite chemoimmunotherapy. Our surgical goal was to improve the patient's respiratory status and mitigate pain symptoms via extensive surgical debulking. The patient was able to achieve a higher quality of life and survived longer than the median average, passing away 1 year after diagnosis. CONCLUSION The management of NUT carcinoma of the lung remains challenging. The role of surgical resection for palliation in advanced tumors has not been previously described and may provide improved quality of life in carefully selected patients.
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Affiliation(s)
- Nathan J Alcasid
- UCSF East Bay, Department of Surgery, 1411 E 31 St, Oakland, CA 94602, United States of America.
| | - Kian C Banks
- UCSF East Bay, Department of Surgery, 1411 E 31 St, Oakland, CA 94602, United States of America
| | - Angela Sun
- Kaiser Permanente Northern California, Department of Thoracic Surgery, 3600 Broadway, Oakland, CA 94611, United States of America
| | - Jeffrey B Velotta
- Kaiser Permanente Northern California, Department of Thoracic Surgery, 3600 Broadway, Oakland, CA 94611, United States of America
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Yagi S, Ida S, Namikawa K, Hayami M, Makuuchi R, Kumagai K, Ohashi M, Sano T, Nunobe S. Clinical outcomes of palliative treatment for gastric bleeding from incurable gastric cancer. Surg Today 2023; 53:360-368. [PMID: 35932300 DOI: 10.1007/s00595-022-02567-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/13/2022] [Indexed: 10/16/2022]
Abstract
PURPOSE Deciding palliative treatment for gastric bleeding from incurable gastric cancer (IGC) is worrying considering different patient situations and the lack of comprehensive assessment of palliative treatment. We evaluated the clinical outcomes and prognostic factors after palliative treatment for gastric bleeding from IGC. METHODS We enrolled 48 consecutive patients with gastric bleeding from IGC who underwent palliative surgery (PS) or palliative radiotherapy (PRT). RESULTS Of the 48 patients, 23 underwent PS and 25 received PRT. More patients who had an Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) ≥ 2 or who received chemotherapy underwent PRT than underwent PS. Severe complications were observed in 2 (8.6%) patients after PS. After PRT, 22 patients achieved hemostasis (88%), but rebleeding was found in 10 (40%). Chemotherapy was introduced after palliative treatment for 21 (91.3%) patients in the PS group and 17 (68%) patients in the PRT group. The median survival time (MST) of patients with and without chemotherapy after PS was 12.5 and 3.1 months, respectively (p ≤ 0.001), while the MST of patients with and without chemotherapy after PRT was 6.5 and 1.6 months (p < 0.001). Multivariate analyses identified ECOG-PS, tumor size, and chemotherapy after palliative treatment as independent risk factors. CONCLUSIONS Palliative treatment strategies for gastric bleeding should be determined with consideration of the general condition, previous chemotherapy, and chemotherapy after palliative treatment.
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Affiliation(s)
- Shusuke Yagi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Ida
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Ken Namikawa
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaru Hayami
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Rie Makuuchi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Koshi Kumagai
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Manabu Ohashi
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Souya Nunobe
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
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Takeda Y, Yamamoto M, Hoshino K, Ito YM, Kato N, Wakasa S, Morimoto Y. Changes in Cerebral Hemodynamics During Systemic Pulmonary Shunt and Pulmonary Artery Banding in Infants with Congenital Heart Disease. Pediatr Cardiol 2023; 44:695-701. [PMID: 36050410 DOI: 10.1007/s00246-022-02999-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/23/2022] [Indexed: 11/27/2022]
Abstract
Palliative surgery is often performed in the treatment of congenital heart disease. Two representative palliative procedures are the systemic pulmonary shunt and pulmonary artery banding. Dramatic changes in cerebral hemodynamics may occur in these operations due to changes in the pulmonary-to-systemic blood flow ratio and systemic oxygenation. However, there seem to be almost no studies evaluating them. Accordingly, we evaluated cerebral perfusion by transcranial Doppler ultrasonography and cerebral oxygenation by near infrared spectroscopy during these procedures. In the post hoc analysis of a previous prospective observational study, cerebral blood flow velocities of the middle cerebral artery measured by transcranial Doppler were compared between the start and end of surgery as were the pulsatility index and resistance index. The cerebral oxygenation values were also compared between the start and end of surgery. Twenty-two infants with systemic pulmonary shunt and 20 infants with pulmonary artery banding were evaluated. There were no significant differences of the flow velocities between the start and end of surgery in either procedure. The pulsatility index significantly increased after pulmonary artery banding, which may compete with the increase in cerebral perfusion due to the increase in systemic blood flow. The cerebral oxygenation decreased in both procedures, possibly due to an increase in body temperature. Arterial oxygen saturation was almost the same before and after both procedures. Contrary to our expectation, the changes in cerebral hemodynamics in the palliative operations were small if the management of physiological indices such as arterial oxygen saturation was properly performed during the procedures.
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Affiliation(s)
- Yoshifumi Takeda
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan
| | - Masataka Yamamoto
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan
| | - Koji Hoshino
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, N14 W5, Sapporo, 0608648, Japan
| | - Nobuyasu Kato
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Sapporo, 060‑8638, Japan
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Sapporo, 060‑8638, Japan
| | - Yuji Morimoto
- Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, N15 W7, Sapporo, 0608638, Japan.
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22
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Magyar CTJ, Rai A, Aigner KR, Jamadar P, Tsui TY, Gloor B, Basu S, Vashist YK. Current standards of surgical management of gastric cancer: an appraisal. Langenbecks Arch Surg 2023; 408:78. [PMID: 36745231 DOI: 10.1007/s00423-023-02789-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 12/02/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Gastric cancer (GC) is the fifth most common malignancy worldwide and portends a grim prognosis due to a lack of appreciable improvement in 5-year survival. We aimed to analyze the available literature and summarize the current standards of surgical care for curative and palliative intent treatment of GC. METHODS We conducted a systematic search on the PubMed database for studies on the management of GC. RESULTS Endoscopic resection is an acceptable treatment option for T1a tumors. The role of optimal resection margin for GC remains unclear. D2 lymph node dissection remains the standard of care with splenectomy needed selectively for splenic hilum involvement. A distal pancreatic resection should be avoided. The advantage of bursectomy and omentectomy in GC surgery is not clear. Multi-visceral resection may be considered for locally advanced GC in carefully selected patients. Minimally invasive approaches are non-inferior to open surgery. Surgery should be abandoned prior even in metastatic GC within the frame of multimodal therapy approach. CONCLUSION Various trials have conclusively shown improved patient outcomes when well-established surgical standards are followed.
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Affiliation(s)
- Christian T J Magyar
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Ankit Rai
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Karl R Aigner
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany
| | | | - Tung Y Tsui
- Department of Surgery, Asklepios Harzklinik, Goslar, Germany
| | - Beat Gloor
- Department of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Yogesh K Vashist
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, India.
- Department of Surgical Oncology, Medias Klinikum, Burghausen, Germany.
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23
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Adams AM, Reames BN, Krell RW. Morbidity and Mortality of Non-pancreatectomy operations for pancreatic cancer: An ACS-NSQIP analysis. Am J Surg 2023; 225:315-321. [PMID: 36088140 DOI: 10.1016/j.amjsurg.2022.08.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 08/13/2022] [Accepted: 08/21/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients with pancreas cancer may undergo palliative gastrointestinal or biliary bypass. Recent comparisons of post-operative outcomes following such procedures are lacking. METHODS We analyzed patients undergoing exploration, gastrojejunostomy, biliary bypass or double bypass for pancreatic cancer using data from the 2005-2019 American College of Surgeons National Surgical Quality Improvement Program. We compared 30-day mortality and complications across procedures and over time periods (2005-10, 2011-14, 2015-19) using multivariable regression models. Factors associated with postoperative mortality were identified. RESULTS Of 43,525 patients undergoing surgery with a postoperative diagnosis of pancreatic cancer, 5572 met inclusion criteria. Palliative operations included 1037 gastrojejunostomies, 792 biliary bypasses, 650 double bypasses, and 3093 explorations. The proportion of biliary and double bypass procedures decreased from 2005-10 to 2015-19. Gastrojejunostomy had higher 30-day mortality rate (11.5%) than other operations (p < 0.001). Adjusted 30-day mortality rates remained stable over time (7.8% vs 6.3%, p = 0.095), while rates of serious complications decreased over time (23.2% vs 17.1%, p < 0.001). CONCLUSIONS Palliative bypass for pancreatic cancer has not become safer over time, and 30-day mortality and complications remain high.
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Affiliation(s)
- Alexandra M Adams
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Bradley N Reames
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Robert W Krell
- Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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24
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Koob S, Schulze-Steinen H, Plöger MM, Randau TM, Strauß AC, Placzek R, Strauß AC. Preoperative embolization of renal cell carcinoma metastases to the bone prior to stabilization procedures does not result in reduction in intraoperative blood loss. Clin Exp Metastasis 2023; 40:117-122. [PMID: 36435893 PMCID: PMC9898427 DOI: 10.1007/s10585-022-10195-2] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The effect of preoperative embolization of bone metastases prior to stabilization procedures in reducing intraoperative blood loss remains controversial. This study aimed to analyze the effect of preoperative embolization on orthopedic stabilization procedures of the extremities and spine in cases with bone metastases from renal cell carcinomas. In particular, do these patients suffer less blood loss during the operation and do they need lesser fluid replacements or packed red cell bags intra- and perioperatively? Does preoperative embolization reduce the duration of surgery? METHODS We retrospectively reviewed stabilization procedures of the spine and extremities at our institution between 2011 and 2021 for group differences (embolization vs. no embolization) in terms of blood loss, fluid substitution, need for packed red cell transfusions, tumor size, and duration of surgery. RESULTS We reviewed 79 stabilization procedures of the spine (n = 36) and extremities (n = 43), of which 30 included preoperative embolization procedures. Surprisingly, the embolization group showed a statistically significant increase in blood loss, the need for fluid substitution, and red cell transfusions. Subgroup analysis revealed a significant negative effect of preoperative embolization on stabilization procedures of the extremities. CONCLUSION Based on our data, preoperative embolization of renal cell carcinoma metastases of the extremities had a negative effect on intraoperative blood loss and the need for fluid substitution and should therefore be avoided. Our data did not show an effect on stabilization procedures of the spine.
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Affiliation(s)
- Sebastian Koob
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Henrike Schulze-Steinen
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Milena M Plöger
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Thomas M Randau
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Anna C Strauß
- Department of Diagnostic and Interventional Radiology, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Richard Placzek
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas C Strauß
- Department of Orthopaedics and Trauma Surgery, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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25
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Fujimoto G, Kusanagi H, Hayashi K, Miyazaki A, Honjo H, Nakagi M. Impact of gastrectomy for incurable advanced gastric cancer in urgent situations in the elderly. Asian J Surg 2023; 46:514-519. [PMID: 35725798 DOI: 10.1016/j.asjsur.2022.06.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Chemotherapy is the standard treatment for incurable advanced gastric cancer; however, its indications are limited in elderly patients. Furthermore, the efficacy of chemotherapy and surgery as well as the treatment strategy for incurable gastric cancer in elderly patients with urgent conditions are unclear. In these situations, palliative gastrectomy or gastrojejunostomy is often performed. Less invasive surgical procedures should be performed on elderly patients in consideration of their condition; however, gastrectomy may be preferable if it can improve the prognosis. Therefore, we investigated the significance of palliative gastrectomy in elderly patients with incurable advanced gastric cancer who underwent surgery due to stenosis or bleeding. METHODS Fifty-six patients aged >80 years with stage IV incurable advanced gastric cancer who underwent surgery at our department between February 1992 and July 2021 were included in the study. The patients underwent gastrectomy (distal and total gastrectomy) or gastrojejunostomy. We examined the association between the clinicopathological factors and overall survival after surgery. RESULTS The subjects included 43 men and 13 women. Twenty-nine patients underwent distal gastrectomy or total gastrectomy, and 27 underwent gastrojejunostomy. The median follow-up duration for all patients was 297 days. The univariate analysis indicated significant differences in the surgical procedure and blood loss. Multivariate analysis showed a significant difference only in the surgical procedure (hazard ratio, 5.32; 95% confidence interval, 2.43-11.6; P < 0.001). CONCLUSIONS Gastrectomy as a palliative surgery for incurable advanced gastric cancer in elderly patients may improve their prognosis.
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Affiliation(s)
- Goshi Fujimoto
- Department of Gastroenterological Surgery, Koga Community Hospital, Yaizu, Shizuoka, Japan.
| | - Hiroshi Kusanagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ken Hayashi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Akinari Miyazaki
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Hirotaka Honjo
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masafumi Nakagi
- Department of Gastroenterological Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan
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Ushiku C, Akiyama S, Ikegami T, Inoue T, Shinohara A, Kobayashi S, Kajiwara T, Arimura D, Katsumi S, Obata S, Soshi S, Saito M. Clinical study of preoperative skeletal muscle mass as a predictor of physical performance recovery following palliative surgery for spinal metastases. J Orthop Sci 2022:S0949-2658(22)00170-1. [PMID: 35811255 DOI: 10.1016/j.jos.2022.06.006] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/05/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass. METHODS We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses. RESULTS The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610-149.00, P < 0.05) and the value of the area of the psoas major muscle at the L3 level normalized by the vertebral area not in the first tertile (OR: 0.22, 95% CI: 0.06-0.82, P < 0.05) were significant predictors of a good postoperative 30-day performance status. CONCLUSIONS A good preoperative performance status and exclusion from the first tertile were clinical factors predicting a good postoperative 30-day performance status. In patients with large psoas muscle mass (third tertile), a good 30-day performance status can be expected after surgery, suggesting that surgery in this population should be pursued aggressively.
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Affiliation(s)
- Chikara Ushiku
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan.
| | - Shoshi Akiyama
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Taku Ikegami
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Takeshi Inoue
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Akira Shinohara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shunsuke Kobayashi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Takayoshi Kajiwara
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Daigo Arimura
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shunsuke Katsumi
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shintaro Obata
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Shigeru Soshi
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Kashiwashita 163-1, Kashiwa, Chiba, 2778567, Japan; Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Nishishimbashi 3-19-18, Minatoku, Tokyo, 1058471, Japan
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Nohria A, Kaslow SR, Hani L, He Y, Sacks GD, Berman RS, Lee AY, Correa-Gallego C. Outcomes After Surgical Palliation of Patients With Gastric Cancer. J Surg Res 2022; 279:304-311. [PMID: 35809355 DOI: 10.1016/j.jss.2022.06.018] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/13/2022] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Surgery is an option for symptom palliation in patients with metastatic gastric cancer. Operative outcomes after palliative interventions are largely unknown. Herein, we assess the trends of surgical palliation use for patients with gastric cancer and describe outcomes of patients undergoing surgical palliation compared to nonsurgical palliation. METHODS Patients with clinical Stage IV gastric cancer in the National Cancer Database (2004-2015) who received surgical or nonsurgical palliation were selected. We identified factors associated with palliative surgery. Survival differences were assessed by Kaplan-Meier estimate, Cox proportional hazard regression, and log rank test. RESULTS Six thousand eight hundred twenty nine patients received palliative care for gastric cancer. Most patients (87%, n = 5944) received nonsurgical palliation: 29% radiation therapy, 57% systemic treatment, and 14% pain management. The number of patients receiving palliative care increased between 2004 and 2015; however, use of surgical palliation declined significantly (22% in 2004, 8% in 2015; P < 0.001). Median overall survival (OS) for the cohort was 5.65 mo (95% confidence interval 5.45-5.85); 1-year and 2-year OS were 24% and 9%, respectively. Older age at diagnosis and diagnosis between 2004 and 2006 were significantly associated with undergoing surgical palliation. Patients who underwent surgical palliation had significantly shorter median OS and a 20% higher hazard of mortality than those who received nonsurgical palliation. CONCLUSIONS Patients with metastatic gastric cancer experience very short survival. While palliative surgery is used infrequently, the observed association with shorter median OS underscores the importance of careful patient selection. Palliative surgery should be offered judiciously and expectations about outcomes clearly established.
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Affiliation(s)
- Ambika Nohria
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Sarah R Kaslow
- Department of Surgery, New York University Grossman School of Medicine, New York, New York.
| | - Leena Hani
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Yanjie He
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Greg D Sacks
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Russell S Berman
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Ann Y Lee
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
| | - Camilo Correa-Gallego
- Department of Surgery, New York University Grossman School of Medicine, New York, New York
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Fujisawa G, Niikura R, Kawahara T, Honda T, Hasatani K, Yoshida N, Nishida T, Sumiyoshi T, Kiyotoki S, Ikeya T, Arai M, Hayakawa Y, Kawai T, Fujishiro M. Effectiveness and safety of chemotherapy for patients with malignant gastrointestinal obstruction: A Japanese population-based cohort study. World J Clin Cases 2022; 10:5253-5265. [PMID: 35812690 PMCID: PMC9210883 DOI: 10.12998/wjcc.v10.i16.5253] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 03/09/2022] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The impacts of chemotherapy on patients with malignant gastrointestinal obstructions remain unclear, and multicenter evidence is lacking.
AIM To evaluate the effectiveness and safety of chemotherapy in patients with unresectable malignant gastrointestinal obstructions.
METHODS We conducted a multicenter retrospective cohort study that compared the chemotherapy group who received any chemotherapeutics after interventions, including palliative surgery or self-expandable metal stent placement, for unresectable malignant gastrointestinal obstruction vs the best supportive care (BSC) group between 2014 and 2019 in nine hospitals. The primary outcome was overall survival, and the secondary outcomes were patency duration and adverse events, including gastrointestinal perforation and gastrointestinal bleeding.
RESULTS In total, 470 patients in the chemotherapy group and 652 patients in the BSC group were analyzed. During the follow-up period of 54.1 mo, the median overall survival durations were 19.3 mo in the chemotherapy group and 5.4 mo in the BSC group (log-rank test, P < 0.01). The median patency durations were 9.7 mo [95% confidence interval (CI): 7.7-11.5 mo] in the chemotherapy group and 2.5 mo (95%CI: 2.0-2.9 mo) in the BSC group (log-rank test, P < 0.01). The perforation rate was 1.3% (6/470) in the chemotherapy group and 0.9% (6/652) in the BSC group (P = 0.567). The gastrointestinal bleeding rate was 1.5% (7/470) in the chemotherapy group and 0.5% (3/652) in the BSC group (P = 0.105).
CONCLUSION Chemotherapy after interventions for unresectable malignant gastrointestinal obstruction was associated with increased overall survival and patency duration.
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Affiliation(s)
- Gota Fujisawa
- Department of Gastroenterology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Ryota Niikura
- Gastroenterological Endoscopy, Tokyo Medical University, Tokyo 1600023, Japan
| | - Takuya Kawahara
- Clinical Research Support Center, The University of Tokyo Hospital, Tokyo 1138655, Japan
| | - Tetsuro Honda
- Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki 8508555, Japan
| | - Kenkei Hasatani
- Department of Gastroenterology, Fukui Prefectural Hospital, Fukui 9108526, Japan
| | - Naohiro Yoshida
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Ishikawa 9208530, Japan
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 5608565, Japan
| | - Tetsuya Sumiyoshi
- Department of Gastroenterology, Tonan Hospital, Hokkaido 0600004, Japan
| | - Shu Kiyotoki
- Department of Gastroenterology, Shuto General Hospital, Yamaguchi 7420032, Japan
| | - Takashi Ikeya
- Department of Gastroenterology, St. Luke's International Hospital, Tokyo 1048560, Japan
| | - Masahiro Arai
- Department of Gastroenterology, Nerima Hikarigaoka Hospital, Tokyo 1790072, Japan
| | - Yoku Hayakawa
- Department of Gastroenterology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
| | - Takashi Kawai
- Gastroenterological Endoscopy, Tokyo Medical University, Tokyo 1600023, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology, Graduate school of Medicine, The University of Tokyo, Tokyo 1138655, Japan
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Laitamäki M, Tyrväinen T, Lehto JT, Laukkarinen J, Ukkonen M. Endoscopic duodenal stenting is efficient, but has higher rate of reoperations than gastrojejunostomy in palliative treatment for gastric outlet obstruction. Langenbecks Arch Surg 2022; 407:2509-2515. [PMID: 35648229 PMCID: PMC9468122 DOI: 10.1007/s00423-022-02565-x] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/17/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical gastrojejunostomy has traditionally been the palliative treatment of choice for patients with advanced malignancies and gastric outlet obstruction syndrome. Recently, palliative endoscopic duodenal stenting has increased in popularity. We report outcomes after gastrojejunostomy and duodenal stenting when used for palliative indications. METHODS Consecutive patients undergoing palliative gastrojejunostomy or palliative endoscopic duodenal stenting in a Finnish tertiary referral center between January 2015 and December 2020 were included. The postoperative outcomes of these two palliative interventions were compared. The main outcome measures were mortality and morbidity, rate of reoperations, postoperative oral intake ability, and length of hospital stay. RESULTS A total of 88 patients, 46 (52%) patients underwent palliative gastrojejunostomy and 42 (48%) duodenal stenting. All patients had malignant disease, most typically hepatopancreatic cancer. Nineteen (44%) patients in duodenal stenting group and 4 (8.7%) patients in gastrojejunostomy group required subsequent interventions due to persisting or progressing symptoms (p < 0.001). Median delay until first oral intake was 2 days (1-24) after gastrojejunostomy and 0 days (0-3) after stenting (p < 0.001). Postoperative morbidity was 30% after gastrojejunostomy and 45% after stenting (p < 0.001). Median length of hospital stay was 7 days (1-27) after surgery and 5 days (0-20) after endoscopy (p < 0.001). CONCLUSIONS Patients undergoing endoscopic duodenal stenting are more able to initiate rapid oral intake and have shorter hospital stay. On the other hand, there are significantly more reoperations in stenting group. If the patient's life expectancy is short, we recommend stenting, but for patients whose life expectancy is longer, gastrojejunostomy could be a better procedure, for the reasons mentioned above.
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Affiliation(s)
- Matti Laitamäki
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Kuntokatu 2, 33520, ElämänaukioTampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Tuula Tyrväinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Kuntokatu 2, 33520, ElämänaukioTampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juho T Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Palliative Care Centre and Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Johanna Laukkarinen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Kuntokatu 2, 33520, ElämänaukioTampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Mika Ukkonen
- Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, Kuntokatu 2, 33520, ElämänaukioTampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Strong EA, Livingston A, Gracz M, Peltier W, Tsai S, Christians K, Gamblin TC, Kersting K, Clarke CN. Palliative Cytoreductive Surgery With or Without Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis: Is It Safe and Effective? J Surg Res 2022; 278:31-38. [PMID: 35588572 DOI: 10.1016/j.jss.2022.04.012] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/19/2022] [Accepted: 04/07/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Palliation is a controversial indication for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Patients with peritoneal carcinomatosis (PC) are living longer, and the roles of palliative CRS and HIPEC are increasingly challenged. The purpose of this study is to evaluate indications, morbidity, and symptom improvement from CRS/HIPEC in advanced PC. METHODS A retrospective review of patients undergoing CRS and/or HIPEC with a palliative intent at a single institution from February 2008 to February 2018 was performed. Main end points included symptom improvement, symptom-free interval, and overall survival. RESULTS Two hundred and seventy seven patients were referred for CRS/HIPEC during the study period and 17 underwent 20 palliative procedures. Appendiceal (n = 6) and colorectal cancers (n = 6) were the most common malignancies. Ascites (n = 8) and bowel obstruction (n = 8) were the most common indications for intervention. The postoperative complication rate was 50% and major complication rate was 20%. Partial symptom improvement or resolution of symptoms was achieved in 18 (90%) cases. A durable symptom control at 90 d was achieved in 13 (65%) cases. The median time to symptom recurrence was 5.1 mo (interquartile range: 2-11.4), and the median overall survival was 11.6 mo (interquartile range: 3.8-28.5). CONCLUSIONS Palliative CRS and/or HIPEC achieve symptom improvement in patients with advanced PC. Risk assessment and expected time to recovery from surgery remain paramount for patient selection.
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Affiliation(s)
- Erin A Strong
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Austin Livingston
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maciej Gracz
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Wendy Peltier
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kathleen Christians
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - T Clark Gamblin
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karen Kersting
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Callisia N Clarke
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin; Palliative Care Center, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Kawabata R, Fujitani K, Sakamaki K, Ando M, Ito Y, Tanizawa Y, Yamada T, Hirao M, Yamada M, Hihara J, Ryoji, Fukushima, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M, Yoshida K. Survival analysis of a prospective multicenter observational study on surgical palliation among patients with malignant bowel obstruction caused by peritoneal dissemination of gastric cancer. Gastric Cancer 2022; 25:422-429. [PMID: 34550490 DOI: 10.1007/s10120-021-01251-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our previous report showed that surgical palliation maintained quality of life (QOL), improved solid food intake, and had an acceptable surgical safety among patients with malignant bowel obstruction (MBO) caused by advanced gastric cancer. This study performed a survival analysis stratified by the patients' QOL to elucidate its impact on survival. METHODS Patients who underwent resection or bypass of the small intestine/colon or ileostomy/colostomy for bowel obstruction caused by peritoneal dissemination of gastric cancer were included. Validated instruments (EuroQoL-5 Dimensions) were used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the Gastric Outlet Obstruction Scoring System (GOOSS). Univariate and multivariate survival analyses were performed using baseline characteristics and changes in QOL and GOOSS scores 2 weeks after surgery to determine prognostic factors. RESULTS We enrolled 60 patients with a median survival time of 6.64 (95% CI 4.76-10.28) months. Patients who received postoperative chemotherapy and had lower baseline C-reactive protein (CRP) levels, higher baseline albumin levels, better baseline EuroQoL-5 Dimensions (EQ-5D) scores, and improved oral intake after palliative surgery exhibited significantly better survival. Multivariate analysis identified postoperative chemotherapy, lower baseline CRP levels, and improved oral intake as independent prognostic factors. CONCLUSIONS The current study revealed that baseline QOL and postoperative QOL changes did not affect survival. Moreover, improved oral intake, lower baseline CRP levels, and postoperative chemotherapy were significant prognostic factors in patients who underwent palliative surgery for advanced gastric cancer with MBO.
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Affiliation(s)
- Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai-city, , Osaka, 5918025, Japan. .,Department of Surgery, Sakai City Medical Center, Sakai, Japan.
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Fukushima
- Department of Surgery, Teikyo University School of Medicine, Itabashi City, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
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Abstract
Surgery for bone metastasis has two primary goals-palliative care to relieve pain, instability and paralysis, and tumor resection for curing the disease. Oncologically en bloc resection, followed by a reconstruction of the bone defect is the treatment of choice in single bone metastasis from renal cell carcinoma or thyroid cancer. Bone metastases may occur in the extremities, pelvis, or spine, and different resection and reconstruction methods depend on the regional anatomy. For instance, multiple options are available for reconstruction of the pelvis, especially for the acetabulum, including anatomical reconstruction using custom-made implants or recycled autologous bone grafting when a long-term prognosis is expected. Recently, for the spine, total en bloc spondylectomy is extensively performed despite the initial limitations of surgical invasiveness, such as blood loss. Principally, palliative surgery aims to maintain lasting bony stability with minimal surgical invasiveness. Intramedullary nails and plate fixation are frequently used in the extremities but the postoperative failure rate is relatively high. Therefore, surgeons should consider the use of long intramedullary nails and long-type stems for endoprosthesis reconstruction along with cement fixation to reduce the failure rate. Although short-term complications, such as dislocation, have been observed with endoprosthesis reconstruction, it is stable in the long-term follow-up. Percutaneous bone cement injection into the spine and pelvis is also effective and less invasive.
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Affiliation(s)
- Katsuhiro Hayashi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan
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Washio M, Hiki N, Hosoda K, Niihara M, Chuman M, Sakuraya M, Wada T, Harada H, Sato T, Tanaka K, Naitoh T, Kumamoto Y, Sangai T, Tanabe S, Yamashita K. Laparoscopic and endoscopic cooperative surgery for advanced gastric cancer as palliative surgery in elderly patients: a case report. Surg Case Rep 2021; 7:241. [PMID: 34779942 PMCID: PMC8593078 DOI: 10.1186/s40792-021-01325-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/31/2021] [Accepted: 11/06/2021] [Indexed: 01/03/2023] Open
Abstract
Background The number of elderly patients with gastric cancer is increasing, with the very elderly often refusing radical gastrectomy with lymph node dissection. Such a patient presented to us and we proposed a palliative surgery involving gastric local resection using laparoscopy endoscopy cooperative surgery (LECS). Case presentation An 89-year-old woman presented to our hospital with progressing anemia. She had an aortic arch replacement for aortic dissection 6 months previously and was taking antithrombotic drugs for atrial fibrillation. She was diagnosed with advanced gastric cancer, and we presented a radical resection treatment plan involving distal gastrectomy with lymph node dissection. However, she strongly refused undergoing radical gastric cancer resection. We believed that at least local control of the tumor could be effective in preventing future bleeding or stenosis due to tumor progression. Therefore, we proposed a local gastrectomy with LECS as an optional treatment, and she agreed to this treatment. The surgery was performed with minimal blood loss, and no postoperative complications were observed. Histopathological examination revealed a 45 × 31-mm, Type 2, poorly differentiated adenocarcinoma (pT4a, ly0, v1a), and the resected margin was negative. The patient was alive 2 years after surgery without apparent recurrence or other illness. In addition, her weight was maintained, together with her daily activity. Conclusion Local resection of gastric cancer with LECS might be an option for the palliative treatment of patients who refuse radical resection of gastric cancer.
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Affiliation(s)
- Marie Washio
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.
| | - Kei Hosoda
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Masahiro Niihara
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Motohiro Chuman
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Mikiko Sakuraya
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Takuya Wada
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Hiroki Harada
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Takeo Sato
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Kiyoshi Tanaka
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.,Division of Pediatric Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Takeshi Naitoh
- Department of Lower Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Yusuke Kumamoto
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Takafumi Sangai
- Department of Breast and Thyroid Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Satoshi Tanabe
- Department of Gastroenterology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Keishi Yamashita
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan.,Division of Advanced Surgical Oncology, Department of Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
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Ramos MFKP, Pereira MA, Dias AR, Sakamoto E, Ribeiro Jr U, Zilberstein B, Nahas SC. Jejunostomy in the palliative treatment of gastric cancer: A clinical prognostic score. World J Clin Oncol 2021; 12:935-946. [PMID: 34733615 PMCID: PMC8546652 DOI: 10.5306/wjco.v12.i10.935] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/03/2021] [Accepted: 09/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Clinical stage IV gastric cancer (GC) may need palliative procedures in the presence of symptoms such as obstruction. When palliative resection is not possible, jejunostomy is one of the options. However, the limited survival of these patients raises doubts about who benefits from this procedure. AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy. METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy. Eleven preoperative clinical variables were selected to define the score categories, with 90-d mortality as the main outcome. After randomization, patients were divided equally into two groups: Development (J1) and validation (J2). The following variables were used: Age, sex, body mass index (BMI), American Society of Anesthesiologists classification (ASA), Charlson Comorbidity index (CCI), hemoglobin levels, albumin levels, neutrophil-lymphocyte ratio (NLR), tumor size, presence of ascites by computed tomography (CT), and the number of disease sites. The score performance metric was determined by the area under the receiver operating characteristic (ROC) curve (AUC) to define low and high-risk groups. RESULTS Of the 363 patients with clinical stage IVCG, 80 (22%) patients underwent jejunostomy. Patients were predominantly male (62.5%) with a mean age of 62.4 years old. After randomization, the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score. The high NLR had the highest value. The ROC curve derived from these pooled parameters had an AUC of 0.712 (95%CI: 0.537-0.887, P = 0.022) to define risk groups. In the validation cohort, the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756, (95%CI: 0.598-0.915, P = 0.006). According to the cutoff, in the validation cohort BMI less than 18.5 kg/m2 (P < 0.001), CCI ≥ 1 (P = 0.001), ASA III/IV (P = 0.002), high NLR (P = 0.012), and the presence of ascites on CT exam (P = 0.004) were significantly associated with the high-risk group. The risk groups showed a significant association with first-line (P = 0.012), second-line chemotherapy (P = 0.009), 30-d (P = 0.013), and 90-d mortality (P < 0.001). CONCLUSION The scoring system developed with 11 variables related to patient's performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.
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Affiliation(s)
- Marcus Fernando Kodama Pertille Ramos
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Marina Alessandra Pereira
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Andre Roncon Dias
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Erica Sakamoto
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Ulysses Ribeiro Jr
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Bruno Zilberstein
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
| | - Sergio Carlos Nahas
- Department of Gastroenterology, Instituto do Cancer, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 01246000, Brazil
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35
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Zhu C, Platoff R, Ghobrial G, Saddemi J, Evangelisti T, Bucher E, Saracco B, Adams A, Kripalani S, Atabek U, Spitz FR, Hong YK. What to do When Decompressive Gastrostomies and Jejunostomies are not Options? A Scoping Review of Transesophageal Gastrostomy Tubes for Advanced Malignancies. Ann Surg Oncol 2021; 29:262-271. [PMID: 34546480 DOI: 10.1245/s10434-021-10667-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/09/2021] [Accepted: 08/05/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND In advanced malignant bowel obstruction, decompressive gastrostomy tubes (GTs) may not be feasible due to ascites, peritoneal carcinomatosis, and altered gastric anatomy. Whereas nasogastric tubes (NGTs) allow temporary decompression, percutaneous transesophageal gastrostomy tubes (PTEGs) are an alternative method for long-term palliative decompression. This study performed a scoping review to determine outcomes with PTEG in advanced malignancies. METHODS A systematic literature search was performed to include all studies that reported the clinical results of PTEGs for malignancy. No language, national, or publication status restrictions were used. RESULTS The analysis included 14 relevant studies with a total of 340 patients. In 11 studies, standard PTEGs were inserted with a rupture-free balloon's placement into the mouth or nose and esophageal puncture under fluoroscopy or ultrasound, followed by a guidewire into the stomach with placement of a single-lumen tube. Of 340 patients, 65 (19.1%) had minor complications, and 5 (2.1%) had significant complications, including bleeding and severe aspiration pneumonia. Of 171 patients, 169 with PTEGs (98.8%) reported relief of nasal discomfort from NGT and alleviation of obstructive symptoms. The one randomized controlled trial reported a significantly higher quality of life with PTEGs than with NGTs. CONCLUSIONS When decompression for advanced malignancy is technically not feasible with a gastrostomy tube, the PTEG is a viable, safe option for palliation. The PTEG is associated with lower significant complication rates than the gastrostomy tube and significantly higher patient-derived outcomes than the NGT.
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Affiliation(s)
- Clara Zhu
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Rebecca Platoff
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Gaby Ghobrial
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Jackson Saddemi
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Taylor Evangelisti
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Emily Bucher
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | | | - Amanda Adams
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Umur Atabek
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Francis R Spitz
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA
| | - Young K Hong
- Department of Surgery, Cooper University Hospital, 3 Cooper Plaza, Suite 411, Camden, NJ, 08103, USA.
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Gaisne E, Bellemère P, Kerjean Y, Loubersac T, Chaves C. Restoration of thumb opposition (opponensplasty). Hand Surg Rehabil 2021; 41S:S105-S111. [PMID: 34537401 DOI: 10.1016/j.hansur.2020.10.024] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
The authors review the therapeutic principles that must be applied when restoring the thumb opposition surgically. Among the many surgical techniques, five are featured: transfer of the flexor digitorum superficialis of the third or fourth finger, transfer of the extensor indicis proprius, transfer of the palmaris longus, translocation of the flexor palmaris longus tendon, transfer of the extensor pollicis longus. After summarizing the procedures, they emphasize the practical points that must be respected. This surgery, which cannot restore sensitivity, requires a precise assessment of the patient's wishes and information on what can be really expected.
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Affiliation(s)
- E Gaisne
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France.
| | - P Bellemère
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - Y Kerjean
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - T Loubersac
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
| | - C Chaves
- IMA Sante Atlantique, Boulevard Charles Gautier, BP 40419, 44819 Saint Herblain, France
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37
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Deo SVS, Kumar N, Rajendra VKJ, Kumar S, Bhoriwal SK, Ray M, Bhatnagar S, Mishra S. Palliative Surgery for Advanced Cancer: Clinical Profile, Spectrum of Surgery and Outcomes from a Tertiary Care Cancer Centre in Low-Middle-Income Country. Indian J Palliat Care 2021; 27:281-285. [PMID: 34511797 PMCID: PMC8428898 DOI: 10.25259/ijpc_399_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/13/2021] [Indexed: 11/11/2022] Open
Abstract
Objectives: Palliative surgery for cancer plays an important role in the overall management, especially in low-middle countries with a significant burden of advanced cancers. There is a paucity of literature related to the field of palliative surgery. In this study, we present the clinical spectrum, profile of surgical interventions and outcomes of palliative surgical procedures performed at a tertiary cancer centre involving multiple organ systems. Materials and Methods: A retrospective analysis of prospectively maintained surgical oncology database of a tertiary care cancer centre was performed. Patients fulfilling the criteria of palliative surgery were analysed for clinical spectrum, indications for surgery, palliative surgical procedures and post-operative outcomes. Results: A total of 678 out of 8300 patients fulfilled the criteria for palliative surgery. Palliative surgical procedures were performed most commonly for gastro-oesophageal malignancies (36.4%) followed by colorectal cancers (24%) and breast cancer (12%). Palliative mastectomy was the most common procedure performed for advanced breast cancer and 7% of sarcoma patients had amputations. Symptom relief could be achieved in 80–90% of patients and post-operative morbidity was relatively high among hepatobiliary, gastrointestinal and gynaecological cancer patients. Conclusion: Globally, a significant number of cancer patients need palliative surgical intervention, especially in LMIC with a high burden of advanced cancers. Results of the current study indicate that gastrointestinal cancer patients constitute a major proportion of patients undergoing palliative surgery. Overall results of the current study indicate that excellent palliation can be achieved in majority of patients with acceptable morbidity and hospital stay.
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Affiliation(s)
- S V S Deo
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Naveen Kumar
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Vinaya Kumar J Rajendra
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep Kumar Bhoriwal
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Mukurdipi Ray
- Department of Surgical Oncology, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Pain Palliative and Onco-Anesthesia, Dr B.R.A., Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Silvera J, Masmejean E. Preoperative imaging assessment of the paralytic upper limb. Hand Surg Rehabil 2021; 41S:S16-S22. [PMID: 34481127 DOI: 10.1016/j.hansur.2020.10.023] [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] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 11/26/2022]
Abstract
Imaging has become an essential tool in the study of the posttraumatic paralytic upper limb, in addition to the clinical examination and electroneuromyography. Upper extremity surgeons must be aware of how these different techniques contribute to the initial and preoperative assessment of nervous injuries. We review the appearance of traumatic nerve damage and muscle denervation during the initial injury assessment, focusing on the main aspects of brachial plexus injuries, paralysis after shoulder dislocation and traumatic damage to the radial nerve. Finally, we discuss the role of imaging for preoperative assessment of musculotendinous and osteoarticular palliative surgeries.
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Affiliation(s)
- J Silvera
- IMPC Bachaumont, 6 Rue Bachaumont, 75002 Paris, France; Research Unit, Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France.
| | - E Masmejean
- Research Unit, Clinique Blomet, 136 bis Rue Blomet, 75015 Paris, France; University of Paris, Medical School, 12, Rue de l'Ecole de Médecine, 75006 Paris, France; Hand, Upper Limb & Peripheral Nerve Surgery Service, Georges-Pompidou European Hospital (HEGP), 20, Rue Leblanc, 75015 Paris, France
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Ito Y, Fujitani K, Sakamaki K, Ando M, Kawabata R, Tanizawa Y, Yoshikawa T, Yamada T, Hirao M, Yamada M, Hihara J, Fukushima R, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M. QOL assessment after palliative surgery for malignant bowel obstruction caused by peritoneal dissemination of gastric cancer: a prospective multicenter observational study. Gastric Cancer 2021; 24:1131-1139. [PMID: 33791885 DOI: 10.1007/s10120-021-01179-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/03/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with peritoneal dissemination of gastric cancer have poor oral intake caused by malignant bowel obstruction (MBO). Palliative surgery has often been undertaken to improve quality of life (QOL), but few prospective studies on palliative surgery in this patient population have been published. PATIENTS AND METHODS We prospectively investigated the significance of palliative surgery using patient-reported QOL measures. Patients underwent palliative surgery by small intestine/colon resection or small intestine/colon bypass or ileostomy/colostomy for MBO. The primary endpoint was change in QOL assessed at baseline, 14 days, 1 month, and 3 months following palliative surgery using the Euro QoL Five Dimensions (EQ-5D™) questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications. RESULTS Between April 2013 and March 2018, 63 patients were enrolled from 14 institutions. The mean EQ-5D™ utility index baseline score of 0.6 remained consistent. Gastric-specific symptoms mostly showed statistically significant improvement from baseline. Forty-two patients (67%) were able to eat solid food 2 weeks after palliative surgery and 36 patients (57%) tolerated it for 3 months. The rate of overall morbidity of ≥ grade III according to the Clavien-Dindo classification was 16% (10 patients) and the 30-day postoperative mortality rate was 3.2% (2 patients). CONCLUSIONS In patients with MBO caused by peritoneal dissemination of gastric cancer, palliative surgery did not improve QOL while improving solid food intake, with an acceptable postoperative morbidity and mortality rate.
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Affiliation(s)
- Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Kazumasa Fujitani
- Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | | | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Clemente EA, Casares ÁP, Frontera PR, Calvar JMC, de Toledo JS. Finding the Optimal Timing for Repair of Standard Tetralogy of Fallot: Analysis of Cardiac Magnetic Resonance and Echocardiography Parameters Related to Intermediate Term Outcomes in a Pediatric Population. Pediatr Cardiol 2021; 42:1324-1333. [PMID: 33934202 DOI: 10.1007/s00246-021-02615-z] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Right ventricular (RV) dilatation is the determining prognostic factor in the long-term follow up of patients with repaired Tetralogy of Fallot (TOF). The objective of this study is to analyze whether the results vary depending on the timing of the complete repair and on the surgical technique applied. MATERIAL-METHODS This is a retrospective longitudinal study in which patients with standard TOF were divided into 3 groups depending on their age at surgical repair: group 1 = Early repair (n = 12,1-8 months), group 2 = Late repair (n = 26, > 8 months), and group 3 = Late repair with previous palliative surgery (n = 17, > 8 months). Clinical, echocardiographic and cardiac magnetic resonance (CMR) data from patients that had received complete reparative surgery in our institution from January 2000 to March 2014 were analyzed and compared. RESULTS 55 patients with echocardiogram and CMR studies (13.39 ± 3.59 years) were reviewed. All patients had at least moderate pulmonary regurgitation (PR). We observed a positive correlation between PR and right ventricular end-diastolic volume (r2 = 0.418; p = 0,004). Group 3 had more severe right ventricular dilatation than patients in groups 1 and 2 (p = 0.001). No differences in right ventricular end-diastolic volume, PR, and pulmonary trunk dimensions were observed between groups 1 and 2. Patients in group 3 had a longer hospital stay. CONCLUSIONS Although all patients from our cohort had significant PR, age at surgery was not related to RV or pulmonary trunk dilatation. Previous palliative surgery was associated with more severe right ventricular dilatation and longer hospital stays. No differences were observed between early and late repair groups. Our study suggests that postponing TOF repair to a late stage does not improve the degree of PR or long-term morbidity from RV dilatation. Palliative surgery should be avoided if possible.
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Affiliation(s)
- Esther Aurensanz Clemente
- Pediatric Cardiology Department, Sant Joan de Déu Children Hospital, C/Passeig Sant Joan de Deu, s/n, 08950, Esplugues, Barcelona, Spain.
| | - Álex Pérez Casares
- Pediatric Cardiology Department, Sant Joan de Déu Children Hospital, C/Passeig Sant Joan de Deu, s/n, 08950, Esplugues, Barcelona, Spain.,CMR Imaging Department, Sant Joan de Déu Children Hospital, Barcelona, Spain
| | - Pablo Ruiz Frontera
- Intensive Care Unit, Cardiac Institute Quiron Salud Teknon, Barcelona, Spain
| | | | - Joan Sanchez de Toledo
- Pediatric Cardiology Department, Sant Joan de Déu Children Hospital, C/Passeig Sant Joan de Deu, s/n, 08950, Esplugues, Barcelona, Spain
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Kanda Y, Kakutani K, Sakai Y, Zhang Z, Yurube T, Miyazaki S, Kakiuchi Y, Takeoka Y, Tsujimoto R, Miyazaki K, Ohnishi H, Hoshino Y, Takada T, Kuroda R. Surgical outcomes and risk factors for poor outcomes in patients with cervical spine metastasis: a prospective study. J Orthop Surg Res 2021; 16:423. [PMID: 34217343 PMCID: PMC8254288 DOI: 10.1186/s13018-021-02562-8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/16/2021] [Indexed: 11/10/2022] Open
Abstract
Background Few studies have addressed the impact of palliative surgery for cervical spine metastasis on patients’ performance status (PS) and quality of life (QOL). We investigated the surgical outcomes of patients with cervical spine metastasis and the risk factors for a poor outcome with a focus on the PS and QOL. Methods We prospectively analyzed patients with cervical spine metastasis who underwent palliative surgery from 2013 to 2018. The Eastern Cooperative Oncology Group PS (ECOGPS) and EuroQol 5-Dimension (EQ5D) score were assessed at study enrollment and 1, 3, and 6 months postoperatively. Neurological function was evaluated with Frankel grading. Univariate and multivariate analyses were performed to identify the risk factors for a poor surgical outcome, defined as no improvement or deterioration after improvement of the ECOGPS or EQ5D score within 3 months. Results Forty-six patients (mean age, 67.5 ± 11.7 years) were enrolled. Twelve postoperative complications occurred in 11 (23.9%) patients. The median ECOGPS improved from PS3 at study enrolment to PS2 at 1 month and PS1 at 3 and 6 months postoperatively. The mean EQ5D score improved from 0.085 ± 0.487 at study enrolment to 0.658 ± 0.356 at 1 month and 0.753 ± 0.312 at 3 months. A poor outcome was observed in 18 (39.1%) patients. The univariate analysis showed that variables with a P value of < 0.10 were sex (male), the revised Tokuhashi score, the new Katagiri score, the level of the main lesion, and the Frankel grade at baseline. The multivariate analysis identified the level of the main lesion (cervicothoracic junction) as the significant risk factor (odds ratio, 5.00; P = 0.025). Conclusions Palliative surgery for cervical spine metastasis improved the PS and QOL, but a cervicothoracic junction lesion could be a risk factor for a poor outcome.
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Affiliation(s)
- Yutaro Kanda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kenichiro Kakutani
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Zhongying Zhang
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takashi Yurube
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shingo Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuji Kakiuchi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yoshiki Takeoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryu Tsujimoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kunihiko Miyazaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Hiroki Ohnishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Toru Takada
- Department of Orthopaedic Surgery, Kobe Hokuto Hospital, 10-3, Umekidani, Shimotanigami, Yamada-cho, Kita-ku, Kobe, 651-1243, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
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Cambon-Binder A, Chammas M, Coulet B, Lazerges C. Palliative surgery for thumb involvement in ulnar paralysis. Hand Surg Rehabil 2021:S2468-1229(21)00177-8. [PMID: 34217899 DOI: 10.1016/j.hansur.2020.10.021] [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] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 10/07/2020] [Accepted: 10/09/2020] [Indexed: 11/22/2022]
Abstract
Ulnar paralysis has multiple clinical presentations, which are due to partial recovery or to anatomical variations between the ulnar and median nerves. The main sequelae of ulnar nerve paralysis are the loss of hand strength with impairment of all intrinsic functions of the fingers and some of the thumb's functions. Weakness of the adductor pollicis and flexor pollicis brevis muscles may manifest as weak key pinch with automatic flexion of the thumb interphalangeal joint when gripping. Indications for palliative surgery have decreased due to advances in peripheral nerve surgery. However, palliative surgery still has a significant role to play when nerve repair techniques are not indicated or do not provide satisfactory results. The principle is to reinforce metacarpophalangeal flexion while stabilizing the thumb's interphalangeal joint, thus supplementing the action of the flexor pollicis brevis. This is generally done by transferring the flexor digitorum superficialis tendon of the fourth finger to the distal insertion of the superficial thenar muscles and the extensor pollicis longus. Restoration of the first dorsal interosseous is more rarely indicated.
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Abstract
Surgical palliation in oncology can be defined as "procedures employed with non-curative intent with the primary goal of improving symptoms caused by an advanced malignancy," and is an important aspect of the end-of-life care of patients with incurable malignancies. Palliative interventions may provide great benefit, but they also carry high risk for morbidity and mortality, which may be minimized with careful patient selection. This can be done by consideration of the patient and his or her indication for the given intervention via open communication, as well as prediction of benefits and risks to define the therapeutic index of the operation or procedure.
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Affiliation(s)
- Cassandra S Parker
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 443, Providence, RI 02903, USA
| | - Thomas J Miner
- Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 593 Eddy Street, APC 443, Providence, RI 02903, USA.
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Louie AD, Miner TJ. Palliative surgery and the surgeon's role in the palliative care team: a review. Ann Palliat Med 2021; 11:907-917. [PMID: 34263642 DOI: 10.21037/apm-20-2381] [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] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/26/2021] [Indexed: 11/06/2022]
Abstract
This review focuses on the role of palliative surgery in the care of the palliative care patient, and the appropriate role of the surgeon. The surgeon has much to bring to the palliative care team. The surgeon's role goes beyond the technical requirements of the palliative procedure, which itself must be strictly defined, and has recognized utility for improving quality of life in selected patients. These benefits may be substantial, but come at significant risk; requiring careful balancing of risks and benefits that is most completely understood by the surgeon. The surgeon's judgement can help determine which procedure best meets a patient's goals. The complex dialogue involved in the decision to undergo a palliative operation requires excellent communication between the palliative care team, the patient, and their family. Integrating the surgeon into the palliative care team could help with earlier initiation of those palliative discussions, and assist deliberation of palliative surgery. Surgeons also understand the importance of communication around palliative surgical interventions and have adapted several teaching models to the specifics of this crucial communication. A palliative team combining both surgeons and palliative care physicians may promote goalconcordant decision-making and remove barriers to communication and team engagement. The future of palliative surgery research will involve measures of success that go beyond physiology or mortality, to include more evaluations of communication and patient goals.
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Affiliation(s)
- Anna D Louie
- Department of Surgery, Brown University, Lifespan Health System and Warren Alpert Medical School, Providence, RI, USA
| | - Thomas J Miner
- Department of Surgery, Brown University, Lifespan Health System and Warren Alpert Medical School, Providence, RI, USA
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45
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Coffey MR, Bachman KC, Worrell SG, Argote-Greene LM, Linden PA, Towe CW. Palliative Surgery Outcomes for Patients with Esophageal Cancer: An NCDB Analysis. J Surg Res 2021; 267:229-234. [PMID: 34161839 DOI: 10.1016/j.jss.2021.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 03/02/2021] [Revised: 04/26/2021] [Accepted: 05/07/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Many patients with esophageal cancer are not candidates for surgical resection with curative intent, given the advanced stage of disease at presentation. Palliative surgery is one treatment option, but relative survival of palliative surgery has not been described. This study aims to describe the outcomes of palliative surgery in patients with esophageal cancer. METHODS We used the National Cancer Database to identify patients with esophageal cancer who received palliative surgery or non-surgical palliation-which consisted of palliative radiation and palliative chemotherapy without any surgery. The outcome of interest was overall survival. Characteristics of patients were compared between the palliative surgery group and the non-surgical group using rank sum test or chi square test. Survival differences between groups were compared using Kaplan Meier estimate and log rank test, and Cox proportional hazards model. RESULTS A total of 14,589 patients were included in the analysis, including 2,812 (19.2%) receiving palliative surgery and 11,777 (80.7%) receiving non-surgical palliation (6,512 palliative radiation and 5,265 palliative chemotherapy). Median overall survival in palliative surgery patients was 5.5 mo, shorter than non-surgical palliation (6.4 mo, P = 0.004). However, when correcting for age, sex, nodal status, metastases, Charlson score, histology, academic center, and private insurance, there was no difference in survival between palliative surgery and non-surgical palliation in Cox proportional hazard modeling (HR 1.03 (0.975-1.090), P = 0.281). CONCLUSIONS Palliative surgery in advanced esophageal cancer is associated with poor overall survival but is similar to other palliative modalities. Palliative Surgery for esophageal cancer patients should be used sparingly given these poor outcomes.
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Affiliation(s)
- Max R Coffey
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Katelynn C Bachman
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Stephanie G Worrell
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Luis M Argote-Greene
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Philip A Linden
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Christopher W Towe
- Division of Thoracic and Esophageal Surgery, Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio; Division of Thoracic and Esophageal Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
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Pierrart J, Aumar A, Masmejean E. Palliative surgery: When? Which technique? Basic principles. Hand Surg Rehabil 2021; 41S:S5-S10. [PMID: 34146745 DOI: 10.1016/j.hansur.2020.10.020] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
Palliative surgery aims to restore or compensate for the loss of a function for which nerve repairs are no longer or not feasible. It includes tendon transfer, tenodesis, arthrodesis and osteotomy techniques. Palliative surgery is based on several well-established principles that are essential to know. The purpose of this introductory chapter is to review the various basic principles before undertaking palliative surgery.
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Affiliation(s)
- J Pierrart
- Cabinet ARCHIMED, Clinique des Deux Caps, 80, Avenue des Longues Pièces, 62231 Coquelles, France.
| | - A Aumar
- Cabinet ARCHIMED, Clinique Lille-Sud, 96, Rue Gustave Delory, 59810 Lesquin, France
| | - E Masmejean
- Hand, Upper Limb & Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 28, Rue Leblanc, 75015 Paris, France; University of Paris, Medical School, 12, Rue de l'Ecole de Médecine, 75006 Paris, France; Clinique Blomet, Research Unit, 136 Bis, Rue Blomet, 75015 Paris, France
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Clavert P, Antoni M. Shoulder arthrodesis in brachial plexus palsy. Hand Surg Rehabil 2021; 41S:S54-S57. [PMID: 34147669 DOI: 10.1016/j.hansur.2018.05.009] [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] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 05/03/2018] [Accepted: 05/20/2018] [Indexed: 11/26/2022]
Abstract
Long considered as the ultimate surgery for limb salvage in case of brachial plexus palsy, shoulder fusion has seen its indications reduced with the development of more numerous and multiple tendon transfers. This option remains valid and should always be suggested first because of its reliable effects on pain and function. However, it is a demanding surgery, the position of the fusion remains difficult to determine and the complication rate is not negligible.
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Affiliation(s)
- P Clavert
- Service de Chirurgie du Membre Supérieur, CHRU Strasbourg, 10, avenue Baumann, 67400 Illkirch-Graffenstaden, France.
| | - M Antoni
- Service de Chirurgie du Membre Supérieur, CHRU Strasbourg, 10, avenue Baumann, 67400 Illkirch-Graffenstaden, France
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Consales A, Casciato S, Asioli S, Barba C, Caulo M, Colicchio G, Cossu M, de Palma L, Morano A, Vatti G, Villani F, Zamponi N, Tassi L, Di Gennaro G, Marras CE. The surgical treatment of epilepsy. Neurol Sci 2021; 42:2249-2260. [PMID: 33797619 DOI: 10.1007/s10072-021-05198-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/27/2020] [Accepted: 03/16/2021] [Indexed: 01/07/2023]
Abstract
In 2009, the Commission for Epilepsy Surgery of the Italian League Against Epilepsy (LICE) conducted an overview about the techniques used for the pre-surgical evaluation and the surgical treatment of epilepsies. The recognition that, in selected cases, surgery can be considered the first-line approach, suggested that the experience gained by the main Italian referral centers should be pooled in order to provide a handy source of reference. In light of the progress made over these past years, some parts of that first report have accordingly been updated. The present revision aims to harmonize the general principles regulating the patient selection and the pre-surgical work-up, as well as to expand the use of epilepsy surgery, that still represents an underutilized resource, regrettably. The objective of this contribution is drawing up a methodological framework within which to integrate the experiences of each group in this complex and dynamic sector of the neurosciences.
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Affiliation(s)
- Alessandro Consales
- Division of Neurosurgery, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Sara Casciato
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, Section of Anatomic Pathology "M. Malpighi", Bellaria Hospital, Bologna, Italy
| | - Carmen Barba
- Neuroscience Department, Meyer Children's Hospital-University of Florence, Florence, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | | | - Massimo Cossu
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Luca de Palma
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, "Sapienza" University, Rome, Italy
| | - Giampaolo Vatti
- Department of Neurological and Sensorial Sciences, University of Siena, Siena, Italy
| | - Flavio Villani
- Division of Neurophysiology and Epilepsy Centre, IRCCS San Martino Policlinic Hospital, Genoa, Italy
| | - Nelia Zamponi
- Child Neuropsychiatric Unit, University of Ancona, Ancona, Italy
| | - Laura Tassi
- "C. Munari" Epilepsy Surgery Center, Niguarda Hospital, Milan, Italy
| | - Giancarlo Di Gennaro
- Epilepsy Surgery Centre, IRCCS Neuromed, Via Atinense, 18, 86170, Pozzilli, IS, Italy.
| | - Carlo Efisio Marras
- Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children Hospital, Rome, Italy
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Wang Y, Man Z, Hu X, Zhou L, Jin H, Liu H, Pang Q. Percutaneous biliary stent with intraluminal brachytherapy versus palliative surgery in the management of extrahepatic cholangiocarcinoma. Int J Clin Oncol 2021; 26:933-940. [PMID: 33630187 DOI: 10.1007/s10147-021-01877-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND To compare the efficacy and outcomes of self-expandable metallic stent combined with catheter-loaded iodine-125 seeds (SEMS-CL-125I) brachytherapy versus conventional palliative surgery (PS) in advanced extrahepatic cholangiocarcinoma (EHCC). METHODS The retrospective analysis consisted of 101 advanced EHCC patients who received SEMS-CL-125I (n = 67) or underwent PS (n = 34). The clinical characteristics, postoperative complications and overall survival (OS) were compared between the two groups. RESULTS Serum levels of bilirubin, transaminase, and albumin (ALB) were significantly improved at 1 month, 3 months, and 6 months postoperatively in both groups (all P < 0.05). At 1 month after operation, the level of ALB in SEMS-CL-125I group was significantly higher than that in PS group (39.07 ± 3.83 vs. 36.60 ± 5.58 g/L, P = 0.015). No statistically significant difference was found in postoperative overall complications between the two groups (P = 0.052). Length of hospital stay was significantly shorter (P < 0.001), hospital costs were significantly less (P < 0.001), and OS was significantly better (P = 0.029) in SEMS-CL-125I group compared to PS group. Multivariate analysis further identified PS (HR = 2.90, 95% CI 1.71-4.93, P < 0.001) and higher level of carbohydrate antigen 19-9 (HR = 2.67, 95% CI 1.36-3.79, P = 0.002) as independent predictors of worse OS. CONCLUSION SEMS-CL-125I significantly improves outcomes compared with PS and could be a safe and effective treatment for advanced EHCC.
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Affiliation(s)
- Yong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China
| | - Zhongran Man
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China
| | - Xiaosi Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China
| | - Lei Zhou
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China
| | - Hao Jin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China
| | - Huichun Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China.
| | - Qing Pang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, 233000, Anhui, China.
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Sakamoto S, Matsumura M, Tani K, Nemoto S, Tsuchida K, Koga F, Seyama Y. Jejunal limb obstruction by a tumor thrombus from pancreatic metastasis of renal cell carcinoma: a case report. Surg Case Rep 2021; 7:37. [PMID: 33534019 PMCID: PMC7859002 DOI: 10.1186/s40792-021-01122-w] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Renal cell carcinoma (RCC) is a primary tumor with the highest frequency of pancreatic metastasis. Although surgical resection can improve the prognosis of some patients with pancreatic metastasis of RCC (PM-RCC), the role of palliative surgery remains unclear. Herein, we described a case of jejunal limb occlusion caused by a tumor thrombus arising from a PM-RCC which was treated by surgical resection. CASE PRESENTATION A 75-year-old, male patient with metastatic RCC was admitted to our hospital with new-onset dysphagia and weight loss. Twenty years earlier he underwent a right nephrectomy with an adrenalectomy for the first surgical resection of RCC, and 12 years ago he underwent a left partial nephrectomy for metachronous primary RCC. Nine years later, multiple pancreatic metastases were detected. After discontinuing interferon therapy, he was followed up at his request without anticancer treatment. Multiple, pulmonary metastases developed 3 years ago, and resection of a brain metastasis was performed 6 months ago. He had also undergone a total gastrectomy with Roux-en Y reconstruction and splenectomy for gastric cancer 23 years ago. Computed tomography revealed a metastatic lesion in the pancreatic tail extending into the jejunal limb, which was obstructed by a tumor thrombus. Jejunal limb resection was performed concomitantly with a distal pancreatectomy as palliative surgery. The jejunal limb remnant was approximately 30 cm long and was re-anastomosed to the esophagus using a circular stapler. Blood perfusion at the anastomotic site was confirmed by indocyanine green fluorescence imaging. He was discharged on postoperative day 24 and was followed in the outpatient clinic. He achieved sufficient oral intake at 8 months postoperatively. CONCLUSIONS PM-RCC can invade the gastrointestinal tract and cause tumor thrombus formation resulting in bowel occlusion requiring surgical intervention.
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Affiliation(s)
- Shinya Sakamoto
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Masaru Matsumura
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Keigo Tani
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Satoshi Nemoto
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Kazuhito Tsuchida
- Department of Gastric Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Yasuji Seyama
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
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