Cement leakage: safety of minimally invasive surgical techniques in the treatment of multiple myeloma vertebral lesions

End-organ damage is the factor that differentiates plasma cell dyscrasia requiring therapy (active multiple myeloma [MM]) from disease that does not require therapy (monoclonal gammopathy of undetermined significance and smoldering [asymptomatic] MM). Progressive skeletal destruction is the hallmark of MM and responsible for principle morbidity in the disease. The spine is the most afflicted skeletal organ, and vertebral fractures have significantly contributed to its poor prognosis. Early mortality in MM is usually attributed to the combined effects of active disease and comorbid factors. Infection and renal failure are the main direct causes of early mortality. Using bisphosphonates to manage skeletal events mainly by preventing or slowing the destructive process has become an important adjunctive treatment in MM. Advances in minimally invasive surgical techniques, such as percutaneous vertebroplasty and kyphoplasty, offer these patients less-invasive options for treating vertebral collapse and restoring function. The aggressive management of other complications of the disease through more effective and less toxic therapy that targets the primary disease, in addition to supportive care, is resulting in patients experiencing less morbidity and probably lower mortality. This article reviews recent advances in the understanding of bone disease in MM, the role of bisphosphonates in preventing skeletal events, and available data on percutaneous vertebroplasty and kyphoplasty, and discusses the management of infection and renal failure, which seem to be responsible for high initial mortality and thereby compromise the current advances in therapy.

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Evolution and Future Perspectives of Rectal Cancer Treatment with Minimally Invasive Surgical Techniques

The First Outstanding 50 Years of “Università Politecnica delle Marche” ◽

10.1007/978-3-030-33832-9_19 ◽

2020 ◽

pp. 285-301

Author(s):

Mario Guerrieri ◽

Roberto Ghiselli

Keyword(s):

Rectal Cancer ◽

Minimally Invasive ◽

Cancer Treatment ◽

Surgical Techniques ◽

Future Perspectives ◽

Minimally Invasive Surgical ◽

Rectal Cancer Treatment

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Minimally Invasive Circumferential Spinal Decompression and Stabilization for Symptomatic Metastatic Spine Tumor

Neurosurgery ◽

10.1227/01.neu.0000365270.23815.b1 ◽

2010 ◽

Vol 66 (3) ◽

pp. E620-E622 ◽

Cited By ~ 22

Author(s):

Alexander Taghva ◽

Khan W. Li ◽

John C. Liu ◽

Ziya L. Gokaslan ◽

Patrick C. Hsieh

Keyword(s):

Spinal Cord ◽

Minimally Invasive ◽

Spinal Cord Compression ◽

Surgical Techniques ◽

Cord Compression ◽

Pedicle Screw Fixation ◽

Lower Extremity Weakness ◽

Hardware Failure ◽

Minimally Invasive Surgical ◽

Potential Benefits

Abstract OBJECTIVE Metastatic epidural spinal cord compression is a potentially devastating complication of cancer and is estimated to occur in 5% to 14% of all cancer patients. It is best treated surgically. Minimally invasive spine surgery has the potential benefits of decreased surgical approach–related morbidity, blood loss, hospital stay, and time to mobilization. CLINICAL PRESENTATION A 36-year-old man presented with worsening back pain and lower extremity weakness. Workup revealed metastatic adenocarcinoma of the lung with spinal cord compression at T4 and T5. INTERVENTION AND TECHNIQUE T4 and T5 vertebrectomy with expandable cage placement and T1–T8 pedicle screw fixation and fusion were performed using minimally invasive surgical techniques. RESULT The patient improved neurologically and was ambulatory on postoperative day 1. At the 9-month follow-up point, he remained neurologically intact and pain free, and there was no evidence of hardware failure. CONCLUSION Minimally invasive surgical circumferential decompression may be a viable option for the treatment of metastatic epidural spinal cord compression.

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Minimally Invasive Surgical Techniques for Cancers of the Small Intestine

Surgery for Cancers of the Gastrointestinal Tract ◽

10.1007/978-1-4939-1893-5_14 ◽

2014 ◽

pp. 157-166

Author(s):

Bestoun Ahmed ◽

Dilendra H. Weerasinghe ◽

Michael S. Nussbaum

Keyword(s):

Small Intestine ◽

Minimally Invasive ◽

Surgical Techniques ◽

Minimally Invasive Surgical

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Minimally Invasive Resection of Benign Gastric Tumors in Challenging Locations: Prepyloric Region or Gastroesophageal Junction

The American Surgeon ◽

10.1177/000313481307901002 ◽

2013 ◽

Vol 79 (10) ◽

pp. 968-972 ◽

Cited By ~ 1

Author(s):

Christopher Armstrong ◽

Alana Gebhart ◽

Brian R. Smith ◽

Ninh T. Nguyen

Keyword(s):

Minimally Invasive ◽

Perioperative Complications ◽

Wedge Resection ◽

Gastroesophageal Junction ◽

Surgical Techniques ◽

Surgical Approaches ◽

Anatomic Resection ◽

Submucosal Tumors ◽

Gastric Tumors ◽

Minimally Invasive Surgical

Benign gastric tumors in a prepyloric location or within 3 cm adjacent of the gastroesophageal junction (GEJ) are often challenging to resect using minimally invasive surgical techniques. The aim of this study was to examine the outcomes of patients who underwent minimally invasive enucleation or resection of benign gastric tumors at these difficult locations. The charts of patients undergoing minimally invasive resection of benign-appearing submucosal gastric tumors between June 2001 and December 2012 were reviewed. Data on tumor size and location, type of minimally invasive surgical resection, perioperative complications, 90-day mortality, pathology, and recurrence were collected. A total of 70 consecutive patients underwent laparoscopic resection of benign-appearing submucosal gastric tumors; there were 24 patients with lesions close to the GEJ and nine patients with lesions close to the prepyloric region. All lesions were successfully resected laparoscopically. For prepyloric tumors, surgical approaches included enucleation (n = 1), wedge resection (n = 2), and distal gastrectomy with reconstruction (n = 6). For tumors close to the GEJ, surgical approaches included enucleation (n = 16), wedge resection (n = 3), and esophagogastrectomy (n = 5). Complications in this series of 33 patients included late strictures requiring endoscopic dilation in three patients who underwent esophagogastrectomy. The 90-day mortality rate was zero. There were no recurrences over a mean follow-up of 15 months (range, 1 to 86 months). Minimally invasive enucleation or formal anatomic resection of submucosal tumors located adjacent to the GEJ or at the prepyloric region is safe and carries a low risk for tumor recurrence. Submucosal gastric lesions adjacent to the GEJ are amenable to laparoscopic enucleation or wedge resection unless they extend proximally into the esophagus. Prepyloric lesions often require formal anatomic resection with reconstruction.

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