Conservative En Bloc Surgery for Aggressive Angiomyxoma Achieves Good Local Control: Analysis of 14 Patients From a Single Institution

2013 ◽  
Vol 23 (3) ◽  
pp. 540-545 ◽  
Author(s):  
Sarah Coppola ◽  
Anant Desai ◽  
Dimitri Tzanis ◽  
Charles Honoré ◽  
Georgina Bitsakou ◽  
...  
Keyword(s):  
Local Control ◽  
Pathological Examination ◽  
Aggressive Angiomyxoma ◽  
Control Analysis ◽  
En Bloc ◽  
Primary Tumors ◽  
Median Size ◽  
Good Local Control ◽  
Wait And See

BackgroundThe purpose of this study was to assess the value of conservative surgery in aggressive angiomyxoma (AA) in our institutional series.MethodThis was a retrospective review of patients with AA treated at our institution between 1999 and 2010.ResultsFourteen consecutive patients were analyzed: 8 primary tumors and 6 recurrences. Female/male ratio was 13:1; median female age was 36 years. Median size of primary lesions was 12 cm (range, 7–17 cm). Median size of recurrences was 20.5 cm (range, 3–44 cm). Twelve patients were operated on. Two asymptomatic patients whose surgery would have been mutilating were placed under wait and see. Four patients had concomitant visceral resections because of massive infiltration. No tumor rupture was recorded on pathological examination. Margins were R0 (n = 2), R1 (n = 10), and R2 (n = 0). Seven patients (50%) received radiotherapy. Median postoperative follow-up was 69 months, and no patient was lost at follow-up. All patients operated on (primaries and recurrences) had no evidence of recurrence.ConclusionConservative and planned en bloc surgery achieves good local control with low morbidity. Radiotherapy could enhance local control in advanced disease. Wait and see is an exploratory option for asymptomatic, stable, and nonprogressing AA in which surgery would be mutilating.

Does stereotactic body radiation therapy have a role in oligoprogressive metastatic colorectal cancer?

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 755-755
Author(s):  
Will Jin ◽  
Aidan M. Burke ◽  
Abdul Rashid ◽  
John Marshall ◽  
Keith Robert Unger
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Metastatic Colorectal Cancer ◽  
Local Control ◽  
Stereotactic Body Radiation Therapy ◽  
Primary Tumors ◽  
Progression Of Disease ◽  
Delay Progression

755 Background: Patients with metastatic colorectal cancer undergoing systemic therapy may enter an oligoprogressive state. Traditionally, local ablative therapy (LAT) has been limited to symptom palliation. We hypothesize that LAT for oligoprogressive lesions with stereotactic body radiation therapy (SBRT) is a feasible alternative to surgical interventions and may delay progression of disease. Methods: An IRB-approved retrospective review of patients with oligoprogressive, metastatic colorectal cancer who were treated with SBRT at Georgetown University Hospital from 2012-2016 was performed. Results: 40 patients with 41 metastatic lesions of the lung (n = 11), liver (n = 10), lymph nodes (n = 8), soft tissue (n = 6), and bone (n = 6) were reviewed. Median follow-up, overall survival, and freedom from distant progression were 10.6, 17.3, and 6.4 months, respectively. Crude one year local control and overall survival were 82.9% and 75%, respectively. First site of progression was distally in 63.4% of patients. Patients treated with SBRT in the liver were significantly more likely to locally progress than other treated sites (13.18 vs. 39.81 months, p = 0.007). On univariate analysis, non-lymph node treated tumors (p = 0.046), larger CEA change at 6 month follow-up (p = 0.048), and right sided primary tumors (p = 0.004) were associated with local failure within 1 year. On multivariate analysis, only right sided primary tumors were significantly more likely to locally progress (p = 0.009). Conclusions: Patients with oligoprogressive colorectal cancer can be effectively treated with SBRT to achieve acceptable rates of local control and potentially delay progression of disease.

scholarly journals Laparoscopic partial nephrectomy: the University of Saskatchewan (Regina division) experience

2013 ◽  
Vol 3 (2) ◽  
pp. 111 ◽  
Author(s):  
Andrew Tse ◽  
Russel Knaus ◽  
Edward Tse
Keyword(s):  
Partial Nephrectomy ◽  
Tumour Size ◽  
Operating Time ◽  
Laparoscopic Partial Nephrectomy ◽  
Pathological Examination ◽  
Incontinence Urinaire ◽  
En Bloc ◽  
Open Partial Nephrectomy ◽  
Imaging Characteristics

Purpose: Open partial nephrectomy (OPN) is now the preferredtreatment for most T1a and selected T1b tumours. Laparoscopicpartial nephrectomy (LPN), created to reduce the morbidity associatedwith OPN, is now a viable option when performed by experiencedlaparoscopic surgeons. We retrospectively review ourLPN experience and propose a new parameter, the LPN utilizationrate (LPN-UR), defined as the probability of any referredpatient with a T1 tumour undergoing LPN before the surgeon’sknowledge of its imaging characteristics, to define the role of LPNat our institution.Methods: Between March 2003 and August 2008, 47 consecutivepatients underwent LPN for T1 tumours. All patients underwenttransient en bloc vascular occlusion of the renal hilum forcold-scissor tumour excisions. Preoperative, intraoperative, postoperativeand pathological data were collected. The LPN-URs for2005, 2006, 2007 and 2008 were calculated.Results: There were 31 nonhilar tumours and 16 hilar tumours. Allprocedures were completed laparoscopically. Mean tumour size was3.8 (range 1.5–7.2) cm. Mean operating time was 2.8 (range 1.2–4.5)hours. Mean hospital stay was 5.2 (range 2.0–15.0) days. Mean warmischemic time (WIT) was 32.7 (range 14.2–50.4) minutes. Six patients(12.8%) received blood transfusions and 1 patient required an emergencynephrectomy for bleeding. One patient developed urinaryleakage. One patient developed a late calyceal stricture. Mean postoperativedifferential renal function was 35%:50%. Median follow-up was 18 months. Pathological examination of all tumoursrevealed 38/47 (80.9%) malignant tumours with 2 positive surgicalmargins (4.3%). The LPN-URs for 2005, 2006, 2007 and 2008were 50%, 54%, 63% and 93%, respectively, for all T1 tumours.Conclusion: Laparoscopic partial nephrectomy can be safely performedand used for treatment of most T1 tumours referred to ourinstitution. Long-term follow-up will be required to determine theoncological efficacy of LPN. Every effort should be made to furtherreduce the WIT. The LPN-UR is a useful parameter for consultingreferring physicians and patients.Objectif : La néphrectomie partielle ouverte (NPO) constitueactuellement le traitement de choix pour la plupart des cas detumeurs T1a et de certaines tumeurs T1b. La néphrectomie partiellelaparoscopique (NPL), technique développée pour réduirela morbidité associée à la NPO, représente maintenant une optionintéressante pour les chirurgiens expérimentés en laparoscopie.Nous avons fait une analyse rétrospective de notre expérienceavec la NPL et nous proposons un nouveau paramètre — le tauxd’utilisation de la NPL (TU-NPL) — afin de mieux définir le rôlede cette technique dans notre établissement.Méthodologie : Entre mars 2003 et août 2008, 47 patients consécutifsont subi une NPL pour traiter une tumeur T1. Tous les patientsont subi un clampage temporaire en bloc des vaisseaux rénauxau niveau du hile en vue d’une excision tumorale à froid parciseaux. Des données opératoires et pathologiques ont été recueilliesavant, pendant et après l’intervention. Les TU-NPL pour 2005,2006, 2007 et 2008 ont été calculés.Résultats : On a relevé 31 tumeurs non hilaires et 16 tumeurshilaires. Toutes les interventions ont été effectuées par laparoscopie.La taille moyenne des tumeurs était de 3,8 (écart : 1,5 à7,2) cm. Le temps moyen passé en salle d’opération était de 2,8(écart : 1,2 à 4,5) heures. La durée moyenne de l’hospitalisationétait de 5,2 (écart : 2,0 à 15,0) jours. La durée moyenne de l’ischémiechaude était de 32,7 (écart : 14,2 à 50,4) min. Six patients(12,8 %) ont reçu des transfusions sanguines et un patient a dûsubir une néphrectomie d’urgence en raison d’une hémorragie.Un patient a présenté une incontinence urinaire et un autre, unesténose tardive au niveau des calices. La fonction rénale différentiellemoyenne après l’opération était de 35 % : 50 %. La duréemédiane du suivi était de 18 mois. L’analyse pathologique a révéléque 38 tumeurs sur 47 (80,9 %) étaient malignes; 2 tumeurs (4,3 %)présentaient des marges chirurgicales positives. Les TU-NPL pour2005, 2006, 2007 et 2008 étaient respectivement de 50 %, 54 %,63 % et 93 % pour les tumeurs T1.Conclusion : La NPL peut être effectuée sans danger et utilisée pourle traitement de la plupart des cas de tumeurs T1 traités par notreétablissement. Un suivi à long terme est nécessaire pour déterminerl’efficacité oncologique de la NPL. Tous les efforts doiventêtre déployés pour réduire davantage la durée de l’ischémiechaude. Le TU-NPL est un paramètre de consultation utile pourles médecins et les patients.

scholarly journals Considerations in Orbital Exenteration

2019 ◽  
Vol 33 (02) ◽  
pp. 103-105 ◽  
Author(s):  
Mofiyinfolu Sokoya ◽  
Jason Cohn ◽  
Scott Kohlert ◽  
Thomas Lee ◽  
Sameep Kadakia ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Local Control ◽  
Paranasal Sinuses ◽  
Careful Consideration ◽  
Radical Operation ◽  
Orbital Exenteration ◽  
Primary Tumors ◽  
Psychosocial Disability ◽  
Work Up

AbstractOrbital exenteration (OE) is a radical operation associated with significant psychosocial disability and functional impairment. Indications for OE include primary tumors of the eye, oral cavity, paranasal sinuses, skin, and brain. Careful consideration regarding the likelihood of local control and cure is needed before proceeding with this operation. Multidisciplinary work-up should be performed before proceeding with surgery. The method of reconstruction after OE should be tailored to the defect and the postoperative needs of the patient. Appropriate follow-up and rehabilitation should be arranged for the patient.

scholarly journals Spinal stereotactic body radiotherapy following intralesional curettage with separation surgery for initial or salvage chordoma treatment

2017 ◽  
Vol 42 (1) ◽  
pp. E4 ◽  
Author(s):  
Dennis T. Lockney ◽  
Timothy Shub ◽  
Benjamin Hopkins ◽  
Natalie A. Lockney ◽  
Nelson Moussazadeh ◽  
...  
Keyword(s):  
Local Control ◽  
Salvage Therapy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Local Control Rate ◽  
High Dose ◽  
En Bloc ◽  
Intralesional Curettage ◽  
Mobile Spine

OBJECTIVE Chordoma is a rare malignant tumor for which en bloc resection with wide margins is advocated as primary treatment. Unfortunately, due to anatomical constraints, en bloc resection to achieve wide or marginal margins is not feasible for many patients as the resulting morbidity would be prohibitive. The objective of this study was to evaluate the efficacy of intralesional curettage and separation surgery followed by spinal stereotactic body radiation therapy (SBRT) in patients with chordomas in the mobile spine. METHODS The authors performed a retrospective chart review of all patients with chordoma in the mobile spine treated from 2004 to 2016. Patients were identified from a prospectively collected database. Initially 22 patients were identified with mobile spine chordomas. With inclusion criteria of cytoreductive separation surgery followed closely by SBRT and a minimum of 6 months of follow-up imaging, 12 patients were included. Clinical and pathological characteristics of each patient were collected and data were analyzed. Patients were divided into two cohorts—those undergoing intralesional resection followed by SBRT as initial chordoma treatment at Memorial Sloan Kettering Cancer Center (MSKCC) (Cohort 1) and those undergoing salvage treatment following recurrence (Cohort 2). Treatment toxicities were classified according to the Common Terminology Criteria for Adverse Events version 4.03. Overall survival was analyzed using Kaplan-Meier analysis. RESULTS The 12 patients had a median post-SBRT follow-up time of 26 months. Cohort 1 had 5 patients with median post-SBRT follow-up time of 65.9 months and local control rate of 80% at last follow-up. Only one patient had disease progression, at 48.2 months following surgery and SBRT. Cohort 2 had 7 patients who had been treated at other institutions prior to undergoing both surgery and SBRT (salvage therapy) at MSKCC. The local control rate was 57.1% and the median follow-up duration was 10.7 months. One patient required repeat irradiation. Major surgery- and radiation-related complications occurred in 18% and 27% of patients, respectively. Epidural spinal cord compression scores were collected for each patient pre- and postoperatively. CONCLUSIONS The combination of surgery and SBRT provides excellent local control following intralesional curettage and separation surgery for chordomas in the mobile spine. Patients who underwent intralesional curettage and spinal SBRT as initial treatment had better disease control than those undergoing salvage therapy. High-dose radiotherapy may offer several biological benefits for tumor control.

Multivisceral resections of gastrointestinal stromal tumors

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 20523-20523
Author(s):  
Y. Zhou ◽  
C. Du ◽  
H. Fu ◽  
G. Zhao ◽  
Y. Shi
Keyword(s):  
Lymph Node ◽  
Imatinib Mesylate ◽  
Gastrointestinal Stromal Tumors ◽  
Abdominal Cavity ◽  
Tumor Diameter ◽  
Gross Margin ◽  
En Bloc ◽  
Primary Tumors ◽  
Stromal Tumors

20523 Background: Gastrointestinal stromal tumors (GISTs) with positive kit staining, although rare, are the most common mesenchymal neoplasms affecting the gastrointestinal tract. We present our experience in the treatment of disease involving adjacent organs with multivisceral resections. Methods: The clinicopathologic records of twenty-two patients with multivisceral resection, among 170 patients suffered from GISTs treated in our hospital from 1994 to 2005, were retrospectively reviewed. Nine primary tumors originated from the stomach, 4 from the small intestine, 6 from the colorectum, 1 from abdominal cavity, and 2 from the retroperitoneal area. Meanwhile complete follow-up records were available in 15 patients with median 5-year follow-up. Results: The patients included 9 men and 13 women, from 36 to 77 year old. The largest tumor diameter ranged from 2 to 20 cm. The types of multivisceral operation comprised splenectomy (n=8), coloectomy (n=6), nephrectomy (n=5), partial hepatectomy (n=1), duodenectomy (n=1), oophorectomy (n=1), pancreatectomy (n=1), and adrenalectomy (n=1). None of lymph node metastatsis was found in 7 patients with lymph node dissection with gastric GISTs (n=5) or small intestinal GISTs (n=2). The involved organs confirmed by the pathologic diagnosis included kidney (n=2), spleen (n=2), pancreas (n=2), mesentery (n=1), and omentum (n=1). There was no perioperative mortality in this series. Among follow up patients, 9 were alive and 5 were died from the tumor recurrence or metastasis. Among them, one person with gastrectomy, pancreatectomy, adrenalectomy is still alive under 2 year follow-up by imatinib mesylate therapy postoperatively. Conclusions: Complete surgical resection with a negative gross margin by en bloc resection of the involved organs remains the standard treatment for non-metastatic GISTs. Imatinib mesylate represents a major breakthrough in the treatment of advanced GISTs and is the first effective systemic therapy for the disease. No significant financial relationships to disclose.

5-Level Spondylectomy for En Bloc Resection of Thoracic Chordoma: Case Report

2011 ◽  
Vol 69 (suppl_2) ◽  
pp. onsE248-onsE256 ◽  
Author(s):  
Daniel M. Sciubba ◽  
Ziya L. Gokaslan ◽  
James H. Black ◽  
Oliver Simmons ◽  
Ian Suk ◽  
...  
Keyword(s):  
Case Report ◽  
Local Control ◽  
Percutaneous Biopsy ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Chest Wall Resection ◽  
En Bloc ◽  
Primary Tumors ◽  
First Case ◽  
Wire Saw

Abstract BACKGROUND AND IMPORTANCE Primary tumors of the spine are considered for en bloc resection to improve local control and even obtain cure. Anatomic restrictions often prohibit extensive resections with negative margins that are safe and feasible. We report the first case involving a patient with a large chordoma of the thoracic spine who underwent a successful 5-level spondylectomy with bilateral chest wall resection for en bloc resection without neurologic compromise. CLINICAL PRESENTATION A 26-year-old woman with a chest mass was found to have a T1-5 chordoma via a percutaneous biopsy. En bloc resection of the mass was thought to be the best option for long-term local control and possible cure. She presented without neurologic or pulmonary dysfunction. The patient underwent a 3-stage procedure. The first stage involved a posterior C2-T8 exposure, allowing release of posterior elements from C7 to T6 and instrumented stabilization from C2 to T8. T1-5 ribs were cut bilaterally, and 2 wire saws were placed ventral to the thecal sac at the C7-T1 and T5-6 disc levels. The second stage involved a right-sided thoracotomy, and the T5-6 wire saw was used to complete the lower osteotomy. The third stage involved completion of the C7-T1 osteotomy with the wire saw, delivery of the tumor specimen en bloc, ventral reconstruction of the spine with a titanium mesh cage, and bilateral thoracoplasty. CONCLUSION This is the first case report of a 5-level spondylectomy for en bloc resection of an extensive thoracic chordoma via a bilateral thoractomy without neurologic compromise.

scholarly journals Recurrence of adenoma after curative endoscopic submucosal dissection for a rectal intramucosal adenocarcinoma in adenoma

2019 ◽  
Vol 07 (04) ◽  
pp. E621-E624
Author(s):  
Yoshiko Nakano ◽  
Takashi Toyonaga ◽  
Eisei Nishino ◽  
Taro Inoue ◽  
Isato Shinjo ◽  
...  
Keyword(s):  
Tumor Cell ◽  
Endoscopic Submucosal Dissection ◽  
Villous Adenoma ◽  
Argon Plasma Coagulation ◽  
Lateral Spreading ◽  
Pathological Examination ◽  
En Bloc ◽  
Submucosal Dissection ◽  
Intramucosal Adenocarcinoma

Abstract Background and study aims A 71-year-old female underwent endoscopic submucosal dissection (ESD) for a subcircumferential lateral-spreading rectal tumor. Pathological examination showed an intramucosal adenocarcinoma in villous adenoma (size: 155 × 140 mm), which had been curatively resected with negative margins. However, follow-up colonoscopy revealed a tumor at the ulcer scar site, which soon grew into a circumferential lesion. Nineteen months after the first ESD procedure, additional ESD was performed for the recurrent lesion, which was resected en bloc without any adverse events, although severe fibrosis was noted in the submucosa. Pathological examination revealed a villous adenoma similar to the primary lesion with negative margins, but tumor cell nests were also present in the submucosa, which implied that tumor cell implantation had occurred during the first ESD. The post-ESD ulcer bed was subjected to argon plasma coagulation to prevent tumor recurrence after confirmation of the pathological results. There have not been any signs of recurrence during 9 years of follow-up.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

scholarly journals Data Driven Mathematical Model of FOLFIRI Treatment for Colon Cancer

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2632
Author(s):  
Aparajita Budithi ◽  
Sumeyye Su ◽  
Arkadz Kirshtein ◽  
Leili Shahriyari
Keyword(s):  
Mathematical Model ◽  
Colon Cancer ◽  
Cancer Patients ◽  
Immune Cell ◽  
Treatment Options ◽  
Data Driven ◽  
T Helper ◽  
Primary Tumors ◽  
Cell Fractions

Many colon cancer patients show resistance to their treatments. Therefore, it is important to consider unique characteristic of each tumor to find the best treatment options for each patient. In this study, we develop a data driven mathematical model for interaction between the tumor microenvironment and FOLFIRI drug agents in colon cancer. Patients are divided into five distinct clusters based on their estimated immune cell fractions obtained from their primary tumors’ gene expression data. We then analyze the effects of drugs on cancer cells and immune cells in each group, and we observe different responses to the FOLFIRI drugs between patients in different immune groups. For instance, patients in cluster 3 with the highest T-reg/T-helper ratio respond better to the FOLFIRI treatment, while patients in cluster 2 with the lowest T-reg/T-helper ratio resist the treatment. Moreover, we use ROC curve to validate the model using the tumor status of the patients at their follow up, and the model predicts well for the earlier follow up days.

scholarly journals Laparoscopic Resection of Renal Capsular Endometriosis in a Woman with Menstrual-Related Flank Pain: Case Report

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Abbas Basiri ◽  
Iman Ghanaat ◽  
Hamidreza Akbari Gilani
Keyword(s):  
Flank Pain ◽  
Pathological Examination ◽  
Histologic Evaluation ◽  
Normal Renal Parenchyma ◽  
Perinephric Space ◽  
Superior Portion ◽  
The Right ◽  
First Time ◽  
Laparoscopic Removal

Abstract Background Although involvement of the urinary system is not uncommon, endometriosis in the kidneys is rare. To date, laparoscopic partial nephrectomy has been the preferred approach for managing renal endometriosis. Here, we report for the first time the results of laparoscopic removal of a renal capsular endometriosis in a malrotated kidney in an attempt to save the whole kidney parenchyma, in terms of feasibility and safety. Case presentation A 37-year-old female presented with periodic right flank pain associated with her menstrual cycle. On imaging, a malrotated right kidney and a hypodense irregular-shaped lesion measuring 30 * 20 * 15 mm were seen in the superior portion of the right perinephric space. Histologic evaluation of the ultrasound-guided biopsy was consistent with renal capsular endometriosis. The patient underwent laparoscopic surgery to remove the capsular mass while preserving the normal renal parenchyma. Pathological examination of the biopsy obtained during surgery was in favor of renal endometriosis. At 6-month follow-up, the patient’s pain had completely disappeared and no complications had occurred. In addition, imaging did not show any remarkable recurrence. Conclusion Renal endometriosis should be strongly considered as a differential diagnosis in female patients with a renal capsular mass and exacerbation of flank pain during menstruation. Based on our experience, with preoperative needle biopsy and clearing the pathology, laparoscopic removal of the mass in spite of renal anatomic abnormality is feasible and safe and thus could be considered as a possible treatment option.

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