Surgical treatment of low stage cervical carcinoma: Back to the old days?

Radical hysterectomies for the treatment of cervical carcinoma are being performed laparoscopically by some surgeons. Others combine the laparoscopic lymphadenectomy with a radical vaginal hysterectomy or a radical trachelectomy, like in the Schauta procedure. In this way the procedure resembles the AVRUEL-procedure (Abdominal Vaginal Radical Uterus Extirpation with transperitoneal Lymphadenectomy), as developed in 1957 by Sindram who combined the Wertheim and the Schauta procedure together with abdominal lymphadenectomy in one single operation. Because of the high complication rate in the form of voiding problems and sexual impairment caused by the Schauta part, this operation is no longer performed. In order to pay attention to the morbidity associated in the past with the combined abdomino-vaginal approach compared to the single abdominal approach, we reassembled the data of several large Dutch centers where patients were treated either by the AVRUEL or the abdominal radical hysterectomy.A total of 730 patients underwent an AVRUEL procedure, all carried out between 1957 and 1981. Fistulas occurred in 57 patients (7.8%), long-term urologic complications in 233 patients (32%), and sexual dysfunction in 71 (9.7%) were found. A total of 928 patients underwent an abdominal radical hysterectomy, of whom in 511 cases the complication rates have been described. Twelve fistulas occurred (2%), long-term micturition problems in 55 (10%), and sexual problems in 11 (2%). There was no difference in 5-year survival rates in both groups. From the abovementioned data it is clear, that returning to the old days in terms of a re-introduction of the Schauta procedure is not to be preferred. In order to conclude if the laparoscopically assisted radical vaginal hysterectomy or the trachelectomy are an improvement, they should be carried out according to clearly defined prospective protocols in which data can be compared to those of other techniques with special attention to late complications including micturition and sexual sequelae.

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The long-term outcomes of modified Harrington procedure using antegrade pins for periacetabular metastasis and haematological diseases

The Bone & Joint Journal ◽

10.1302/0301-620x.101b12.bjj-2019-0265.r1 ◽

2019 ◽

Vol 101-B (12) ◽

pp. 1557-1562

Author(s):

Roger Tillman ◽

Yusuke Tsuda ◽

Manoj Puthiya Veettil ◽

Peter S. Young ◽

Deepak Sree ◽

...

Keyword(s):

Large Diameter ◽

Survival Rates ◽

Late Complications ◽

Complication Rates ◽

Implant Survival ◽

Long Term Outcomes ◽

Perioperative Mortality ◽

Acetabular Loosening

Aims The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. Patients and Methods A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). Results The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. Conclusion The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557–1562

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Self-Reported Long-Term Autonomic Function After Laparoscopic Total Mesometrial Resection for Early-Stage Cervical Cancer: A Multicentric Study

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001045 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1501-1507 ◽

Cited By ~ 4

Author(s):

Alessandro Lucidi ◽

Swetlana Windemut ◽

Marco Petrillo ◽

Margherita Dessole ◽

Giulio Sozzi ◽

...

Keyword(s):

Cervical Cancer ◽

Cancer Patients ◽

Radical Hysterectomy ◽

Vaginal Hysterectomy ◽

Early Stage ◽

Nerve Sparing ◽

Laparoscopic Radical Hysterectomy ◽

Early Stage Cervical Cancer ◽

Laparoscopic Assisted

ObjectivesThis multicentric retrospective study investigates the early and long-term self-reported urinary, bowel, and sexual dysfunctions in early-stage cervical cancer patients who submitted to laparoscopic total mesometrial resection (L-TMMR), total laparoscopic radical hysterectomy, vaginal-assisted laparoscopic radical hysterectomy, and laparoscopic-assisted radical vaginal hysterectomy.MethodsCervical cancer patients, FIGO (International Federation of Gynecology and Obstetrics) stage IA2–IB1/IIA1 who submitted to nerve-sparing radical hysterectomy were recruited. Pelvic functions were assessed within 30 days (early outcome) and 12 months after surgery (long-term outcome).ResultsTwo hundred thirteen subjects receiving nerve-sparing radical hysterectomy were enrolled. Laparoscopic total mesometrial resection was performed in 46 patients (21.6%), total laparoscopic radical hysterectomy in 65 patients (30.5%), vaginal-assisted laparoscopic radical hysterectomy in 54 patients (25.4%), and laparoscopic-assisted radical vaginal hysterectomy in 48 women (22.5%). Operative time was significantly lower in the L-TMMR group (240 minutes; range, 120–670 minutes; P = 0.001). The overall perioperative complication rate was 11.3%, with no statistically significant differences among the 4 groups. Stress incontinence and sensation of bladder incomplete emptying were detected, respectively, in 54 patients (25.6%) and 65 patients (30.7%) with a significantly lower prevalence among those in the L-TMMR group, which resulted, respectively, in 11.1% (P = 0.022) and 13.3% (P = 0.036). The prevalence rates of constipation, sensation of incomplete bowel emptying, and effort during evacuation were significantly higher among those in the L-TMMR group, resulting in, respectively, 37% (P = 0.001), 42.3% (P = 0.012), and 50% (P = 0.039). One hundred forty-nine patients (70%) were sexually active. Fifty-eight women (38.9%) reported low enjoyment, 83 women (55.7%) medium enjoyment, and 8 women (5.4%) reported high enjoyment, without statistically significant differences among the 4 groups.ConclusionsLaparoscopic total mesometrial resection is associated with improved long-term urinary autonomic functions and worse gastrointestinal autonomic outcome. Further larger prospective trials are needed to evaluate both the oncological and functional outcomes in order to establish the most appropriate surgical approach for early-stage cervical cancer patients.

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LONG-TERM RESULTS AND LATE COMPLICATIONS AFTER INTRACAVITARY YTTRIUM-90 COLLOID IRRADIATION OF RECURRENT CYSTIC CRANIOPHARYNGIOMAS

Neurosurgery ◽

10.1227/01.neu.0000255528.68963.ef ◽

2007 ◽

Vol 61 (2) ◽

pp. 288-296 ◽

Cited By ~ 50

Author(s):

Jenö Julow ◽

Erik-Olof Backlund ◽

Ferenc Lányi ◽

Márta Hajda ◽

Katalin Bálint ◽

...

Keyword(s):

Survival Rates ◽

Late Complications ◽

Long Term Results ◽

Actuarial Survival ◽

Valuable Treatment ◽

Internal Carotid Artery Injury ◽

Beta Dose ◽

Anatomic Localization ◽

Yttrium 90

Abstract OBJECTIVE Data were analyzed to assess the value of stereotactically applied intracystic colloidal yttrium-90 (YTx) for the treatment of recurrent cystic craniopharyngiomas during a 30-year period. METHODS This article compares data from 73 YTx procedures in 60 patients between 1975 and 2006. The cumulative beta dose aimed at the inner surface of the cyst wall was 300 Gy. RESULTS After YTx, the initial cyst volumes decreased an average of 79%. In 47, the reduction was more than 80%; in 27 of them, the cyst disappeared completely within 1 year. The mean survival after YTx was 9.4 years (range, 0.7–30 yr). Actuarial survival rates at 5, 10, 15, 20, 25, and 30 years were 81, 61, 45, 18, 2, and 0%, respectively. Late complications of YTx were related to the anatomic localization of the cyst, either presellar and retrosellar, e.g., a presellar (prechiasmatic/suprasellar) localization caused neuro-ophthalmological complications in 5.8% and internal carotid artery injury in 1.6%. The treatment of retrosellar (retrochiasmatic, suprasellar) tumors occasionally induced hypothalamic and/or pontomesencephalothalamic damage obviously by untoward radiation to the so-called perforating arteries. This occurred in 3.2% of these latter patients. CONCLUSION Despite sporadic complications, intracavitary YTx irradiation is a valuable treatment alternative for craniopharyngioma cysts, sometimes as part of a multimodality management in these tumors, especially in precarious surgical cases.

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Late Effects and Survivorship Issues in Patients with Neuroblastoma

Children ◽

10.3390/children5080107 ◽

2018 ◽

Vol 5 (8) ◽

pp. 107 ◽

Cited By ~ 7

Author(s):

Danielle Friedman ◽

Tara Henderson

Keyword(s):

Late Effects ◽

Survival Rates ◽

Premature Mortality ◽

The Past ◽

Excess Morbidity ◽

Related Risk ◽

Impaired Quality ◽

Made In

Over the past two decades, marked progress has been made in understanding the biology of neuroblastoma; this has led to refined risk stratification and treatment modifications with resultant increasing 5-year survival rates for children with neuroblastoma. Survivors, however, remain at risk for a wide variety of potential treatment-related complications, or “late effects”, which may lead to excess morbidity and premature mortality in this cohort. This review summarizes the existing survivorship literature on long-term health outcomes for survivors of neuroblastoma, focusing specifically on potential injury to the endocrine, sensory, cardiovascular, pulmonary, and renal systems, as well as survivors’ treatment-related risk for subsequent neoplasms and impaired quality of life. Additional work is needed to assess the potential late effects of newer multimodality therapies with the aim of optimizing long-term medical and psychosocial outcomes for all survivors of neuroblastoma.

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How I treat relapsed acute lymphoblastic leukemia in the pediatric population

Blood ◽

10.1182/blood.2019004043 ◽

2020 ◽

Vol 136 (16) ◽

pp. 1803-1812 ◽

Cited By ~ 1

Author(s):

Stephen P. Hunger ◽

Elizabeth A. Raetz

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Pediatric Population ◽

Lymphoblastic Leukemia ◽

Treatment Options ◽

Survival Rates ◽

Treatment Decision ◽

Term Survival ◽

Hematopoietic Stem ◽

The Past

Abstract Relapsed acute lymphoblastic leukemia (ALL) has remained challenging to treat in children, with survival rates lagging well behind those observed at initial diagnosis. Although there have been some improvements in outcomes over the past few decades, only ∼50% of children with first relapse of ALL survive long term, and outcomes are much worse with second or later relapses. Recurrences that occur within 3 years of diagnosis and any T-ALL relapses are particularly difficult to salvage. Until recently, treatment options were limited to intensive cytotoxic chemotherapy with or without site-directed radiotherapy and allogeneic hematopoietic stem cell transplantation (HSCT). In the past decade, several promising immunotherapeutics have been developed, changing the treatment landscape for children with relapsed ALL. Current research in this field is focusing on how to best incorporate immunotherapeutics into salvage regimens and investigate long-term survival and side effects, and when these might replace HSCT. As more knowledge is gained about the biology of relapse through comprehensive genomic profiling, incorporation of molecularly targeted therapies is another area of active investigation. These advances in treatment offer real promise for less toxic and more effective therapy for children with relapsed ALL, and we present several cases highlighting contemporary treatment decision-making.

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Total wrist arthroplasty: a systematic review of the evidence from the last 5 years

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193414539796 ◽

2014 ◽

Vol 40 (5) ◽

pp. 458-468 ◽

Cited By ~ 37

Author(s):

D. Yeoh ◽

L. Tourret

Keyword(s):

Range Of Motion ◽

Survival Rates ◽

Complication Rates ◽

Level Of Evidence ◽

Total Wrist Arthroplasty ◽

Functional Scores ◽

Wrist Fusion ◽

Wrist Arthroplasty

We reviewed evidence on total wrist replacement from the last 5 years. Eight articles met a minimum set standard. The results of 405 prostheses were available, including seven different manufacturers. The mean follow up was 2.3–7.3 years with an average age of 52–63. Rheumatoid arthritis was the indication in 42% of patients. Motec demonstrated the best post-operative DASH scores. Only Maestro achieved a defined functional range of motion post-operatively. Universal 2 displayed the highest survival rates (100% at 3–5 years), while Elos had the lowest (57% at 5 years). Biaxial had the highest complication rates (68.7%), while Remotion had the lowest (11%). Wrist arthroplasty preserves some range of motion. Functional scores improved and were maintained over the mid- to long-term. Complication rates were higher than wrist fusion, with reports of radiological loosening and osteolysis. The evidence does not support the widespread use of arthroplasty over arthrodesis, and careful patient selection is essential. Level of Evidence: III

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Small Cell Neuroendocrine Cervical Carcinoma: A Case Report

Journal of Family & Reproductive Health ◽

10.18502/jfrh.v14i4.5212 ◽

2021 ◽

Author(s):

Malihe Hasanzadeh ◽

Nooshin Babapour ◽

Marjaneh Farazestanian ◽

Farzaneh Hashem Niay Torshizi

Keyword(s):

Cervical Cancer ◽

Case Report ◽

Neuroendocrine Tumor ◽

Cervical Carcinoma ◽

Radical Hysterectomy ◽

Survival Rates ◽

Small Cell ◽

Therapeutic Approaches ◽

Vaginal Cuff ◽

Cervical Tumors

Objective: Small cell neuroendocrine cervical carcinoma is a neuroendocrine tumor with the great aggravation that comprises 0.5 to 3 percent of cervical tumors and progresses rapidly with early lymphogenous and hematogenous metastases. Case report: We reported a 40 years old woman with cervical cancer in stage IB2 that had radical hysterectomy with mistaken diagnosis of squamous cervical cancer. The disease has progressed after 50 days of surgery with a 6 cm tumor in vaginal cuff; review of pathology demonstrated small cell neuroendocrine cervical carcinoma. Conclusion: Recognition of this separate histopathological entity with IHC analysis is important. Chemoradiotherapy and multimodality therapeutic approaches could improve the survival rates.

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Single Center Experience with Short-term Circulatory Support: A Comparison of Demography, Indication and Clinical Outcome over the past Decade

Open Journal of Cardiovascular Surgery ◽

10.4137/ojcs.s5396 ◽

2010 ◽

Vol 3 ◽

pp. OJCS.S5396

Author(s):

J. Linneweber ◽

P. Swojanowsky ◽

P. Dohmen ◽

H. Grubitzsch ◽

S. Dushe ◽

...

Keyword(s):

Clinical Outcome ◽

Surgical Procedure ◽

Survival Rates ◽

Severity Of Illness ◽

Circulatory Support ◽

Complication Rates ◽

Short Term ◽

Related Complication ◽

The Past ◽

Single Center Experience

Objective Aim of the study was to analyze changes over a ten years observation period regarding demography, indication for support and clinical outcome in patients treated with short-term mechanical circulatory support (MCS) for cardiogenic failure. Methods 39 patients treated with MCS between 2006–2008 (2008 group) were analyzed, assessing demography, complication rates and survival. Results were compared with 36 consecutive patients that had received centrifugal MCS between 1996–1998 (1998 group) at our institution. Results Mean age was 59.9 ± 12.9 (1998 group) and 60.9 ± 13.9 years ( P = 0.74). Mean logEuroScores rose from 12.0% ± 14.6% (1998 group) to 26.9% ± 20.5% (2008 group); P < 0.001. Postcardiotomy low output syndrome was the main cause for MCS. However the percentage of patients in cardiogenic shock prior to surgery increased from 19.4% (1998 group) to 33.3% (2008 group); P = 0.17. Complexity and urgency of the primary surgical procedure increased significantly. 16.7% (1998 group) vs. 41.0% (2008 group); P = 0.02 of interventions were classified “salvage/emergent”. Mean duration of support was 2.9 ± 1.9 days (1998 group) and 3.8 ± 3.1 days (2008 group); P = 0.14. Significantly more biventricular support was implemented in the 2008 group (23.1% vs. 5.6% in the 1998 group); P = 0.03. The incidence of complications, including device failure, thromboembolism and infection remained the same in both groups. 63.9% (1998 group) and 61.5% (2008 group) of the patients were successfully weaned from the device ( P = 0.83), 12% (1998 group) and 3% (2008 group) of the VAD patients were bridged to long-term VAD ( P = 0.12). Overall 30-day survival rates were similar (22.2% 1998 group vs. 28.2%; 2008 group); P = 0.55, however, survival rate in BVAD supported patients improved significantly. Conclusion These data demonstrate the beneficial effect of MCS to salvage patients with cardiac failure. Taking into consideration that the severity of illness, the complexity and urgency of the primary surgical procedure have steadily increased a comparable improvement in MCS outcome over the past decade was observed. Nevertheless, in-hospital mortality and VAD related complication rates such as bleeding remain high.

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Survival Trends and Long-Term Toxicity in Pediatric Patients with Osteosarcoma

Sarcoma ◽

10.1155/2012/636405 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 21

Author(s):

Melanie M. Hagleitner ◽

Eveline S. J. M. de Bont ◽

D. Maroeska W. M. te Loo

Keyword(s):

Survival Data ◽

Clinical Characteristics ◽

Pediatric Patients ◽

Survival Rates ◽

Treatment Results ◽

The Past ◽

High Grade Osteosarcoma ◽

Improvement In Survival ◽

Basic Treatment

Background. This study was conducted to investigate the clinical characteristics and treatment results of osteosarcoma in pediatric patients during the past 30 years. Trends in survival rates and long-term toxicity were analyzed.Procedure. 130 pediatric patients under the age of 20 years with primary localized or metastatic high-grade osteosarcoma were analyzed regarding demographic, treatment-related variables, long-term toxicity, and survival data.Results. Comparison of the different time periods of treatment showed that the 5-year OS improved from 58.6% for children diagnosed during 1979–1983 to 78.6% for those diagnosed during 2003–2008 (P=0.13). Interestingly, the basic treatment agents including cisplatin, doxorubicin, and methotrexate remained the same. Treatment reduction due to acute toxicity was less frequent in patients treated in the last era (7.1% versus 24.1% in patients treated in 1979–1983;P=0.04). Furthermore, late cardiac effects and secondary malignancies can become evident many years after treatment.Conclusion. We elucidate the prevalence of toxicity to therapy of patients with osteosarcoma over the past 30 years. The overall improvement in survival may in part be attributed to improved supportive care allowing regimens to be administered to best advantage with higher tolerance of chemotherapy and therefore less chemotherapy-related toxicity.

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