Total retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation): a novel surgical technique for advanced ovarian cancer

2020 ◽  
Vol 30 (5) ◽  
pp. 648-653 ◽  
Author(s):  
Mustafa Zelal Muallem ◽  
Jalid Sehouli ◽  
Andrea Miranda ◽  
Rolf Richter ◽  
Jumana Muallem
Keyword(s):  
Ovarian Cancer ◽  
Tumor Resection ◽  
Advanced Ovarian Cancer ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
Conventional Surgery ◽  
Complete Tumor Resection ◽  
En Bloc ◽  
Complete Tumor

BackgroundA Total Retroperitoneal en bloc resection Of Multivisceral-Peritoneal packet (TROMP operation) is a no-touch isolation technique in a retroperitoneal space to resect the parietal peritoneum and the affected organs in advanced ovarian cancer. The study prescribed and analysed the results of this novel technique for primary cytoreductive surgery.MethodsThe study included 208 patients operated between January 2015 and December 2017 in Charité, Berlin. The TROMP operation was performed in 58 patients, whereas the other 150 patients were operated with the conventional cytoreductive method.ResultsThe complete tumor resection rate accounts for 87.9% in TROMP group and 61.3% in the conventional surgery group. (p=0.001). This difference was even stronger in the sub-group of very advanced stages (T3c+T4) (85.1% of TROMP group and in only 53.1% in the conventional surgery group, p=0.001). The duration of the primary cytoreductive surgery was about 33 minutes shorter in TROMP group (median: 335 minutes vs 368 minutes; TROMP vs conventional, respectively) in spite of the fact that the most advanced cytoreductive procedures were performed statically significant more in TROMP operation arm in comparison with the conventional surgery arm. There was no statistically significant difference between the groups regarding the postoperative complication, blood loss or the length of stay in intensive care unit.ConclusionTotal retroperitoneal en bloc resection of multivisceral-peritoneal packet (TROMP operation) is a feasible and very effective technique of surgical therapy in advanced ovarian cancer. This technique increased the complete tumor resection rate to 87.9% without increasing the blood loss, postoperative complications or the duration of surgery. A prospective randomized study is advised to validate these results.

scholarly journals Peranal endoscopic myectomy (PAEM) for rectal lesions with severe fibrosis and exhibiting the muscle-retracting sign

Endoscopy ◽  
2018 ◽  
Vol 50 (08) ◽  
pp. 813-817 ◽  
Author(s):  
Takashi Toyonaga ◽  
Yoshiko Ohara ◽  
Shinichi Baba ◽  
Hiroshi Takihara ◽  
Manabu Nakamoto ◽  
...  
Keyword(s):  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Tumor Resection ◽  
En Bloc ◽  
Additional Surgery ◽  
Muscle Invasive ◽  
Longitudinal Muscles ◽  
Complete Tumor ◽  
Severe Fibrosis

Abstract Background Although endoscopic submucosal dissection has enabled complete tumor resection and accurate pathological assessment in a manner that is less invasive than surgery, the complete resection of lesions with severe fibrosis in the submucosal layer and exhibiting the muscle-retracting sign is often difficult. We have devised a new method, peranal endoscopic myectomy (PAEM), for rectal lesions with severe fibrosis, in which dissection is performed between the inner circular and outer longitudinal muscles, and have examined the usefulness and safety of this new technique. Methods All of the patients who underwent PAEM in our hospital and affiliated hospitals between July 2015 and June 2017 were retrospectively reviewed. Results 10 rectal lesions were treated with PAEM. En bloc resection with a negative vertical margin was achieved in eight patients (80 %), whose lesions were mucosal (n = 2), shallow submucosal (n = 1), deep submucosal (n = 4), and muscle invasive (n = 1). The clinical course of all patients after PAEM was favorable. In patients who underwent additional surgery, anus preservation was achieved on the basis of the pathological results from PAEM. Conclusions PAEM for lesions with severe fibrosis exhibiting the muscle-retracting sign appears to be both safe and useful.

scholarly journals Usefulness of tumor traction with a snare and endoclips in gastric submucosal tumor resection: a propensity-score-matching analysis

2020 ◽  
Author(s):  
Qiang Zhang ◽  
Jian-Qun Cai ◽  
Zhen Wang
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Operative Time ◽  
Perioperative Complications ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Gastric Submucosal Tumors

Abstract Background Endoscopic resection, including endoscopic submucosal dissection (ESD) and endoscopic full-thickness resection (EFR), was used to resect small gastric submucosal tumors (SMTs). Our team explored a method of tumor traction using a snare combined with endoclips to assist in the resection of SMTs. This study aims to explore the safety and effectiveness of the method. Methods This research performed a propensity-score-matching (PSM) analysis to compare ESD/EFR assisted by a snare combined with endoclips (ESD/EFR with snare traction) with conventional ESD/EFR for the resection of gastric SMTs. Comparisons were made between the two groups, including operative time, en bloc resection rate, perioperative complications, and operation-related costs. Results A total of 253 patients with gastric SMTs resected between January 2012 and March 2019 were included in this study. PSM yielded 51 matched pairs. No significant differences were identified between the two groups in perioperative complications or the costs of disposable endoscopic surgical accessories. However, the ESD/EFR-with-snare-traction group had a shorter median operative time (39 vs 60 min, P = 0.005) and lower rate of en bloc resection (88.2% vs 100%, P = 0.027). Conclusions ESD/EFR with snare traction demonstrated a higher efficiency and en bloc resection rate for gastric SMTs, with no increases in perioperative complications and the costs of endoscopic surgical accessories. Therefore, the method seems an appropriate choice for the resection of gastric SMTs.

scholarly journals SURG-04. THE APPLICATION OF EN BLOC RESECTION IN THE OPERATION OF PEDIATRIC POSTERIOR FOSSA TUMOR

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii461-iii461
Author(s):  
Ma Jie ◽  
Weiwei Mao ◽  
Shuaiwei Tian ◽  
Baocheng Wang ◽  
Yang Zhao
Keyword(s):  
Posterior Fossa ◽  
Tumor Resection ◽  
Operation Time ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Posterior Fossa Tumor ◽  
Control Group ◽  
Observation Group ◽  
Resection Rate ◽  
En Bloc

Abstract OBJECTIVE To explore the efficacy and safety of en bloc resection therapy on posterior fossa tumor in children. METHODS A retrospective analysis was conducted on the clinical data of 94 patients with posterior fossa tumor admitted to Department of Pediatric Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School Of Medicine from January 2018 to December 2019. Among them, 35 cases were treated with traditional resection (control group) and 59 cases with en bloc resection (observation group). We counted the amount of blood loss and the time during tumor resection, We compare the symptoms and signs between the two groups and determine a extent of tumor resection based on microscopic observation and preoperative and postoperative imaging comparison. RESULT: The total tumor resection rate of the observation group (88.1%, 52 / 59) was significantly higher than that of the control group (62.85%, 22 / 35, P < 0.05). The average bleeding volume of 90.8ml in the observation group was significantly smaller than that of the control group (113.3ml, P < 0.05), and the average operation time of 38.6min in the observation group was shorter than that of the control group (57.4min, P < 0.05) only for tumor resection procedure. CONCLUSION En bloc resection technique can effectively accelerate the resection time, reduce intraoperative bleeding and improve the total resection rate of tumors in children’s posterior cranial fossa.

TRUST: Trial of radical upfront surgical therapy in advanced ovarian cancer (ENGOT ov33 / AGO‐OVAR OP7).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. TPS5602-TPS5602 ◽  
Author(s):  
Sven Mahner ◽  
Florian Heitz ◽  
Alexander Burges ◽  
Alexander Reuss ◽  
Bernhard Kraemer ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Surgical Therapy ◽  
Tumor Resection ◽  
Advanced Ovarian Cancer ◽  
Phase Iii ◽  
Surgical Morbidity ◽  
Complete Tumor Resection ◽  
Surgical Quality ◽  
Platinum Based Chemotherapy ◽  
Complete Tumor

TPS5602 Background: Primary cytoreductive surgery (PDS) followed by chemotherapy has been considered as standard management for advanced ovarian cancer patients (pts) over decades. An alternative approach of interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) was subsequently reported by two randomized phase III trials (EORTC‐GCG, CHORUS). Owing to important limitations of these studies, especially regarding surgical quality, optimal timing of surgical therapy in advanced ovarian cancer is still unclear. Methods: TRUST is an international open, randomized, controlled multicenter trial investigating overall survival (OS; primary endpoint) after PDS vs NACT and subsequent IDS in pts with FIGO stage IIIB‐IVB ovarian, tubal, and peritoneal carcinoma. Secondary objectives are safety of complete tumor resection, progression‐free survival and quality of life (QoL) as well as surgical morbidity. In order to guarantee adequate surgical quality, participating centers need to fulfill specific quality assurance criteria (e.g. ≥50% complete resection rate in upfront surgery for FIGO IIIB-IV pts, ≥36 debulking-surgeries/year) and agree to independent audits by TRUST Quality committee delegates. A 1:1 randomization to PDS or NACT followed by IDS stratified by center and age‐ECOG combination (ECOG 0 and age ≤65 years vs ECOG > 0 or age > 65 years) is performed. Pts in the PDS arm will undergo surgery followed by 6 cycles of platinum-based chemotherapy, whereas pts in the IDS arm will be treated with 3 cycles of NACT after histologic confirmation of the disease, followed by IDS and subsequently 3 cycles of platinum-based chemotherapy. Intention of surgery for both groups will be complete tumor resection as per guideline recommendations. Health related QoL will be assessed using the EORTC QLQ‐C30, QLQ‐OV28, and EQ‐5D‐3L questionnaires. For sample size planning, we considered a prolongation of median OS from 45 months in the IDS arm to 60 months in the PDS arm (HR 0.75) as clinically relevant. 380 events are needed to obtain a power of 80% in two‐sided log-rank test with significance level of 0.05. The primary analysis will be done in the ITT‐population of 686 randomized pts. By Feb 3 2017, 46 pts were randomized. Clinical trial information: NCT02828618.

ID: 3518501 EN-BLOC RESECTION RATE OF COLORECTAL POLYPS ≤ 20 MM IS LOW AMONG ADVANCED ENDOSCOPY TRAINEES

2021 ◽  
Vol 93 (6) ◽  
pp. AB70
Author(s):  
William W. King ◽  
Peter V. Draganov ◽  
Andrew Y. Wang ◽  
Dushant Uppal ◽  
Nikhil A. Kumta ◽  
...  
Keyword(s):  
En Bloc Resection ◽  
Bloc Resection ◽  
Colorectal Polyps ◽  
Resection Rate ◽  
En Bloc

scholarly journals Prevention and Management of Complications and Education in Endoscopic Submucosal Dissection

2021 ◽  
Vol 10 (11) ◽  
pp. 2511
Author(s):  
Yoshitsugu Misumi ◽  
Kouichi Nonaka
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Endoscopic Mucosal Resection ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Resection Rate ◽  
En Bloc ◽  
Educational Methods ◽  
Submucosal Dissection ◽  
Management Of Complications

Endoscopic submucosal dissection (ESD) is considered superior to endoscopic mucosal resection as an endoscopic resection because of its higher en bloc resection rate, but it is more difficult to perform. As ESD techniques have become more common, and the range of treatment by ESD has expanded, the number of possible complications has also increased, and endoscopists need to manage them. In this report, we will review the management of critical complications, such as hemorrhage, perforation, and stenosis, and we will also discuss educational methods for acquiring and improving ESD skills.

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