Therapeutic strategy involving endoscopic resection for cN0 superficial carcinoma of the esophagus.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 1-1
Author(s):  
T. Iizuka ◽  
D. Kikuchi ◽  
S. Hoteya
Keyword(s):  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Additional Treatment ◽  
En Bloc ◽  
Carcinoma Of The Esophagus ◽  
Secondary Hemorrhage ◽  
Long Term Follow Up

1 Background: With the progress in endoscopic submucosal dissection (ESD) which enables en bloc resection irrespective of the size of lesion, a therapeutic strategy has become feasible whereby ESD is undertaken first, followed by considering additional treatment based on the results of histologic exploration. In this study, we attempted to clarify the clinical results in patients who had undergone additional treatment after endoscopic resection (ER) for cN0 superficial carcinoma. Methods: Of 140 patients diagnosed as having T1a-MM-SM2 lesions of squamous cell carcinoma of the esophagus who had undergone ER between January 1998 and March 2010, 83 patients who received additional treatment after ER (surgery, 27 pts; chemoradiotherapy [CRT], 56 pts.) were the subjects of this study. The mean duration of observation was 45.1 months. Results: The en bloc resection rate was 86%. There were 5 patients (6%) who had complications associated with ER, including perforation in 2 patients, secondary hemorrhage in a patient and pneumonia in 2 patients. Complications associated with additional treatment were noted in 13 patients (15.6%), including secondary hemorrhage, recurrent laryngeal nerve paralysis and pulmonary infarction in one patient each, pneumonia in 3, grade ≥ 3 myelosuppression in 5, and syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and radiation pneumonitis in one patient each. Long-term follow-up revealed no local recurrence and no patients who experienced late toxicity due to CRT. The tumor recurred in 4 patients, the site of recurrent lesion being the mediastinum in 3 patients and the cervical lymph node in one patient, of whom 2 patients died of the primary disease. The 5-year survival rate was 88.4%. Conclusions: Endoscopic resection plus additional treatment for superficial carcinoma of the esophagus did not entail the development of any serious complications; thus, such combined treatment was safe and feasible. The long-term follow-up results were fairly gratifying, and ER with subsequent additional treatment is considered to be valid for patients with cN0 superficial carcinoma of the esophagus. No significant financial relationships to disclose.

scholarly journals Long-term follow-up after colorectal endoscopic submucosal dissection in 182 cases

2021 ◽  
Vol 09 (02) ◽  
pp. E258-E262
Author(s):  
Christian Suchy ◽  
Moritz Berger ◽  
Ingo Steinbrück ◽  
Tsuneo Oyama ◽  
Naohisa Yahagi ◽  
...  
Keyword(s):  
Case Series ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Published Data ◽  
Low Grade ◽  
Recurrence Rates ◽  
En Bloc ◽  
Long Term Follow Up

Abstract Background and study aims We previously reported a case series of our first 182 colorectal endoscopic submucosal dissections (ESDs). In the initial series, 155 ESDs had been technically feasible, with 137 en bloc resections and 97 en bloc resections with free margins (R0). Here, we present long-term follow-up data, with particular emphasis on cases where either en bloc resection was not achieved or en bloc resection resulted in positive margins (R1). Patients and methods Between September 2012 and October 2015, we performed 182 consecutive ESD procedures in 178 patients (median size 41.0 ± 17.4 mm; localization rectum vs. proximal rectum 63 vs. 119). Data on follow-up were obtained from our endoscopy database and from referring physicians. Results Of the initial cohort, 11 patients underwent surgery; follow-up data were available for 141 of the remaining 171 cases (82,5 %) with a median follow-up of 2.43 years (range 0.15–6.53). Recurrent adenoma was observed in 8 patients (n = 2 after margin positive en bloc ESD; n = 6 after fragmented resection). Recurrence rates were lower after en bloc resection, irrespective of involved margins (1.8 vs. 18,2 %; P < 0.01). All recurrences were low-grade adenomas and could be managed endoscopically. Conclusions The rate of recurrence is low after en bloc ESD, in particular if a one-piece resection can be achieved. Recurrence after fragmented resection is comparable to published data on piecemeal mucosal resection.

PD12-11 LONG-TERM FOLLOW-UP IN HIGH RISK NON MUSCLE INVASIVE BLADDER CANCER “EN-BLOC” RESECTION

2020 ◽  
Vol 203 ◽  
pp. e263
Author(s):  
Marco Paciotti* ◽  
Fasulo Vittorio ◽  
Massimo Lazzeri ◽  
Domanico Luigi ◽  
Federica Regis ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Long Term Follow Up ◽  
Muscle Invasive

scholarly journals Endoscopic Resection of Ampullary Tumours: Long-term Outcomes and Adverse Events

2019 ◽  
Vol 3 (1) ◽  
pp. 17-25
Author(s):  
Ali Alali ◽  
Alberto Espino ◽  
Maria Moris ◽  
Myriam Martel ◽  
Ingrid Schwartz ◽  
...  
Keyword(s):  
Adverse Events ◽  
Endoscopic Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Low Grade ◽  
Long Term Outcomes ◽  
En Bloc ◽  
Tertiary Center

Abstract Background The management of ampullary lesions has shifted from surgical approach to endoscopic resection. Previous reports were limited by small numbers of patients and short follow-up. The aim of this study is to describe short- and long-term outcomes in a large cohort of patients undergoing endoscopic ampullectomy. Methods Retrospective study of endoscopic ampullectomies performed at a tertiary center from January 1999 to October 2016. Information recorded includes patient demographics, clinical outcomes, lesion pathology, procedural events, adverse events and follow-up data. Results Overall, 103 patients underwent endoscopic resection of ampullary tumours (mean age 62.3 ± 14.3 years, 50.5% female, mean lesion size 20.9 mm; 94.9% adenomas, with a majority of lesions exhibiting low-grade dysplasia (72.7%). Complete endoscopic resection was achieved in 82.5% at initial procedure. Final complete endoscopic resection was achieved in all patients with benign pathology on follow-up procedures. Final pathology showed that 11% had previously undiagnosed invasive carcinoma. Delayed postprocedure bleeding occurred in 21.4%, all of which were managed successfully at endoscopy. Acute pancreatitis complicated 15.5% of procedures (mild in 93.8%). Perforation occurred in 5.8%, all treated conservatively except for one patient requiring surgery. Piecemeal resection was associated with significantly higher recurrence compared to en-bloc resection (54.3% versus 26.2%, respectively, P = 0.012). All recurrences were treated endoscopically. Conclusion Endoscopic ampullectomy appears both safe and effective in managing patients with ampullary tumours in experienced hands. Most adverse events can be managed conservatively. Many patients develop recurrence during long-term follow-up but can be managed endoscopically. Recurrence rates may be reduced by performing initial en-bloc resection.

Long-term follow-up in high risk non muscle invasive bladder cancer (NMIBC) “en-bloc” resection

2018 ◽  
Vol 17 (2) ◽  
pp. e1063 ◽  
Author(s):  
R. Hurle ◽  
M. Lazzeri ◽  
A. Saita ◽  
N. Buffi ◽  
G. Lughezzani ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Muscle Invasive Bladder Cancer ◽  
En Bloc ◽  
Long Term Follow Up ◽  
Muscle Invasive

scholarly journals Tumor rupture of gastric gastrointestinal stromal tumors during endoscopic resection: a risk factor for peritoneal metastasis?

2018 ◽  
Vol 06 (08) ◽  
pp. E950-E956 ◽  
Author(s):  
Shiyi Song ◽  
Wei Ren ◽  
Yi Wang ◽  
Shu Zhang ◽  
Song Zhang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Endoscopic Resection ◽  
Peritoneal Metastasis ◽  
Gastrointestinal Stromal Tumors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Rupture ◽  
En Bloc ◽  
Stromal Tumors

Abstract Background and study aims Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. Up to the present time, complete surgical excision has been the standard treatment for primary GISTs greater than 2 cm. It is well known that tumor rupture during surgery is an independent risk factor for peritoneal metastasis; however, it is not known whether the risk of peritoneal metastasis increases in cases where the tumor is ruptured during endoscopic resection. Patients and methods A total of 195 patients treated for GIST between January 2014 and December 2016 in our hospital were enrolled in this study. They were divided into two groups according to whether the tumor was ruptured during endoscopic resection. The rate of peritoneal metastasis in patients in the two groups who also suffered perforation was investigated from the follow-up results. Results Approximately 55.4 % of all patients were female and the average age of the study group was 59.0 ± 10.3 years. Of the 195 patients, the tumors in 27 were ruptured and the remaining 168 patients underwent en bloc resection. There was no statistically significant difference in gender or age between the two groups. The median tumor size (maximum diameter) in all patients was 1.5 cm (0.3 – 5.0 cm): 2.5 cm (0.8 – 5.0 cm) and 1.4 cm (0.3 – 4.0 cm) in the tumor rupture group and en bloc resection group, respectively (P < 0.001). Most of the tumors were located in the gastric fundus. At a median follow-up of 18.7 ± 10.2 months, neither tumor recurrence (liver metastasis, peritoneal metastasis, local recurrence) nor mortality related to GISTs were detected. Conclusions Tumor rupture during endoscopic resection of gastric GISTs may not be a risk factor for peritoneal metastasis.

Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients

2020 ◽  
Vol 32 (1) ◽  
pp. 89-97
Author(s):  
Shaohui He ◽  
Yuduo Xu ◽  
Jialin Li ◽  
Yue Zhang ◽  
Haifeng Wei ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Ki 67 ◽  
Factors Affecting ◽  
The Mean ◽  
Piecemeal Resection

OBJECTIVELeiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS).METHODSTwelve patients presented to the authors’ institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant.RESULTSThe mean patient age was 49.7 ± 12.9 years (range 22–73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0–15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5–21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6–78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS.CONCLUSIONSSurgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.

Retrospective assessment of the dismasking flap procedure as a craniofacial approach

2011 ◽  
Vol 7 (4) ◽  
pp. 345-350 ◽  
Author(s):  
Takuya Fujimoto ◽  
Keisuke Imai ◽  
Makoto Takahashi ◽  
Takaharu Hatano ◽  
Motoki Tamai ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Bone Fractures ◽  
En Bloc Resection ◽  
Lower Eyelid ◽  
Postoperative Management ◽  
En Bloc ◽  
Craniofacial Bone ◽  
Long Term Follow Up

Object In 1997 the authors presented the case of a 3-year-old girl who underwent complete resection of a huge tumor via a new technique using a dismasking flap. Since that report, 14 patients have undergone surgery using this technique. There have been few reports on long-term follow-up after a craniofacial surgical approach and reconstruction of a huge tissue defect. The authors report details of this procedure based on these cases, including long-term follow-up in the original case. Methods The dismasking flap is a cranioorbitofacial degloving method that uses a circumpalpebral approach with or without piriform margin incisions and presents a wide surgical field under direct vision. Fourteen patients have undergone surgery using the dismasking flap technique. These patients had multiple craniofacial bone fractures (3 cases) and malignant or premalignant craniofacial tumors (11 cases). Patients ranged in age from 3 to 62 years old. The longest follow-up period was 15 years. The results of these cases are reported regarding changes in the facial bones and soft tissues with growth, the various pathologies involved, and complications. Results Complications using this approach were lagophthalmos with ectropion of the lower eyelid, disturbance of the superior orbital nerve, disturbance of the inferior orbital nerve, maxillary hypoplasia, and blepharoptosis. In all affected patients these complications were almost always temporary. In 2 of the 14 cases, a repair operation for lagophthalmos was necessary, while others showed spontaneous improvement approximately 6 months to a year after the procedure. In the case with the longest follow-up duration, the patient's nose is asymmetrical, especially the alar portion, due to hypoplasia of the grafted bone and/or the fixation with titanium miniplates. Conclusions This flap is very useful for en bloc resection of huge skull base tumors, multiple craniofacial bone fractures, and as a lateral approach to a deep portion of the middle cranial base. Careful attention is necessary, however, because one may encounter unexpected complications if one does not ensure adequate protection of the perioperative flap. Meticulous postoperative management is also essential.

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