Influence of type and volume of surgical resection on postoperative period in patients with gliomas

283 patients with gliomas were included in this study. Age, sex, neurological status and Karnovsky performance were analyzed before and after surgery, also tumor location, type and volume of surgical resection, postoperative complications were considered. Volume of tumor resection did not depend on glioma localization, excluding deep located tumors, in which case stereotactic cryotomy was performed (p < 0,01). In cases of stereotactic cryotomy postoperative neurological deficit worsening was noted in 12,5%, in patients with open biopsy and partial resection — 10,9%, and in case of total or subtotal tumor resection in 7,0% (p > 0,05). Partial gliom resection often related with postoperative complications and neurological deficit worsening then open surgery total tumour resection. Stereotactic cryotomy does not lead to bigger postoperative complications frequency in comparisons with open surgery.

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Successful surgical resection of a rare case of a giant sacral chordoma: a multidisciplinary feat

BMJ Case Reports ◽

10.1136/bcr-2020-235045 ◽

2020 ◽

Vol 13 (9) ◽

pp. e235045

Author(s):

Safwan Omar Alomari ◽

Shadi Bsat ◽

Mohammad Khalife ◽

Ghassan Skaf

Keyword(s):

Surgical Resection ◽

Neurological Deficit ◽

Rare Case ◽

Tumour Resection ◽

Two Stage ◽

En Bloc ◽

Ct Guided ◽

Second Stage ◽

Sacral Chordoma ◽

Ct Guided Biopsy

We, here, report the case of a 72-year-old man who presented with a giant sacral chordoma without aggressive clinical and neurological course and confirmed with a CT guided biopsy. The patient underwent multidisciplinary, two-stage successful complete en bloc sacrectomy along with total gross tumour resection, followed by lumboiliac fusion and instrumentation in the second stage without any neurological deficit nor bladder or bowel-related complications.

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Utility of intraoperative real-time near-infrared fluorescence surgery for spinal schwannoma

Neurosurgical Focus: Video ◽

10.3171/2021.10.focvid21158 ◽

2022 ◽

Vol 6 (1) ◽

pp. V12

Keyword(s):

Real Time ◽

Near Infrared ◽

Tumor Resection ◽

Tumor Location ◽

Tumor Removal ◽

Near Infrared Fluorescence ◽

Tumor Visualization ◽

Before And After ◽

Spinal Schwannoma ◽

Near Infrared Fluorescence Imaging

The authors report the first cases of fluorescence-guided spinal surgery of schwannomas using near-infrared fluorescence imaging with the delayed window indocyanine (ICG) green (DWIG) technique for accurate real-time intraoperative tumor visualization. Patients with intradural spinal schwannomas received 0.5 mg/kg ICG at the beginning of surgery. After 1 hour, using the DWIG technique, near-infrared spectroscopy (NIRS) detected the spinal schwannomas, showing the exact tumor location and boundaries. DWIG with NIRS microscopy confirmed the exact location of spinal schwannomas before and after opening of the dura mater, thereby facilitating successful tumor dissection from the surrounding tissues, tumor resection, and confirmation of tumor removal. The video can be found here: https://stream.cadmore.media/r10.3171/2021.10.FOCVID21158

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COMPARISON OF LAPAROSCOPIC RESECTION OF THE KIDNEY IN RENAL TUMORS WITH AND WITHOUT THE APPLICATION OF A HEMOSTATIC SUTURE

Problems in oncology ◽

10.37469/0507-3758-2017-63-2-281-286 ◽

2017 ◽

Vol 63 (2) ◽

pp. 281-286

Author(s):

Sergey Petrov ◽

Andrey Mishchenko ◽

A. Nosov ◽

P. Lushina ◽

A. Vorobev ◽

...

Keyword(s):

Postoperative Complications ◽

Comparative Evaluation ◽

Laparoscopic Resection ◽

Ct Perfusion ◽

Tumor Resection ◽

Renal Tumors ◽

Adhesive Compositions ◽

Before And After ◽

Resection Area ◽

Results Of Surgery

There is proposed to refuse from the sealing of the parenchyma since the ligature method of hemostasis is an additional factor damaging the parenchyma of the kidney. In our opinion it is sufficient to perform electrohemostasis with the addition of local adhesive compositions. In the analysis of data from 2015 to 2016 on the basis of the Department of Urology of the N.N. Petrov Research Institute of Oncology there were performed 90 laparoscopic resections without ischemia and without a hemostatic suture applied to the resection area. The volume of blood loss, the duration of the operation, the volume of the functioning parenchyma of the kidney, before and after surgery, postoperative complications were estimated. With a comparative evaluation of the volume of the functioning parenchyma of the kidney before and after the operation, according to data of CT and CT-perfusion, the volume of functioning parenchyma of the resected kidney decreased only by the volume of the removed tumor. Resection of the kidney without applying a hemostatic suture to the area of resection, in conditions of hypotension, allowed improving the results of surgery relatively to kidney function in comparison with resection with the classical ligature method of hemostasis.

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Effect of age on outcome in patients with cerebral stroke

Medical alphabet ◽

10.33667/2078-5631-2020-2-41-45 ◽

2020 ◽

pp. 41-45

Author(s):

G. R. Kuchava ◽

E. V. Eliseev ◽

B. V. Silaev ◽

D. A. Doroshenko ◽

Yu. N. Fedulaev

Keyword(s):

Ischemic Stroke ◽

Neurological Deficit ◽

Neurological Status ◽

Statistical Correlation ◽

Multiple Organ ◽

The Body ◽

Social Adaptation ◽

Cerebral Stroke ◽

Septic Complications ◽

Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

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Artifact removal from neurophysiological signals: impact on intracranial and arterial pressure monitoring in traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2019.2.jns182260 ◽

2020 ◽

Vol 132 (6) ◽

pp. 1952-1960 ◽

Cited By ~ 1

Author(s):

Seung-Bo Lee ◽

Hakseung Kim ◽

Young-Tak Kim ◽

Frederick A. Zeiler ◽

Peter Smielewski ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Neurological Status ◽

Cerebrovascular Reactivity ◽

Cerebral Hypoperfusion ◽

Clinical Parameters ◽

Artifact Removal ◽

Clinical Events ◽

Arterial Blood ◽

Before And After

OBJECTIVEMonitoring intracranial and arterial blood pressure (ICP and ABP, respectively) provides crucial information regarding the neurological status of patients with traumatic brain injury (TBI). However, these signals are often heavily affected by artifacts, which may significantly reduce the reliability of the clinical determinations derived from the signals. The goal of this work was to eliminate signal artifacts from continuous ICP and ABP monitoring via deep learning techniques and to assess the changes in the prognostic capacities of clinical parameters after artifact elimination.METHODSThe first 24 hours of monitoring ICP and ABP in a total of 309 patients with TBI was retrospectively analyzed. An artifact elimination model for ICP and ABP was constructed via a stacked convolutional autoencoder (SCAE) and convolutional neural network (CNN) with 10-fold cross-validation tests. The prevalence and prognostic capacity of ICP- and ABP-related clinical events were compared before and after artifact elimination.RESULTSThe proposed SCAE-CNN model exhibited reliable accuracy in eliminating ABP and ICP artifacts (net prediction rates of 97% and 94%, respectively). The prevalence of ICP- and ABP-related clinical events (i.e., systemic hypotension, intracranial hypertension, cerebral hypoperfusion, and poor cerebrovascular reactivity) all decreased significantly after artifact removal.CONCLUSIONSThe SCAE-CNN model can be reliably used to eliminate artifacts, which significantly improves the reliability and efficacy of ICP- and ABP-derived clinical parameters for prognostic determinations after TBI.

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Immune-Related Circulating miR-125b-5p and miR-99a-5p Reveal a High Recurrence Risk Group of Pancreatic Cancer Patients after Tumor Resection

Applied Sciences ◽

10.3390/app9224784 ◽

2019 ◽

Vol 9 (22) ◽

pp. 4784

Author(s):

Vietsch ◽

Peran ◽

Suker ◽

van den Bosch ◽

Sijde ◽

...

Keyword(s):

Cancer Progression ◽

B Lymphocyte ◽

Immune Cell ◽

Tumor Resection ◽

Progression Free Survival ◽

Tumor Stroma ◽

Recurrence Risk ◽

High Serum ◽

Ductal Adenocarcinoma ◽

Before And After

Clinical follow-up aided by changes in the expression of circulating microRNAs (miRs) may improve prognostication of pancreatic ductal adenocarcinoma (PDAC) patients. Changes in 179 circulating miRs due to cancer progression in the transgenic KrasG12D/+; Trp53R172H/+; P48-Cre (KPC) animal model of PDAC were analyzed for serum miRs that are altered in metastatic disease. In addition, expression levels of 250 miRs were profiled before and after pancreaticoduodenectomy in the serum of two patients with resectable PDAC with different progression free survival (PFS) and analyzed for changes indicative of PDAC recurrence after resection. Three miRs that were upregulated ≥3-fold in progressive PDAC in both mice and patients were selected for validation in 26 additional PDAC patients before and after resection. We found that high serum miR-125b-5p and miR-99a-5p levels after resection are significantly associated with shorter PFS (HR 1.34 and HR 1.73 respectively). In situ hybridization for miR detection in the paired resected human PDAC tissues showed that miR-125b-5p and miR-99a-5p are highly expressed in inflammatory cells in the tumor stroma, located in clusters of CD79A expressing cells of the B-lymphocyte lineage. In conclusion, we found that circulating miR-125b-5p and miR-99a-5p are potential immune-cell related prognostic biomarkers in PDAC patients after surgery.

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NCMP-13. LEPTOMENINGEAL DISEASE FOLLOWING RESECTION OF INTRAVENTRICULAR MELANOMA METASTASIS DIAGNOSED THROUGH CIRCULATING TUMOR CELLS

Neuro-Oncology ◽

10.1093/neuonc/noaa215.524 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii125-ii125

Author(s):

Christopher Wang ◽

Melissa Limia ◽

Peter Forsyth ◽

James Liu

Keyword(s):

Early Intervention ◽

Tumor Cells ◽

Circulating Tumor Cells ◽

Surgical Resection ◽

Tumor Resection ◽

Leptomeningeal Disease ◽

Melanoma Metastasis ◽

Tumor Seeding ◽

Csf Analysis ◽

Dismal Prognosis

Abstract Leptomeningeal disease in the setting of malignant melanoma metastatic to the brain provides a dismal prognosis. The relationship between intraventricular metastatic tumor seeding following surgical resection and development of leptomeningeal disease (LMD) is not completely clear, although there appears to be correlation. While the mechanisms that drive the development of LMD is not well understood, monitoring of cerebrospinal fluid (CSF) for circulating tumor cells (CTCs) in high risk patients may allow for early intervention for LMD prior to radiographical diagnosis. This report describes a patient with metastatic melanoma who developed ventricular trapping from an intraventricular melanoma metastasis. The patient underwent endoscopic assisted resection of the tumor. Due to concern for leptomeningeal seeding given the location of the tumor and use of surgical resection, CSF analysis was performed. CTC count was increased shortly after surgical resection along with cytology that was suspicious for malignancy. Due to the increase in CTCs, the patient was treated for LMD with whole brain radiation therapy and intrathecal pembrolizumab. Subsequent CSF analysis revealed clearing of malignant cells in the CSF. The patient developed symptoms consistent with LMD approximately 9 months after the surgery and died 21 months after resection of his brain metastasis. This case illustrates a rare occurrence of an intraventricular melanoma metastasis, and the use of CTC presence within the CSF to diagnose LMD for early intervention. This emphasizes that the risk of developing LMD must be considered with intraventricular metastasis or ventricular exposure during tumor resection, and that CTCs may be an effective factor to monitor for early development of disease with possible prolonged survival benefit.

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Postoperative Complications Are Associated with Long-Term Changes in the Gut Microbiota Following Colorectal Cancer Surgery

Life ◽

10.3390/life11030246 ◽

2021 ◽

Vol 11 (3) ◽

pp. 246

Author(s):

Felix C.F. Schmitt ◽

Martin Schneider ◽

William Mathejczyk ◽

Markus A. Weigand ◽

Jane C. Figueiredo ◽

...

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Gut Microbiota ◽

Gut Microbiome ◽

Tumor Resection ◽

Microbial Composition ◽

Colorectal Cancer Surgery ◽

Long Term Changes ◽

Stool Samples

Changes in the gut microbiome have already been associated with postoperative complications in major abdominal surgery. However, it is still unclear whether these changes are transient or a long-lasting effect. Therefore, the aim of this prospective clinical pilot study was to examine long-term changes in the gut microbiota and to correlate these changes with the clinical course of the patient. Methods: In total, stool samples of 62 newly diagnosed colorectal cancer patients undergoing primary tumor resection were analyzed by 16S-rDNA next-generation sequencing. Stool samples were collected preoperatively in order to determine the gut microbiome at baseline as well as at 6, 12, and 24 months thereafter to observe longitudinal changes. Postoperatively, the study patients were separated into two groups—patients who suffered from postoperative complications (n = 30) and those without complication (n = 32). Patients with postoperative complications showed a significantly stronger reduction in the alpha diversity starting 6 months after operation, which does not resolve, even after 24 months. The structure of the microbiome was also significantly altered from baseline at six-month follow-up in patients with complications (p = 0.006). This was associated with a long-lasting decrease of a large number of species in the gut microbiota indicating an impact in the commensal microbiota and a long-lasting increase of Fusobacterium ulcerans. The microbial composition of the gut microbiome shows significant changes in patients with postoperative complications up to 24 months after surgery.

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Treatment of tumor thrombus in the superior mesenteric vein due to advanced colon cancer with complete surgical resection and chemotherapy: a case report

Surgical Case Reports ◽

10.1186/s40792-020-01091-6 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yoshitsugu Yanagida ◽

Takahiro Amano ◽

Ryuji Akai ◽

Akira Toyoshima ◽

Jotaro Kobayashi ◽

...

Keyword(s):

Colon Cancer ◽

Liver Metastasis ◽

Surgical Resection ◽

Tumor Thrombus ◽

Superior Mesenteric Vein ◽

Tumor Resection ◽

Term Survival ◽

Mesenteric Vein ◽

Advanced Colon Cancer ◽

Complete Surgical Resection

Abstract Background Tumor thrombus in the superior mesenteric vein secondary to colon cancer is rare. We report a case of tumor thrombus in the superior mesenteric vein and liver metastasis due to advanced colon cancer that was treated with chemotherapy and complete surgical resection. Case presentation A 72-year-old man after transverse colectomy with lymph node dissection for advanced colon cancer was diagnosed with tumor thrombus in the superior mesenteric vein and liver metastasis. He underwent adjuvant chemotherapy and had complete surgical tumor resection involving tumor thrombectomy and hepatectomy. There has been no recurrence at 36 months after surgery. Conclusion Herein, we report a rare case of tumor thrombus in the superior mesenteric vein related to advanced colon cancer. The combination of chemotherapy and complete surgical tumor resection may provide long-term survival.

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Brain Tumor Resection in Elderly Patients: Potential Factors of Postoperative Worsening in a Predictive Outcome Model

Cancers ◽

10.3390/cancers13102320 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2320

Author(s):

Paolo Ferroli ◽

Ignazio Gaspare Vetrano ◽

Silvia Schiavolin ◽

Francesco Acerbi ◽

Costanza Maria Zattra ◽

...

Keyword(s):

Brain Tumor ◽

Postoperative Complications ◽

Elderly Patients ◽

Performance Status ◽

Tumor Resection ◽

Patient Specific ◽

Invasive Treatment ◽

Tertiary Referral Center ◽

Surgical Complexity

The decision of whether to operate on elderly patients with brain tumors is complex, and influenced by pathology-related and patient-specific factors. This retrospective cohort study, based on a prospectively collected surgical database, aims at identifying possible factors predicting clinical worsening after elective neuro-oncological surgery in elderly patients. Therefore, all patients ≥65 years old who underwent BT resection at a tertiary referral center between 01/2018 and 12/2019 were included. Age, smoking, previous radiotherapy, hypertension, preoperative functional status, complications occurrence, surgical complexity and the presence of comorbidities were prospectively collected and analyzed at discharge and the 3-month follow-up. The series included 143 patients (mean 71 years, range 65–86). Sixty-five patients (46%) had at least one neurosurgical complication, whereas 48/65 (74%) complications did not require invasive treatment. Forty-two patients (29.4%) worsened at discharge; these patients had a greater number of complications compared to patients with unchanged/improved performance status. A persistent worsening at three months of follow-up was noted in 20.3% of patients; again, this subgroup presented more complications than patients who remained equal or improved. Therefore, postoperative complications and surgical complexity seem to influence significantly the early outcome in elderly patients undergoing brain tumor surgery. In contrast, postoperative complications alone are the only factor with an impact on the 3-month follow-up.

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