scholarly journals Clinical features and treatment of spinal metastatic pheochromocytoma and paraganglioma: a single institutional experience with 18 patients

2021 ◽  
Author(s):  
Suiyong Du ◽  
Panpan Hu ◽  
Shaomin Yang ◽  
Hongqing Zhuang ◽  
Feng Wei ◽  
...  
Keyword(s):  
Clinical Features ◽  
Target Therapy ◽  
Tumor Resection ◽  
Treatment Guideline ◽  
En Bloc Resection ◽  
Neurological Deficits ◽  
Tumor Control ◽  
En Bloc ◽  
Local Pain ◽  
Adjuvant Therapies

Abstract Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors, which can potentially metastasize to the spine. Clinical researches and treatment guideline on this entity are lacking. This study described the clinical features and treatment outcomes of metastatic PPGLs on the spine. We reviewed 18 patients with spinal PPGLs who were consecutively treated in our spinal center. The cohort included ten cases of pheochromocytomas and eight paragangliomas. The local pain and neurological deficits were the two most common symptoms. One third of the spinal PPGLs were diagnosed as functional tumors. The surgical strategies for the cohort included percutaneous vertebroplasty, neurological decompression and partial tumor resection with or without internal fixation, and total en-bloc resection. The postoperative courses were uneventful except one patient developed heart failure. The adjuvant therapies were implemented in six patients with 131I-MIBG, five with radiotherapy, two with chemotherapy and one with target therapy. The median survival period was 39 months. The patients’ Karnofsky performance scores were positively correlated with the overall survival (p < 0.05).Therefore, surgery is indicated for intractable local pain and neurological impairment in the patients with spinal PPGLs, while a holistic set of adjuvant therapies shall be incorporated for a better tumor control.

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 High-dose proton-based radiation therapy in the management of spine chordomas: outcomes and clinicopathological prognostic factors

2015 ◽  
Vol 23 (6) ◽  
pp. 788-797 ◽  
Author(s):  
Ronny L. Rotondo ◽  
Wendy Folkert ◽  
Norbert J. Liebsch ◽  
Yen-Lin E. Chen ◽  
Frank X. Pedlow ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Prognostic Factors ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Tumor Control ◽  
High Dose ◽  
Recurrence Rates ◽  
En Bloc ◽  
Primary Tumors ◽  
Entire Cohort

OBJECT Spinal chordomas can have high local recurrence rates after surgery with or without conventional dose radiation therapy (RT). Treatment outcomes and prognostic factors after high-dose proton-based RT with or without surgery were assessed. METHODS The authors conducted a retrospective review of 126 treated patients (127 lesions) categorized according to disease status (primary vs recurrent), resection (en bloc vs intralesional), margin status, and RT timing. RESULTS Seventy-one sacrococcygeal, 40 lumbar, and 16 thoracic chordomas were analyzed. Mean RT dose was 72.4 GyRBE (relative biological effectiveness). With median follow-up of 41 months, the 5-year overall survival (OS), local control (LC), locoregional control (LRC), and distant control (DC) for the entire cohort were 81%, 62%, 60%, and 77%, respectively. LC for primary chordoma was 68% versus 49% for recurrent lesions (p = 0.058). LC if treated with a component of preoperative RT was 72% versus 54% without this treatment (p = 0.113). Among primary tumors, LC and LRC were higher with preoperative RT, 85% (p = 0.019) and 79% (0.034), respectively, versus 56% and 56% if no preoperative RT was provided. Overall LC was significantly improved with en bloc versus intralesional resection (72% vs 55%, p = 0.016), as was LRC (70% vs 53%, p = 0.035). A trend was noted toward improved LC and LRC for R0/R1 margins and the absence of intralesional procedures. CONCLUSIONS High-dose proton-based RT in the management of spinal chordomas can be effective treatment. In patients undergoing surgery, those with primary chordomas undergoing preoperative RT, en bloc resection, and postoperative RT boost have the highest rate of local tumor control; among 28 patients with primary chordomas who underwent preoperative RT and en bloc resection, no local recurrences were seen. Intralesional and incomplete resections are associated with higher local failure rates and are to be avoided.

scholarly journals Covered Stent of the Left Common Carotid and Subclavian Arteries Assist the Invasive Tumor Resection

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Yo Tsukamoto ◽  
Takeo Nakada ◽  
Soichiro Fukushima ◽  
Mitsuo Yabe ◽  
Naoki Toya ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Neurofibromatosis Type ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Covered Stent ◽  
Nerve Sheath Tumor ◽  
En Bloc ◽  
Invasive Tumor ◽  
Superior Mediastinum ◽  
Fatal Bleeding

Background. Some recent reports have described the usefulness of thoracic aortic stent grafts to facilitate en bloc resection of tumors invading the aortic wall. We report on malignant peripheral nerve sheath tumor resection in the left superior mediastinum of a 16-year-old man with neurofibromatosis type 1. The pathological margin was positive at the time of the first tumor resection, and radiation therapy was added to the same site. After that, a local recurrence occurred. The tumor was in wide contact with the left common carotid and subclavian arteries and was suspected of infiltration. After stent graft placement of these arteries to avoid fatal bleeding and cerebral ischemia by clamping these arteries and bypass procedure, we successfully resected the tumor without any complications. Conclusions. Here, we report the usefulness of the prior covered stent placement to aortic branch vessels for the resection of invasive tumor.

COMPARATIVE RISK OF LEPTOMENINGEAL DISSEMINATION OF CANCER AFTER SURGERY OR STEREOTACTIC RADIOSURGERY FOR A SINGLE SUPRATENTORIAL SOLID TUMOR METASTASIS

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 664-676 ◽  
Author(s):  
Dima Suki ◽  
Mustafa Aziz Hatiboglu ◽  
Akash J. Patel ◽  
Jeffrey S. Weinberg ◽  
Morris D. Groves ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Stereotactic Radiosurgery ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Cancer Center ◽  
Leptomeningeal Disease ◽  
En Bloc ◽  
University Of Texas ◽  
The Difference

Abstract OBJECTIVE To test the hypothesis that differential risks of developing leptomeningeal disease (LMD) exist in patients having a single supratentorial brain metastasis resected via a piecemeal or en bloc approach or treated with stereotactic radiosurgery (SRS). METHODS Between 1993 and 2006, 827 patients with a supratentorial brain metastasis underwent resection or SRS at The University of Texas M.D. Anderson Cancer Center. The primary outcome was the incidence of LMD. RESULTS Resection was performed piecemeal in 191 patients and en bloc in 351 patients; 285 patients received SRS. LMD occurred in 33 patients, 29 in the resection group and 4 in the SRS group. Risk of LMD was significantly higher with piecemeal tumor resection than with other procedures (SRS: hazard ratio [HR] for piecemeal, 5.8; 95% confidence interval [CI], 1.9–17.2; P = 0.002; en bloc, HR for piecemeal, 2.7; 95% CI, 1.3–5.6; P = 0.009). The difference between piecemeal and en bloc was particularly pronounced in patients with a melanoma primary (HR, 8.4; 95% CI, 1.8–39.2; P = 0.007). The risk of LMD was not significantly different between en bloc resection and SRS (HR for en bloc, 2.1; 95% CI, 0.7–6.4; P = 0.21). Similar results were obtained when comparing effects of SRS and both resection approaches after limiting the sample to patients with tumors in a specific volume range. CONCLUSION Piecemeal resection of a supratentorial brain metastasis carries a higher risk of LMD than en bloc resection or SRS. Further assessment of the role of the 2 surgical resection approaches and SRS in a controlled prospective setting with large numbers of patients is warranted.

scholarly journals En bloc resection and reconstruction of a huge chondrosarcoma involving multilevel upper thoracic spine and chest wall: case report

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaodong Tang ◽  
Zhenyu Cai ◽  
Ruifeng Wang ◽  
Tao Ji ◽  
Wei Guo
Keyword(s):  
Case Report ◽  
Chest Wall ◽  
Thoracic Spine ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Thoracic Cavity ◽  
En Bloc ◽  
Upper Thoracic Spine ◽  
Upper Thoracic

Abstract Background En bloc resection of malignant tumors involving upper thoracic spine is technically difficult. We surgically treated a patient with grade 2 chondrosarcoma involving T1–5, left upper thoracic cavity, and chest wall. Case presentation A 37 years old, male patient was referred to our hospital for a huge lump involved left shoulder and chest wall. In order to achieve satisfied surgical margins, anterior approach, posterior approach, and lateral approach were carried out sequentially. After en bloc tumor resection, the upper thoracic spine was reconstructed with a 3D-printed modular vertebral prosthesis, and the huge chest wall defect was repaired by a methyl methacrylate layer between 2 pieces of polypropylene mesh. Postoperatively, the patient suffered from pneumonia and neurological deterioration which fully recovered eventfully. At 24 months after operation, the vertebral prosthesis and internal fixation were intact; there was no tumor local recurrence, and the patient was alive with stable pulmonary metastases. Conclusion This case report describes resection of a huge chondrosarcoma involving not only multilevel upper thoracic spine, but also entire left upper thoracic cavity and chest wall. Although with complications, en bloc tumor resection with combined surgical approach and effective reconstructions could improve oncologic and functional prognosis in carefully selected spinal tumor patients.

En bloc hemisacrectomy and internal hemipelvectomy via the posterior approach

2014 ◽  
Vol 21 (3) ◽  
pp. 458-467 ◽  
Author(s):  
Michelle J. Clarke ◽  
Patricia L. Zadnik ◽  
Mari L. Groves ◽  
Hormuzdiyar H. Dasenbrock ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Pelvic Ring ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Surgical Morbidity ◽  
En Bloc ◽  
Internal Hemipelvectomy

Object Traditionally, hemisacrectomy and internal hemipelvectomy procedures have required both an anterior and a posterior approach. A posterior-only approach has the potential to complete an en bloc tumor resection and spinopelvic reconstruction while reducing surgical morbidity. Methods The authors describe 3 cases in which en bloc resection of the hemisacrum and ilium and subsequent lumbopelvic and pelvic ring reconstruction were performed from a posterior-only approach. Two more traditional anterior and posterior staged procedures are also included for comparison. Results In all 3 cases, an oncologically appropriate surgery and spinopelvic reconstruction were performed through a posterior-only approach. Conclusions The advantage of a midline posterior approach is the ability to perform a lumbosacral reconstruction, necessary in cases in which the S-1 body is iatrogenically disrupted during tumor resection.

scholarly journals Safe Transanal Tumor Resection Using a Harmonic Scalpel

2014 ◽  
Vol 99 (1) ◽  
pp. 17-22
Author(s):  
Yuji Inoue ◽  
Takeshi Ohki ◽  
Ryousuke Nakagawa ◽  
Masakazu Yamamoto
Keyword(s):  
Harmonic Scalpel ◽  
Hyperplastic Polyp ◽  
Tumor Resection ◽  
Muscularis Propria ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
En Bloc ◽  
Intraoperative Bleeding ◽  
Submucosal Invasive Cancer

Abstract We performed a safe and simple transanal tumor resection involving total layer resection using a harmonic scalpel as a resecting device. Here we report the results of our experience with this technique between 2005 and 2011. This study involved 32 patients who underwent transanal tumor resection using a harmonic scalpel. The subjects comprised 18 men and 14 women ranging in age from 34 to 87 years (mean: 64.5 years). The tumors measured 8 to 70 mm (mean: 31 mm) in diameter. The operation took 7 to 86 minutes (mean: 29 minutes), and the amount of bleeding was 0 to 165 mL (mean: 16.2 mL). There was no intraoperative blood loss that necessitated hemostatic procedures. Histopathologically, the lesions included hyperplastic polyp in 1 case, adenoma in 9, carcinoma in situ in 7, submucosal invasive cancer in 6, muscularis propria cancer in 4, carcinoid in 1, malignant lymphoma in 1, gastrointestinal stromal tumor in 1, mucosal prolapsed syndrome in 1, and mucosa-associated lymphoid tissue lymphoma in 1. With our technique, en bloc resection was achieved in all patients, and the use of a harmonic scalpel enabled us to complete the operation within 30 minutes, on average, without intraoperative bleeding.

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 &lt; 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 &lt; 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 &lt; 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.

scholarly journals Distal Radius Allograft Reconstruction Utilizing a Step-Cut Technique After En Bloc Tumor Resection

Hand ◽  
2018 ◽  
Vol 14 (4) ◽  
pp. 530-533 ◽  
Author(s):  
Timothy J. Luchetti ◽  
Robert W. Wysocki ◽  
Mark S. Cohen
Keyword(s):  
Distal Radius ◽  
Tumor Resection ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Iliac Crest Bone Graft ◽  
Bony Union ◽  
Optimal Size ◽  
Bony Defect ◽  
Giant Cell Tumors ◽  
En Bloc

Background: En bloc resection of the distal radius is a common treatment for advanced and recurrent giant cell tumors and less commonly for sarcoma. Various reconstructive options exist, including ulnar transposition, osteoarticular autograft and allograft, and allograft arthrodesis. We present a technique of reconstruction using a distal radius bulk allograft with a step-cut to allow for precise restoration of proper length and to promote bony union. Methods: Preoperative templating is performed with affected and contralateral radiographs to assess the size of the expected bony defect, location of the step-cut, and the optimal size of the distal radius allograft required. A standard dorsal approach to the distal radius is utilized, and the tumor is resected. A proximal row carpectomy is performed, and the plate/allograft construct is applied to the remaining host bone. Iliac crest bone graft is harvested and introduced at the graft-bone interface and radiocarpal arthrodesis sites. Results: We have previously reported outstanding union rates with the step-cut technique compared with a standard transverse cut. Conclusions: The technique described provides reproducible union and stabilization of the wrist and forearm with adequate function following en bloc resection of the distal radius for tumor.

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