Surgical Approaches to the Irradiated Breast

2020 ◽  
Author(s):  
Megan Fracol ◽  
Neil Fine
Keyword(s):  
Radiation Therapy ◽  
Breast Surgery ◽  
Surgical Approaches ◽  
Autologous Reconstruction ◽  
Breast Irradiation ◽  
Surgery Complications ◽  
Number Of Patients ◽  
Operative Complications ◽  
Salvage Mastectomy ◽  
Post Operative Complications

The use of radiation therapy for treatment of breast cancer has steadily increased since the 1990s. Plastic surgeons must be prepared to reconstruct patients with prior lumpectomy and radiation now needing salvage mastectomy, as well as the growing number of patients who will go on to need post mastectomy radiation therapy. Operating in the irradiated field presents unique challenges, including but not limited to intra-operative difficulties such as friable vessels when performing autologous-based reconstruction and higher rates of post-operative complications when performing implant-based reconstruction. Reconstructed outcomes are often inferior to the non-irradiated patient and as such the plastic surgeon should be prepared to perform further revision as necessary. This chapter will review indications for radiation therapy, both autologous- and implant-based approaches to reconstructing the irradiated breast and how to manage post-operative complications. This review contains 3 figures, 5 tables, and 75 references. Keywords: radiation, breast irradiation, breast reconstruction, radiation therapy, autologous reconstruction, implant-based reconstruction, revisionary breast surgery, complications

scholarly journals NEOADJUVANT RADIATION THERAPY FOR RECTAL CANCER WITH SYNCHRONOUS LIVER METASTASES (LITERATURE REVIEW)

2021 ◽  
Vol 20 (5) ◽  
pp. 123-137
Author(s):  
T. P. Pochuev ◽  
A. A. Nevolskikh ◽  
L. O. Petrov ◽  
L. N. Titova ◽  
A. A. Karpov
Keyword(s):  
Rectal Cancer ◽  
Radiation Therapy ◽  
Liver Metastases ◽  
Cancer Patients ◽  
Distant Metastases ◽  
Point Of View ◽  
Surgical Approaches ◽  
Primary Tumors ◽  
Synchronous Liver Metastases ◽  
Number Of Patients

Background. In Russia, synchronous distant metastases are annually detected in approximately 6,200 patients and synchronous liver metastases in 4,000 patients. To plan treatment for rectal cancer with synchronous liver metastases, it is necessary to consider the location of the tumor, extent of the primary tumor involvement, tumor-related complications, and resectability of metastases.The purpose of this review was to analyze the results of studies aimed at finding the best regimens for treating rectal cancer patients with synchronous liver metastases.Material and Methods. The review includes both retrospective and prospective studies devoted to treatment of rectal cancer with synchronous liver metastases. Previous reviews and clinical recommendations were analyzed.Results. Most oncologists are in favor of preoperative radiotherapy, especially when rectal cancer is located in the lower-and middle-ampullary regions. However, there are no randomized trials with a representative number of patients to confirm or refute this point of view. Due to the increased life expectancy of patients and introduction of modern minimally invasive surgical approaches, there is an urgent need for radical treatment of rectal cancer patients. Thus, the approaches to the treatment of primary tumors with synchronous metastatic liver damage should be the same as in stage II–III of the disease, and neoadjuvant radiation therapy is an integral part of this strategy. 

scholarly journals Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

2020 ◽  
Author(s):  
Atef Mejri ◽  
khaoula Arfaoui ◽  
Mohamed Firas Ayadi ◽  
Badreddine Aloui ◽  
Jasser Yaakoubi
Keyword(s):  
Hydatid Cyst ◽  
Hospital Stay ◽  
Surgical Techniques ◽  
Case Series ◽  
Surgical Approaches ◽  
Average Hospital ◽  
Spleen Preserving ◽  
Operative Complications ◽  
Total Splenectomy ◽  
Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

scholarly journals 491 Comparison of Pandemic and Pre-pandemic Practices of Managing Acute Appendicitis

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Salih ◽  
R Sabaratnam ◽  
H K Kim ◽  
K Bevan
Keyword(s):  
Acute Appendicitis ◽  
Open Surgery ◽  
District General Hospital ◽  
Similar Time ◽  
Time Period ◽  
Number Of Patients ◽  
Operative Complications ◽  
One Year ◽  
Post Operative Complications

Abstract Aim Acute appendicitis (AA) is a common indication for abdominal surgery, with more than 30,000 appendicectomies performed in England per year. However, SARS-CoV-2 (COVID-19) changed usual surgical practices following advice to minimise laparoscopic surgery, and instead favouring conservative management, or open surgery for AA. Method In this study, we compared the management of 50 patients with suspected/confirmed AA during the first wave of the COVID-19 pandemic at a district general hospital (DGH) with our usual practices, against 50 patients admitted with suspected/confirmed AA during a similar time period, one year prior to the pandemic. Results Demographics of patients in both groups were comparable with median age of 34 in the pandemic vs 32.5 in the pre-pandemic group. 74% of patients in the pandemic group (PG) underwent imaging to confirm appendicitis, compared to 58% of patients in the pre-pandemic group (PPG). 64% of PG patients were treated conservatively, compared to 8% in PPG patients. Outcomes demonstrated re-attendance events of 12% in the PG, as compared to 10% in the PPG, although the follow up period was longer in the PPG. Despite a significantly smaller number of patients managed surgically during the pandemic, 27% of patients undergoing appendicectomies had post-operative complications in the PG, as compared to 7% in the PPG. Conclusions During the pandemic, more patients at our DGH with AA were treated conservatively, more patients had re-attendance events and post-operative complications when compared to patients in the pre-pandemic group.

scholarly journals The Importance of Culture Change Associated With Novel Surgical Approaches and Innovation: Does Perioperative Care Transcend Technical Considerations for Pulmonary Lobectomy?

2021 ◽  
Vol 8 ◽  
Author(s):  
Kathrin Freystaetter ◽  
Benjamin R. Waterhouse ◽  
Nicholas Chilvers ◽  
Jason Trevis ◽  
Jonathan Ferguson ◽  
...  
Keyword(s):  
Perioperative Care ◽  
Culture Change ◽  
Thoracoscopic Surgery ◽  
Surgical Approaches ◽  
Pulmonary Lobectomy ◽  
Substantial Impact ◽  
Significant Difference ◽  
Operative Complications ◽  
Technical Considerations ◽  
Post Operative Complications

Robotic thoracic surgery for pulmonary lobectomy was introduced at our unit in 2015, along with enhanced perioperative patient care pathways. We evaluated the effect of this practice change on short-term outcomes. Data on all adult patients who underwent a lobectomy in our unit between 2015 and 2019 were obtained retrospectively from our surgical database. Patients fell into three groups: conventional open surgery via thoracotomy, video-assisted thoracoscopic surgery (VATS), and robot-assisted thoracoscopic surgery (RATS). Survival was defined as survival to discharge. Our cohort included 722 patients. Three hundred and ninety-two patients (54.3%) underwent an open operation, 259 patients (35.9%) underwent VATS surgery, and 71 patients (9.8%) underwent a robotic procedure. Comparing these surgical approaches, there was no statistically significant difference in the overall incidence of post-operative complications (p = 0.15) as well as the incidence of wound infections, arrhythmias, prolonged air leaks, respiratory failure, or ICU readmissions. Additionally, there was no statistically significant difference in survival to discharge (p = 0.66). However, patients who had a VATS procedure were less likely to develop a post-operative chest infection (p = 0.01). Evaluating our practice over time, we found a decrease in the overall incidence of post-operative complications (p = 0.01) with an improvement in survival to discharge (p = 0.02). In our experience, VATS lobectomy was associated with a lower incidence of post-operative chest infections. However, the limitations of our study must be considered; factors such as patient selection that may have had a substantial impact. The culture change associated with adoption of a VATS and robotic surgical programme appears to have corresponded with an improved survival to discharge for all lobectomy patients, irrespective of surgical approach. Perioperative care may therefore have a more significant impact on outcomes than technical considerations.

scholarly journals Reconstruction of Diaphragmatic Defects With Human Acellular Dermal Matrix

2018 ◽  
Vol 4 ◽  
pp. 2513826X1775111 ◽  
Author(s):  
Valerie Hurdle ◽  
Kristine Ly ◽  
Justin K. Yeung ◽  
Andrew J. Graham ◽  
Gary A. Gelfand ◽  
...  
Keyword(s):  
Literature Review ◽  
Acellular Dermal Matrix ◽  
Published Data ◽  
Dermal Matrix ◽  
Number Of Patients ◽  
Operative Complications ◽  
Acellular Dermal ◽  
Human Acellular Dermal Matrix ◽  
Post Operative Complications

Large diaphragmatic defects present a reconstructive challenge, often necessitating the use of synthetic materials. We report our experience reconstructing large diaphragmatic defects using human acellular dermal matrix (HADM). Patients unable to undergo primary repair of diaphragmatic defects from 2009 to 2013 were reconstructed using HADM. A chart review was performed to investigate immediate and late post-operative outcomes. Construct stability was assessed with repeat imaging. In addition, a literature review was performed to identify studies in which HADM had been used for diaphragm repair. Four patients required reconstruction of large hemi-diaphragmatic defects. All patients had chest tubes placed, which remained in situ from 4 to 10 days post-operatively. Two patients also had drains in dead space surrounding HADM; these were removed between 6 and 9 days post-procedure. Length of hospital stay ranged from 8 to 65 days. Post-operative complications were seen in 2 patients: surgical site cellulitis and failure of extubation due to persistent respiratory failure. There were no adverse events related to HADM, and all patients remained disease free without evidence of repair failure on radiographic follow-up, ranging from 14 to 62 months. The literature review identified 3 studies in which all diaphragms repaired with HADM remained intact without need for explantation despite common post-operative complications including fluid collections and surgical site infections. Diaphragm reconstruction with HADM is limited to a small number of patients and modest follow-up periods; the neodiaphragms appear durable in contaminated fields, without evidence of repair failure. Our results, and previously published data, indicate HADM is a reasonable option for diaphragm repair.

scholarly journals Frequency of early post operative complications of modified radical mastectomy within period of four weeks

2020 ◽  
Vol 8 (5) ◽  
pp. 1838
Author(s):  
Rekha Melwani ◽  
Sadaf Jabeen Malik ◽  
Sobohi Shakeel ◽  
Shahid Zafar ◽  
Muhammad Yousif Khoso ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Wound Infection ◽  
Radical Mastectomy ◽  
Care Hospital ◽  
Modified Radical Mastectomy ◽  
Shoulder Dysfunction ◽  
Number Of Patients ◽  
Increased Risk ◽  
Operative Complications ◽  
Post Operative Complications

Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.

scholarly journals Colorectal Cancer in Elderly Patients with Surgical Indication: State of the Art, Current Management, Role of Frailty and Benefits of a Geriatric Liaison

2021 ◽  
Vol 18 (11) ◽  
pp. 6072
Author(s):  
Nicolás M. González-Senac ◽  
Jennifer Mayordomo-Cava ◽  
Angela Macías-Valle ◽  
Paula Aldama-Marín ◽  
Sara González ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Elderly Patients ◽  
Preoperative Evaluation ◽  
The Elderly ◽  
Surgical Indication ◽  
Surgical Approaches ◽  
Operative Complications ◽  
Geriatric Intervention ◽  
Operative Recovery ◽  
Post Operative Complications

Six out of every 10 new colorectal cancer (CRC) diagnoses are in people over 65 years of age. Current standardized surgical approaches have proved to be tolerable on the elderly population, although post-operative complications are more frequent than in the younger CRC population. Frailty is common in elderly CRC patients with surgical indication, and it appears to be also associated with an increase of post-operative complications. Fast-track pathways have been developed to assure and adequate post-operative recovery, but comprehensive geriatric assessments (CGA) are still rare among the preoperative evaluation of elderly CRC patients. This review provides a thorough study of the effects that a CGA assessment and a geriatric intervention have in the prognosis of CRC elderly patients with surgical indication.

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