scholarly journals Vulva Cancer Treatment with Cryosurgery

2018 ◽  
Vol 4 (1) ◽  
pp. 1-10
Author(s):  
Mauro JE ◽  
Storino C ◽  
Bianconi MI ◽  
Farah C ◽  
D’Atri FJ
Keyword(s):  
Quality Of Life ◽  
Genital Tract ◽  
Vulvar Cancer ◽  
Tumor Resection ◽  
Safety Margin ◽  
Previous Treatment ◽  
Complete Healing ◽  
High Morbidity

Vulvar cancer represents 4% to 5% of Low Genital Tract Tumors (LGTT) and 1% of all cancers in women. Treatment depends on stage, and when possible surgery is preferable. Advanced cancers require large resections (with needs grafts and-or rotating flaps), radio and/or chemotherapy, all of which can lead to high morbidity and quality of life impairment. To minimize these effects, in 1994, we developed a cryosurgery prospective protocol to manage vulvar cancer in patients with comorbid conditions.Patients and Methods: Between 1994 and 2019 we treated n=41 patients: FIGO stages I: n=2 (4.88%) II: n=9 (21.95%), III: n=28 (68.29%), IV: n=2 (4.88%). Median age 64.3 (28 to 90 years old), and 70% were 70 years old or older, 59% had severe comorbidities (diabetes, autoimmune diseases, immunosuppressive user).Cryosurgery Protocol:Firstly, tumor resection, hemostasis, and 2 rapid freezing- slow thawing cycles with Liquid Nitrogen (LN) spray. The cycles should include the logde and a 1.5 cm safety margin. After complete healing (between 45 and 95 days after cryosurgery), nodes are treated according to FIGO stages. Result:All patients after the effects of the anesthesia were able to urinate spontaneously, walk, had minimal analgesic requirements, with good postoperative. The patients remained in the hospital for one or two days, and with rare exceptions, were discharged the following day with controls twice a week at the hospital. None of the patients required flaps or grafts to repair the treated areas. After complete healing they maintained the vulvar sensitivity and considerably improved their quality of life. Some of them, who had a partner, were able to resume their sexual intercourse.Mean follow-up: 55.39 (3 months to 258 months). Five patients had local recurrences between 12 and 72 months after treatment, and were controlled with a new cryosurgery. Six patients had HPV related lesions located in other areas of the lower genital tract, which were also controlled with cryosurgery. Twenty five of them died 19 due to an unrelated cause of death, and 6 due to disease progression in the nodes without vulvar recurrence, 9 patients survived and were free of disease with a mean follow-up of 53 months. Seven patients, after a disease free follow up of 17.2 months, weren ́t able to be controlled, as they lived more than 400 km way from the hospital. Local control was achieved in all patients.Comments: Cryosurgery can be done after any previous treatment, and can be repeated to control recurrences.Conclusion: Given the simplicity of the technique, its low cost, the possibility of being used in patients with multiple co-morbidities, the absence of major complications, and the anatomical and functional results obtained, we believe that cryosurgery can be considered among the best options to control of vulvar cancer, even large or advanced cases, in elderly patients and-or with severe comorbidities.

scholarly journals Quality of life following surgical treatment of lesions within the pineal region

2018 ◽  
Vol 130 (1) ◽  
pp. 28-37 ◽  
Author(s):  
Stepan Fedorko ◽  
Klaus Zweckberger ◽  
Andreas W. Unterberg
Keyword(s):  
Quality Of Life ◽  
Surgical Treatment ◽  
Neurological Outcome ◽  
Tumor Resection ◽  
Pineal Region ◽  
Subtotal Resection ◽  
Modified Rankin Scale ◽  
Tumor Patients

OBJECTIVEPineal region tumors are a rare and heterogeneous group of lesions. The optimal therapeutic approach is currently a topic of controversy, particularly in light of the potential operative risks and complications. The potential beneficial effects of surgery have already been described, but information about neurological outcome and, in particular, health-related quality of life (HRQOL) is still lacking in the literature. The aim of this study was to assess the therapeutic effect of resection of pineal region lesions, emphasizing grade of tumor resection, neurological outcome, quality of life, and the necessity of additional shunt procedures.METHODSThe authors performed a prospective study of HRQOL in 32 patients who had undergone surgical treatment of lesions in the pineal region (20 tumors and 12 cysts) between 2008 and 2014. All patients had at least 6 months of follow-up, with reexamination including standardized neurological assessment, an evaluation of dependency using the modified Rankin Scale, and an evaluation of HRQOL. The authors retrospectively examined patient charts and collected information regarding imaging studies, neurological status prior to surgery, surgical strategies used, any complications, and histological diagnoses.RESULTSIn this study, there was no surgery-associated mortality or major morbidity. Permanent minor morbidity was reported for 4 patients (13%). Comparing pre- and postoperative neurological symptoms, 75% of tumor patients had either complete resolution or improvement of preoperative symptoms; symptoms were unchanged in 10% of tumor patients and deteriorated in 15%. In patients with pineal cysts, long-term follow-up showed that 42% of patients were free of any symptoms and 58% experienced improvement of their preoperative symptoms. These outcomes were also reflected in the modified Rankin Scale scores, which demonstrated significant improvement following resection of pineal region lesions. Furthermore, significant improvements in HRQOL scores occurred in global health status, in all functional scales, and in pain, nausea and vomiting, fatigue, and insomnia (p < 0.0001). Moreover, a significant reduction in the necessity for permanent shunt procedures was observed after gross-total tumor resection compared with subtotal resection (p = 0.035) of pineal cysts.CONCLUSIONSDespite potential risks, (radical) surgery is a highly effective and safe treatment option for pineal region lesions and should be considered for the majority of patients.

Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas Based on Preoperative Imaging

2021 ◽  
Author(s):  
Yang Li ◽  
Xingshu Zhang ◽  
Chaoying Qin ◽  
Jun Su ◽  
Xiangyu Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Artery ◽  
Cerebral Arteries ◽  
Tumor Resection ◽  
Preoperative Imaging ◽  
Karnofsky Performance Scale ◽  
Simpson Grade ◽  
Protection Strategies

Abstract OBJECTIVE Parasellar meningiomas represent a cohort of skull base tumors localize to parasellar region. Those meningiomas tend to compress, encase or even invade cerebral arteries and their perforating branches. Surgical resection of PMs is a challenging operation without damaging perforating arteries. The study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral arteries protection strategy based on preoperative imaging. METHODS A retrospective review of a single surgeon’s experience with microsurgical removal of PMs in 163 patients between January 2012 to March 2020. Individualized approaches with bidirectional dissection strategy were used. Cerebral Artery invasion classification, neurological outcomes, MRC Scale Muscle Strength Grading, and Karnofsky Performance Scale were used to assess the tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively. RESULTS Total resection (Simpson Grade I or II) was achieved in 114 (69.9%) patients in our series. Vision improved in 44.7% of patients with consecutive follow-up, was stable in 51.1% and deteriorated in 3.8%. Improvement in cranial nerve IIII, IV, and VI was observed in 41.1%, 36.2%, and 44.8%, respectively. The mean follow-up time was (38.8±27.9) months and KPS at the last follow-up was (89.6±8.5). Recurrence was observed in 8 (13.8%) patients with CSMs while the rate was only 3.8% and 2.8% in ACMs and MSWMs. CONCLUSIONS Preoperative imaging is of great significance in the selection of surgical approach. Maximum tumor resection and cerebral artery protection can be achieved concurrently utilizing bidirectional dissection. Those Individualized cerebral artery protection strategies not only are of great utility to neurosurgeons but also can improve patient’s quality of life.

A Comparative Study of Video Endoscopic Inguinal Lymphadenectomy and Conventional Open Inguinal Lymphadenectomy for Treating Vulvar Cancer

2017 ◽  
Vol 27 (9) ◽  
pp. 1983-1989 ◽  
Author(s):  
Menglei Zhang ◽  
Limei Chen ◽  
Xuyin Zhang ◽  
Jingxin Ding ◽  
Keqin Hua
Keyword(s):  
Quality Of Life ◽  
Vulvar Cancer ◽  
Life Quality ◽  
Wound Complications ◽  
Lymph Node Yield ◽  
Oncological Outcomes ◽  
Inguinal Lymphadenectomy ◽  
The Veil

ObjectiveThis study aims to compare the complications, oncological outcomes, cosmetic satisfaction, and quality of life experienced by women with vulvar cancer undergoing video endoscopic inguinal lymphadenectomy (VEIL) versus conventional open inguinal lymphadenectomy (COIL).Patients and MethodsForty-eight consecutive patients with vulvar cancer who underwent COIL (n = 27) or VEIL (n = 21) at the Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China between 2003 and 2016 were included in this retrospective cohort study. The perioperative data, postoperative complications, oncological outcomes, cosmetic satisfaction, and quality of life of the COIL and VEIL groups were compared.ResultsTwenty patients (74.1%) in the COIL group and 19 patients (90.5%) in the VEIL group returned for follow-up after the operation. The median follow-up time was 73 months (8–162 months) for the COIL group and 28 months (8–58 months) for the VEIL group. The inguinal lymph node yield in the VEIL group was comparable with that in the COIL group (15 ± 5 vs 18 ± 6,P= 0.058). The VEIL and COIL groups had a similar 2-year recurrence rate (10.5% vs 10%,P= 0.957) and 2-year disease-specific survival rate (95.5% vs 93.3%,P= 0.724). The wound complication rate was significantly lower in the VEIL group than the COIL group (4.8% vs 55.6%,P= 0.000). The VEIL group had higher body image scores (16.27 ± 1.20 vs 13.16 ± 0.87,P< 0.0001) and cosmetic scores (20.13 ± 0.98 vs 16.92 ± 0.72,P< 0.0001) than the COIL group. The patients in the VEIL group had higher life quality scores on the Functional Assessment of Cancer Therapy—Vulvar questionnaire than those in the COIL group (165.9 ± 6.3 vs 160.5 ± 6.0,P= 0.026).ConclusionsCompared with COIL, VEIL can effectively reduce postoperative wound complications and improve patients' cosmetic satisfaction and life quality without compromising therapeutic efficacy. Hence, we believe that VEIL is a good alternative to COIL for vulvar cancer patients when surgical expertise is available.

scholarly journals Improved patient quality of life following intradural extramedullary spinal tumor resection

2016 ◽  
Vol 25 (5) ◽  
pp. 640-645 ◽  
Author(s):  
Matthew J. Viereck ◽  
George M. Ghobrial ◽  
Sara Beygi ◽  
James S. Harrop
Keyword(s):  
Quality Of Life ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Spinal Tumor ◽  
Administrative Database ◽  
Spinal Tumors ◽  
Descriptive System ◽  
Intradural Extramedullary

OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1–3 months postoperatively, 3–12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1–3, 3–12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.

scholarly journals Quality of Life with Vulvar Carcinoma Treated with Palliative Electrochemotherapy: The ELECHTRA (ELEctroCHemoTherapy vulvaR cAncer) Study

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1622
Author(s):  
Anna Myriam Perrone ◽  
Martina Ferioli ◽  
Lisa Argnani ◽  
Francesca De Terlizzi ◽  
Cecilia Pirovano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Vulvar Cancer ◽  
Pain Scale ◽  
Outcome Data ◽  
Before And After ◽  
Effective Option ◽  
Cancer Project ◽  
Multicenter Prospective Observational Study

The ELECHTRA (ELEctroChemoTherapy vulvaR cAncer) project was conceived to collect data on palliative electrochemotherapy (ECT) in vulvar cancer (VC) assessing patients’ outcomes (response and survival) and impact on quality of life (QoL). After reporting outcome data in 2019, here, we present the results on QoL. A multicenter prospective observational study was conducted on patients with VC refractory or not amenable to standard therapies undergoing palliative ECT as per clinical practice. The following questionnaires were administered before and after ECT (two and four months later, early and late follow-up): visual analog pain scale (VAS), EuroQol 5-Dimension 5-Level (EQ-5D-L5) and Functional Assessment of Cancer Therapy—Vulva cancer (FACT—V). Analyses were conducted on both the whole study population and by subgroups (clinical response after ECT and site, number and size of lesions). Questionnaires from 55 patients were evaluated. Compared to the baseline (6.1 ± 2.1), the VAS was significantly reduced at early (4.3 ± 2.5) and late follow-up (4.6 ± 2.8) (p < 0.0001). The FACT—V score improved significantly at early (9.6 ± 4.0) (p < 0.0001) and late follow-up (8.9 ± 4.1) (p < 0.0054) as compared to the baseline (7.1 ± 3.6). No EQ-5D-5L statistically significant changes were observed. Subgroup analyses showed worse QoL in patients with stable or progressive disease, posterior site and multiple or larger than 3 cm nodules. This is the first study reporting improved QoL in VC patients after palliative ECT. Based on these results, ECT in VC should be considered an effective option based on the favorable outcomes both in terms of response and QoL.

scholarly journals Individualized Cerebral Artery Protection Strategies for the Surgical Treatment of Parasellar Meningiomas on the Basis of Preoperative Imaging

2021 ◽  
Vol 11 ◽  
Author(s):  
Yang Li ◽  
XingShu Zhang ◽  
Jun Su ◽  
Chaoying Qin ◽  
Xiangyu Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cerebral Artery ◽  
Tumor Resection ◽  
Cranial Nerves ◽  
Preoperative Imaging ◽  
Surgical Approaches ◽  
Karnofsky Performance Scale ◽  
Protection Strategies

ObjectiveParasellar meningiomas (PMs) represent a cohort of skull base tumors that are localized in the parasellar region. PMs tend to compress, encase, or even invade the cerebral arteries and their perforating branches. The surgical resection of PMs without damaging neurovascular structures is challenging. This study aimed to analyze functional outcomes in a series of patients who underwent surgery with individualized cerebral artery protection strategies based on preoperative imaging.MethodsA retrospective review was performed on a single surgeon’s experience of the microsurgical removal of PMs in 163 patients between January 2012 and March 2020. Individualized approaches with a bidirectional dissection strategy were used. Cerebral artery invasion classification, neurological outcomes, MRC Scale for muscle strength, and Karnofsky performance scale were used to assess tumor vascular invasion, functional outcome, and patient quality-of-life outcomes, respectively.ResultsTotal resection (Simpson grade I or II) was achieved in 114 patients (69.9%) in our study. A total of 44.7% of patients had improved vision at consecutive follow-ups, 51.1% were stable, and 3.8% deteriorated. Improvements in cranial nerves III, IV, and VI were observed in 41.1%, 36.2%, and 44.8% of patients, respectively. The mean follow-up time was (38.8 ± 27.9) months, and the KPS at the last follow-up was 89.6 ± 8.5. Recurrence was observed in eight patients (13.8%) with cavernous sinus meningiomas, and the recurrence rates in anterior clinoid meningiomas and medial sphenoid wing meningiomas were 3.8% and 2.8%, respectively.ConclusionsPreoperative imaging is important in the selection of surgical approaches. Maximum tumor resection and cerebral artery protection can be achieved concurrently by utilizing the bidirectional dissection technique. Individualized cerebral artery protection strategies provide great utility in improving a patient’s quality of life.

scholarly journals Expanding indications for the extended endoscopic endonasal approach to hypothalamic gliomas: preliminary report

2014 ◽  
Vol 37 (4) ◽  
pp. E11 ◽  
Author(s):  
Matteo Zoli ◽  
Diego Mazzatenta ◽  
Adelaide Valluzzi ◽  
Gianluca Marucci ◽  
Nicola Acciarri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Tumor Resection ◽  
Small Sample ◽  
Anterior Communicating Artery ◽  
Moderate Increase ◽  
Endoscopic Endonasal Approach ◽  
Endonasal Approach ◽  
Endoscopic Endonasal

Object In the last decade the indications for the endoscopic endonasal approach have been progressively expanded to include lesions that have not been traditionally considered amenable to resection through the transsphenoidal route. In this study, the authors analyze their experience with hypothalamic gliomas treated via the endoscopic endonasal approach. Methods Consecutive cases of hypothalamic gliomas treated since 2007 via an endoscopic endonasal approach were reviewed. Preoperative and postoperative neuroimaging as well as endocrinological, neurological, and visual symptoms were analyzed to assess the surgical outcome. Signs and symptoms of hypothalamic dysfunction including body mass index (BMI), memory, sleep-wake rhythm, and polyphagia were prospectively collected pre- and postoperatively to assess hypothalamic function. Quality of life was evaluated using the Katz scale. Results In the initial phase the endoscopic endonasal approach was adopted in 3 cases with a palliative intent, to obtain a biopsy sample or for debulking of the mass followed by radio- or chemotherapy. In 2 later cases it was successfully adopted to achieve gross-total tumor resection. Complications consisted of 2 postoperative CSF leaks, which required an endoscopic endonasal reintervention. Visual deficit improved in 3 cases and normalized in the other 2. Four patients developed diabetes insipidus, and 3 an anterior panhypopituitarism. All patients had a moderate increase in BMI. No patients presented with any other signs of hypothalamic damage, and their quality of life at follow-up is normal. Conclusions Despite the limitations of a short follow-up and small sample, the authors’ early experience with the endoscopic endonasal approach has revealed it to be a direct, straightforward, and safe approach to third ventricle astrocytomas. It allowed the authors to perform tumor resection with the same microsurgical technique: dissecting the tumor with 2 hands, performing a central debulking, and controlling the bleeding with bipolar coagulation. The main limitations were represented by some anatomical conditions, such as the position of the chiasm and the anterior communicating artery complex and, finally, by the challenge of watertight plastic repair. To definitively evaluate the role of this approach in hypothalamic gliomas, a comparison with transcranial series would be necessary, but due to the rarity of these cases such a study is still lacking. The authors observed that more aggressive surgery is associated with a worse endocrinological outcome; thus they consider it to be an open question (in particular in prepubertal patients) whether radical removal is an advisable goal for hypothalamic gliomas.

scholarly journals Survival and quality of life of patients with oral and oropharyngeal cancer at 1-year follow-up of tumor resection

2010 ◽  
Vol 18 (3) ◽  
pp. 279-284 ◽  
Author(s):  
Maria Gabriela Haye Biazevic ◽  
José Leopoldo Ferreira Antunes ◽  
Janina Togni ◽  
Fabiana Paula de Andrade ◽  
Marcos Brasilino de Carvalho ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Oropharyngeal Cancer ◽  
Tumor Resection ◽  
Oral And Oropharyngeal Cancer

scholarly journals Quality of life in head and neck cancer patients at 5 years after free flap reconstruction: a significant decline during the follow-up

2022 ◽  
Author(s):  
Sanna Lahtinen ◽  
Krisztina Molnár ◽  
Siiri Hietanen ◽  
Petri Koivunen ◽  
Pasi Ohtonen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Free Flap ◽  
Tumor Resection ◽  
Well Being ◽  
Significant Decline ◽  
Flap Surgery ◽  
Free Flap Surgery

Abstract Purpose Free flap reconstructions following head and neck tumor resection are known to involve more than 50% rate of complications and other adverse events and up to 50% mortality during a 5-year follow-up. We aimed to examine the difference in the long-term quality of life (QoL) between the 2-year and 5-year assessments after free flap surgery for cancer of the head and neck. Methods A total of 28 of the 39 eligible patients responded to the survey. QoL was assessed at 5 years after operation and compared with the assessment performed at 2 years after the operation using RAND-36, EORTC-C30 and H&N-35, and SWAL-QOL tools. Results The criteria for poor QoL using RAND-36 tool was met in 11 (39.3%) patients in contrast to 4 (14.3%, P = 0.003) patients in the 2-year assessment. EORTC-C30 global score was decreased from 83.9 (SD16.4) to 64.6 (SD 24.0, P < 0.001) during the follow-up. In both RAND-36 and EORTC-C30 surveys, decline was found in physical and role functioning together with energy and emotional well-being domains. SWAL-QOL showed poor swallowing-related QoL in both assessments. Conclusion We found a significant decline in QoL during a 5-year follow-up after free flap surgery for cancer of the head and neck.

scholarly journals Quality of Life in Patients with Acromegaly before and after Transsphenoidal Surgical Resection

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jing Gu ◽  
Shiyuan Xiang ◽  
Min He ◽  
Meng Wang ◽  
Yanfang Gu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Somatostatin Analogs ◽  
Tumor Resection ◽  
Repeated Measurements ◽  
Sf 36 ◽  
Before And After ◽  
Discordant Group

Objective. We aimed to determine the perioperative changes in the quality of life (QoL) in patients with acromegaly and to reveal the relationship between biochemical indicators and quality of life change after tumor resection. Methods. Patients with acromegaly were enrolled from a tertiary pituitary center. SF-36 scale and AcroQoL scale were used to determine the QoL before and after surgery. We analyzed changes in QoL using a generalized linear model for repeated measurements. We compared the changes in QoL among three groups (remission, active, and discordant group) based on postoperative growth hormone (GH) and insulin-like growth factor-1. Results. 151 patients (75 males and 76 females) diagnosed with acromegaly were included. The average age was 43.9 ± 12.3 years. The median total SF-36 scale was 65.3% (IQR: 63.2%–69.2%). Overall AcroQoL score at baseline was 59.1% (IQR: 51.8%–71.8%). Nadir GH levels (coefficient −0.08, p=0.047), T3 levels (coefficient 2.8, p=0.001), and testosterone levels (coefficient −0.20, p=0.033) in males were independent predictive factors of the total SF-36 score. During the follow-up, the median overall SF-36 score increased to 66.1% at 3 months and 75.3% at 6 months (p<0.001) after surgery. The median overall AcroQoL score increased to 74.5% at 3 months and 77.3% at 6 months (p<0.001) after surgery. At 6-month follow-up, median scores were still less than 70% in appearance, vitality, and mental health dimensions. The QoL after surgery were similar among the three groups, although higher GH and more preoperative somatostatin analogs usage were observed in the active group. Conclusion. In conclusion, acromegalic patients were associated with low QoL, which could be reversed partially by surgery. The improvement was independent of the endocrine remission. Appearance, vitality, and mental health were three major aspects that warrant further attention from physicians and caregivers after surgery.

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