scholarly journals Soft-tissue reconstruction after total en bloc sacrectomy

2015 ◽  
Vol 22 (6) ◽  
pp. 571-581 ◽  
Author(s):  
Jennifer E. Kim ◽  
John Pang ◽  
Joani M. Christensen ◽  
Devin Coon ◽  
Patricia L. Zadnik ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Treatment Algorithm ◽  
Assistive Device ◽  
Johns Hopkins Hospital ◽  
Soft Tissue Reconstruction ◽  
Metastatic Colon Cancer ◽  
Flap Reconstruction ◽  
En Bloc ◽  
Total Sacrectomy

OBJECT Total en bloc sacrectomy is a dramatic procedure that results in extensive sacral defects. The authors present a series of patients who underwent flap reconstruction after total sacrectomy, report clinical outcomes, and provide a treatment algorithm to guide surgical care of this unique patient population. METHODS After institutional review board approval, data were collected for all patients who underwent total sacrectomy between 2002 and 2012 at The Johns Hopkins Hospital. Variables included demographic data, medical history, tumor characteristics, surgical details, postoperative complications, and clinical outcomes. All subtotal sacrectomies were excluded. RESULTS Between 2002 and 2012, 9 patients underwent total sacrectomy with flap reconstruction. Diagnoses included chordoma (n = 5), osteoblastoma (n = 1), sarcoma (n = 2), and metastatic colon cancer (n = 1). Six patients received gluteus maximus (GM) flaps with a prosthetic rectal sling following a single-stage, posterior sacrectomy. Four required additional paraspinous muscle (PSM) or pedicled latissimus dorsi (LD) fasciocutaneous flaps. Three patients underwent multistage sacrectomy with an anterior-posterior approach, 2 of whom received pedicled vertical rectus abdominis myocutaneous (VRAM) flaps, and 1 of whom received local GM, LD, and PSM flaps. Flap complications included dehiscence (n = 4) and infection (n = 1). During the 1st year of follow-up, 2 of 9 patients (22%) were able to ambulate with an assistive device by the 1st postoperative month, and 6 of 9 (67%) were ambulatory with a walker by the 3rd postoperative month. By postoperative Month 12, 5 of 9 patients (56%)—or 5 of 5 patients not lost to follow-up (100%)—were able to able to ambulate independently. CONCLUSIONS The authors' experience suggests that the GM and pedicled VRAM flaps are reliable options for softtissue reconstruction of total sacrectomy defects. For posterior-only operations, GM flaps with or without a prosthetic rectal sling are generally used. For multistage operations including a laparotomy, the authors consider the pedicled VRAM flap to be the gold standard for simultaneous reconstruction of the pelvic diaphragm and obliteration of dead space.

Sacral tumor resection and the impact on pelvic incidence

2011 ◽  
Vol 14 (1) ◽  
pp. 78-84 ◽  
Author(s):  
Oren N. Gottfried ◽  
Ibrahim Omeis ◽  
Vivek A. Mehta ◽  
Can Solakoglu ◽  
Ziya L. Gokaslan ◽  
...  
Keyword(s):  
Pelvic Incidence ◽  
Tumor Resection ◽  
Surgical Techniques ◽  
Clinical Importance ◽  
Johns Hopkins Hospital ◽  
En Bloc ◽  
Sacral Tumor ◽  
Si Joint ◽  
The Impact ◽  
Total Sacrectomy

Object Pelvic incidence (PI) directly regulates lumbar lordosis and is a key determinant of sagittal spinal balance in normal and diseased states. Pelvic incidence is defined as the angle between the line perpendicular to the S-1 endplate at its midpoint and the line connecting this point to a line bisecting the center of the femoral heads. It reflects an anatomical value that increases with growth during childhood but remains constant in adulthood. It is not altered by changes in patient position or after traditional lumbosacral spinal surgery. There are only 2 reports of PI being altered in adults, both in cases of sacral fractures resulting in lumbopelvic dissociation and sacroiliac (SI) joint instability. En bloc sacral amputation and sacrectomy are surgical techniques used for resection of certain bony malignancies of the sacrum. High, mid, and low sacral amputations result in preservation of some or the entire SI joint. Total sacrectomy results in complete disruption of the SI joint. The purpose of this study was to determine if PI is altered as a result of total or subtotal sacral resection. Methods The authors reviewed a series of 42 consecutive patients treated at The Johns Hopkins Hospital between 2004 and 2009 for sacral tumors with en bloc resection. The authors evaluated immediate pre- and postoperative images for modified pelvic incidence (mPI) using the L-5 inferior endplate, as the patients undergoing a total sacrectomy are missing the S-1 endplate postoperatively. The authors compared the results of total versus subtotal sacrectomies. Results Twenty-two patients had appropriate images to measure pre- and postoperative mPI; 17 patients had high, mid, or low sacral amputations with sparing of some or the entire SI joint, and 5 patients underwent a total sacrectomy, with complete SI disarticulation. The mean change in mPI was statistically different (p < 0.001) for patients undergoing subtotal versus those undergoing total sacrectomy (1.6° ± 0.9° vs 13.6° ± 4.9° [± SD]). There was no difference between patients who underwent a high sacral amputation (partial SI resection, mean 1.6°) and mid or low sacral amputation (SI completely intact, mean 1.6°). Conclusions The PI is altered during total sacrectomy due to complete disarticulation of the SI joint and discontinuity of the spine and pelvis, but it is not changed if any of the joint is preserved. Changes in PI influence spinopelvic balance and may have postoperative clinical importance. Thus, the authors encourage attention to spinopelvic alignment during lumbopelvic reconstruction and fixation after tumor resection. Long-term studies are needed to evaluate the impact of the change in PI on sagittal balance, pain, and ambulation after total sacrectomy.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate ◽  
Distant Metastasis Rate

Abstract Background Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications. Methods From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups. Results The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P = 0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P < 0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P < 0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P = 0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P = 0.016), compared to 99.6% in the AI group and 100% in the EI group. Conclusion The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals Tongue flap- a good choice for intraoral reconstruction after marginal mandibulectomy: a single institution retrospective study of 27 cases

2019 ◽  
Vol 5 (5) ◽  
pp. 1217
Author(s):  
Gopu Govindhasamy ◽  
Subbiah Shanmugam ◽  
Rajiv Michael
Keyword(s):  
Functional Outcomes ◽  
Primary Tumour ◽  
Donor Site ◽  
Good Choice ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Tongue Flap ◽  
Marginal Mandibulectomy

<p class="abstract"><strong>Background:</strong> Marginal mandibulectomy with wide excision of the primary tumour in the treatment of the oral cavity squamous cell cancers preserves the form and function of the mandible, without compromise in obtaining oncologically safe margins. Of the various methods of reconstruction of the composite intraoral tissue defect, tongue flaps offer an easy and effective method of reconstruction.</p><p class="abstract"><strong>Methods:</strong> We have collected the records of 27 patients who underwent marginal mandibulectomy and tongue flap reconstruction in the last 6 years from the cancer department master case sheets, operative records and follow up records. The information on the immediate and long term complications were obtained from the records and functional outcomes of patients were recorded at the time of last follow up and analysed. All the 27 patients had horizontal marginal mandibulectomy with an anteriorly or posteriorly based tongue flap reconstruction.  </p><p class="abstract"><strong>Results:</strong> The most common early postoperative complication was infection around the flap site that occurred in 18.5% of patients. The other complications including haemorrhage, flap dehiscence occurred in few patients which were managed effectively. There was no incidence of major flap necrosis. Speech and swallowing difficulty was encountered in 18.5% and 14.8% of patients respectively. The long term complications were managed conservatively with speech and swallowing therapy.</p><strong>Conclusions:</strong>In our experience, tongue is an excellent donor site for intraoral soft tissue reconstruction, providing an analogous tissue for reconstruction. The technique is simple with acceptable rates of immediate and long term complications and with good functional outcomes.<p> </p>

scholarly journals Development, Practice Patterns, and Early Clinical Outcomes of a Multidisciplinary Liver Cancer Clinic

2021 ◽  
Vol 28 ◽  
pp. 107327482110099
Author(s):  
Angela Y. Jia ◽  
Aleksandra Popovic ◽  
Aditya A. Mohan ◽  
Jane Zorzi ◽  
Paige Griffith ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Practice Patterns ◽  
Multidisciplinary Care ◽  
Johns Hopkins Hospital ◽  
Borderline Resectable ◽  
Tract Cancer ◽  
Liver Cancers ◽  
High Adherence ◽  
Therapeutic Recommendations

Multidisciplinary care has been associated with improved survival in patients with primary liver cancers. We report the practice patterns and real world clinical outcomes for patients presenting to the Johns Hopkins Hospital (JHH) multidisciplinary liver clinic (MDLC). We analyzed hepatocellular carcinoma (HCC, n = 100) and biliary tract cancer (BTC, n = 76) patients evaluated at the JHH MDLC in 2019. We describe the conduct of the clinic, consensus decisions for patient management based on stage categories, and describe treatment approaches and outcomes based on these categories. We describe subclassification of BCLC stage C into 2 parts, and subclassification of cholangiocarcinoma into 4 stages. A treatment consensus was finalized on the day of MDLC for the majority of patients (89% in HCC, 87% in BTC), with high adherence to MDLC recommendations (91% in HCC, 100% in BTC). Among patients presenting for a second opinion regarding management, 28% of HCC and 31% of BTC patients were given new therapeutic recommendations. For HCC patients, at a median follow up of 11.7 months (0.7-19.4 months), median OS was not reached in BCLC A and B patients. In BTC patients, at a median follow up of 14.2 months (0.9-21.1 months) the median OS was not reached in patients with resectable or borderline resectable disease, and was 11.9 months in patients with unresectable or metastatic disease. Coordinated expert multidisciplinary care is feasible for primary liver cancers with high adherence to recommendations and a change in treatment for a sizeable minority of patients.

scholarly journals Clinical Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Neoplasms: A Retrospective Single-Center Study in China

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
Yanfang Chen ◽  
Ye Zhao ◽  
Xiaojing Zhao ◽  
Ruihua Shi
Keyword(s):  
Clinical Outcomes ◽  
Squamous Cell ◽  
En Bloc Resection ◽  
Bloc Resection ◽  
Complete Resection ◽  
Resection Rate ◽  
En Bloc ◽  
End Points ◽  
Squamous Cell Neoplasms

Aims. To retrospectively analyze the clinical outcomes for a large number of endoscopic submucosal dissections (ESDs) in early esophageal squamous cell neoplasms (ESCNs) at the First Affiliated Hospital of Nanjing Medical University.Patients and Methods. From January 2010 to February 2014, 296 patients (mean age 61.4 years, range 31–85 years; 202 men) with 307 early ESCNs (79 intramucosal invasive esophageal squamous cell carcinomas (ESCCs) and 228 high-grade intraepithelial neoplasia (HGIN) cases) were included from a total of 519 consecutive patients who were treated by esophageal ESD at our hospital. The primary end points of the study were rates of en bloc resection and complete resection. Secondary end points were complications, residual and recurrence rates, and mortality during follow-up.Results. The en bloc resection rate and complete resection rate were 93.5% and 78.2%, respectively. Complications included strictures (8.4%), perforations (1.0%), and bleedings (0.7%). Twenty-seven (9.1%) patients experienced residual and 18 (6.1%) patients experienced recurrence during a mean follow-up period of 30 months. Thirteen patients died from causes unrelated to ESCC, and no cancer-related death was observed.Conclusions. Our study showed that ESD is a successful and relatively safe treatment for intramucosal invasive ESCC and HGIN, fulfilling the criteria of lymph node negative tumors. This should encourage clinicians to select ESD performed by experienced operators as a potential or even preferred treatment option for lesions amenable to endoscopic treatment.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2020 ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate ◽  
Distant Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P=0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P<0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P<0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P=0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P=0.016), compared to 99.6% in the AI group and 100% in the EI group.Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

scholarly journals Clinical outcomes of early gastric cardiac cancer treated with endoscopic submucosal dissection in patients with different indications

2020 ◽  
Author(s):  
Ting Fan ◽  
Qi Sun ◽  
Shouli Cao ◽  
Xiangshan Fan ◽  
Qin Huang ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Clinical Outcomes ◽  
Resection Rate ◽  
En Bloc ◽  
Cardiac Cancer ◽  
Submucosal Dissection ◽  
Metastasis Rate ◽  
Distant Metastasis Rate

Abstract Background: Endoscopic submucosal dissection (ESD) has been accepted as a standard treatment for early gastric cardiac cancer (EGCC). Here, we investigate the clinical outcomes of the EGCC patients who underwent ESD in different indications.Methods: From January 2011 to October 2019, we enrolled 502 EGCC lesions from 495 patients which were resected by ESD at our center. We retrospectively analyzed the short-term and long-term clinical outcomes among different indication groups.Results: The number of the patients in the absolute indication (AI), expanded indication (EI) and beyond the expanded indication (BEI) groups was 265, 137 and 93, respectively. The en bloc resection rate was 100%, 100% and 98.9% (P=0.185). The complete resection rate was 99.3%, 98.5% and 74.5%, respectively (P<0.001). During a median follow-up of 48.1 months, the lymph node metastasis rate was 0%, 0% and 2.3% (P<0.001). The distant metastasis rate was 0.4%, 0% and 2.3% (P=0.150). The five-year disease-specific survival rate in the BEI group was 96.6% (P=0.016), compared to 99.6% in the AI group and 100% in the EI group.Conclusion: The efficacy for ESD patients in EI group was almost equal to the AI group. Patients in the BEI group showed generally favorable clinical outcomes and needed to be carefully checked after ESD. ESD may be an optional treatment for patients unsuitable for gastrectomy.

Anticoagulation does Not Prevent Venous Thromboembolism Following IVC Filter Placement: A Retrospective Study of 702 Patients.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2104-2104 ◽  
Author(s):  
Anand Narayan ◽  
Michael B. Streiff ◽  
Kelvin Hong ◽  
Adrea Lee ◽  
Hyun Kim
Keyword(s):  
Venous Thromboembolism ◽  
Clinical Outcomes ◽  
Conflicts Of Interest ◽  
The United States ◽  
Johns Hopkins Hospital ◽  
Filter Placement ◽  
All Cause Mortality ◽  
The Impact ◽  
Post Filter

Abstract Abstract 2104 Poster Board II-81 Purpose: Inferior vena cava filters (IVCF) are extensively used in the United States to treat venous thromboembolism (VTE). Although IVCF prevent pulmonary embolism (PE), IVCF are associated with an increased incidence of deep vein thrombosis (DVT) and IVC thrombosis (IVCT). It remains unclear whether anticoagulation (AC) could reduce thrombotic events post-filter placement. The purpose of this study was to examine the impact of AC on clinical outcomes post-IVCF placement Materials and Methods: After institutional review board approval was obtained, consecutive patients who received an IVCF at the Johns Hopkins Hospital were identified using Current Procedural Terminology (CPT) codes. Demographic and clinical data were retrieved from the institutional electronic medical record (EMR). Clinical events including objectively-documented VTE were confirmed by an independent EPR review by two investigators. Clinical outcomes with and without AC were compared using non-parametric and parametric statistics. Marginal structural models were used to model the impact of anticoagulation on VTE Results: Between January 1, 2002 and December 31, 2006, 702 patients had an IVCF placed at the Johns Hopkins Hospital. AC was used in 276 patients(39.4%) post-filter placement. 46.8% of patients were female and 60.1% were white and these parameters did not differ based upon AC status (p > 0.45). Patients on AC were younger than patients not on AC (54.9 years versus 59.0 years, p = 0.0025). The most common reason for IVCF placement in both groups was a contraindication to AC. Patients subsequently treated with AC were equally likely to present with DVT (p = 0.852) but were more likely to present with PE (p < 0.001) and IVC thrombus (p = 0.043). Retrievable filter use was more common in patients who were treated with AC. (p = 0.002). The mean duration of follow up was 434 days (range 1 - 2638 days). Follow up was longer for patients on AC than patients not on AC (576 versus 341 days, p < 0.001). All-cause mortality was lower for patients treated with AC (37.7% versus 56.0%, p <0.001). Post-filter placement, VTE occurred in more patients on AC than off AC (63/235, 26.8% versus 54/378, 14.1%, p<0.001). DVT (20.3% versus 11.1%, p = 0.001), PE (7.3% versus 3.5%, p=0.027) and IVCT (6.9% versus 2.1%, p=0.002) were more common in patients who were treated with AC. Conclusions: In a large retrospective single center cohort study, AC use was associated with a reduced all cause mortality but an increased frequency of VTE in patients after IVCF placement. These data suggest AC may not protect patients from thrombotic complications associated with IVCF placement and warrant prospective confirmation. IVCF should be reserved for patients who have acute VTE and a contraindication to anticoagulation. Disclosures: No relevant conflicts of interest to declare.

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

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