Early Experience of Oncological Reconstructive Surgery at Dharmais National Cancer Center

Background: Oncological reconstructive surgery is a new paradigm in which it combines oncologic principles with reconstruction techniques. This study aims to present patients’ characteristics who had undergone oncological reconstructive surgery at the Department of Surgical Oncology, Dharmais National Cancer Center. Methods: This descriptive study identified patients’ characteristics who underwent oncological reconstructive surgery, their cancer types, and their therapies. All data were obtained from surgery registration and medical records from January 2019 to January 2020. Data were then presented in number and percentage.Results: A total of 174 patients had undergone oncological reconstructive surgery within one year. The mean age of all patients was 48.2 ± 16.7 years old. Most patients were female (72.1%), with breast cancer making up most cases (43.7%). Most of the participants also underwent mastectomy (42.1%), which was later followed by various reconstruction types. Sixty patients received free tissue transfer with microsurgery (34.4%), of which head and neck cancer constituted most cases. In addition, the most common donor site for the free flap was the Anterolateral Thigh (41.7%). Of all 174 patients, 75.2% presented with locally advanced cancer, and 17.8% had metastatic cancer. Within one year of follow-up, the survival rate was 87.4%, while local recurrence was 3%. Conclusions: The oncological reconstructive surgery approach plays a therapeutic and reconstructive role, and such might be the preferred method of choice for patients presenting with advanced-stage cancer

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Basic Principles in Microvascular Anastomosis and Free Tissue Transfer

Vascular Biology - Selection of Mechanisms and Clinical Applications ◽

10.5772/intechopen.91917 ◽

2020 ◽

Author(s):

Ignacio Vila ◽

Iván Couto-González ◽

Beatriz Brea-García

Keyword(s):

Reconstructive Surgery ◽

Donor Site ◽

Free Tissue Transfer ◽

Microvascular Anastomosis ◽

First Line ◽

Basic Principles ◽

Tissue Transfer ◽

Aesthetic Results ◽

Surgical Field ◽

Vascular Suture

Free tissue transfer pursues the best functional and aesthetic results in reconstructive surgery. As these techniques completely maximise the donor tissues’ disposability, these treatments have become a first-line option in many situations. When the donor site is taken form the same patient, these surgeries are often referred to as autotransplants. Free tissue transfer sustains in microvascular anastomosis, which are defined by a vessel lumen diameter inferior to 3 mm. Particular attention to some details is important in these techniques, as, for example, to preclude any damage to the vessel walls or any leakage in the microvascular anastomosis. But the success of these techniques does not only depend on an adequate vascular suture, but also on a constellation of details that must be taken into account. These go from the availability of a trained team, to the ergonomics of the surgeon, through the scrupulous cleanliness of the surgical field.

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Standardizing coordination between surgical oncology and reconstructive surgery for breast cancer patients undergoing mastectomy with immediate reconstruction.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.30_suppl.110 ◽

2014 ◽

Vol 32 (30_suppl) ◽

pp. 110-110

Author(s):

Mehra Golshan ◽

Charles A. Hergrueter ◽

Kristen Camuso ◽

Nancy U. Lin ◽

Linda Cutone ◽

...

Keyword(s):

Breast Cancer ◽

Operating Room ◽

Reconstructive Surgery ◽

Surgical Oncology ◽

Care Quality ◽

Cancer Center ◽

Breast Cancer Patients ◽

Immediate Reconstruction ◽

Definitive Surgery ◽

Surgical Teams

110 Background: Timely diagnosis and treatment of breast cancer, endorsed by organizations such as ASCO and NCCN, are essential to ensure optimal clinical outcomes and patient satisfaction. Inefficient care coordination may adversely affect care quality. At our cancer center, 75% of patients who undergo mastectomy seek a reconstructive surgery consult and over 60% elect mastectomy with immediate reconstruction. We sought to evaluate and reduce the time to reconstructive surgery consult and first definitive surgery (FDS) by streamlining coordination between services. Methods: We studied 330 patients who underwent mastectomy with immediate reconstruction between January 2011 and April 2013. Time intervals between initial surgical consult, reconstruction consult, and FDS were calculated. After examining existing best practices in patient referral and scheduling, we established targets of 7 days from initial consult to reconstruction consult and 28 days from initial consult to FDS. To achieve these targets, facilitated sessions were held with administrative and clinical experts to create a standard referral and scheduling process, including a referral template and establishing surgical teams based on clinic and operating room alignment. The interventions were implemented over a 6-month period. Results: Mean days from initial consult to reconstructive surgery consult decreased, with significant improvement in reaching the 7 day target. No significant changes from time of initial consult to FDS were observed. Conclusions: Standardizing coordination has led to timelier reconstructive surgery consults for patients undergoing mastectomy with immediate reconstruction. Other factors, such as operating room availability, pre-operative testing and patient preference should be explored to reduce the time to FDS. [Table: see text]

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Assessing the immediate impact of COVID‐19 on surgical oncology practice: Experience from an NCI‐designated Comprehensive Cancer Center in the Northeastern United States

Journal of Surgical Oncology ◽

10.1002/jso.26475 ◽

2021 ◽

Author(s):

Victor Gazivoda ◽

Alissa Greenbaum ◽

Joshua Roshal ◽

Jenna Lee ◽

Lekha Reddy ◽

...

Keyword(s):

United States ◽

Surgical Oncology ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Northeastern United States ◽

Practice Experience ◽

Oncology Practice

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New Targeted Therapies and Immunotherapies for Locally Advanced Periocular Malignant Tumours: Towards a New ‘Eye-Sparing’ Paradigm?

Cancers ◽

10.3390/cancers13112822 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2822

Author(s):

Arnaud Martel ◽

Sandra Lassalle ◽

Alexandra Picard-Gauci ◽

Lauris Gastaud ◽

Henri Montaudie ◽

...

Keyword(s):

Targeted Therapies ◽

Paradigm Shift ◽

Adjuvant Radiotherapy ◽

Locally Advanced ◽

Second Step ◽

Malignant Tumours ◽

New Paradigm ◽

Eye Pain ◽

Almost All ◽

Orbital Lesions

The management of periocular skin malignant tumours is challenging. Surgery remains the mainstay of treatment for localised eyelid cancers. For more locally advanced cancers, especially those invading the orbit, orbital exenteration has long been considered the gold standard; however, it is a highly disfiguring and traumatic surgery. The last two decades have been marked by the emergence of a new paradigm shift towards the use of ‘eye-sparing’ strategies. In the early 2000s, the first step consisted of performing wide conservative eyelid and orbital excisions. Multiple flaps and grafts were needed, as well as adjuvant radiotherapy in selected cases. Although being incredibly attractive, several limitations such as the inability to treat the more posteriorly located orbital lesions, as well as unbearable diplopia, eye pain and even secondary eye loss were identified. Therefore, surgeons should distinguish ‘eye-sparing’ from ‘sight-sparing’ strategies. The second step emerged over the last decade and was based on the development of targeted therapies and immunotherapies. Their advantages include their potential ability to treat almost all tumours, regardless of their locations, without performing complex surgeries. However, several limitations have been reported, including their side effects, the appearance of primary or secondary resistances, their price and the lack of consensus on treatment regimen and exact duration. The aim of this article was to review the evolution of the management of locally advanced periocular malignant tumours over the last three decades and highlight the new paradigm shift towards the use of ‘eye-sparing’ strategies.

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Health-Care Workers’ Perception of Reimbursement for Complex Surgical Oncology Procedures

The American Surgeon ◽

10.1177/000313482008600234 ◽

2020 ◽

Vol 86 (2) ◽

pp. 140-145

Author(s):

Shoshana Levi ◽

Emily Alberto ◽

Dakota Urban ◽

Nicholas Petrelli ◽

Gregory Tiesi

Keyword(s):

Health Care ◽

Health Care Workers ◽

Online Survey ◽

Surgical Oncology ◽

Patient Perceptions ◽

Cancer Center ◽

Physician Reimbursement ◽

Care Workers ◽

Before And After ◽

Fee Schedule

Perception of physician reimbursement for surgical procedures is not well studied. The few existing studies illustrate that patients believe compensation to be higher than in reality. These studies focus on patient perceptions and have not assessed health-care workers’ views. Our study examined health-care workers’ perception of reimbursement for complex surgical oncology procedures. An anonymous online survey was distributed to employees at our cancer center with descriptions and illustrations of three oncology procedures—hepatectomy, gastrectomy, and pancreaticoduodenectomy. Participants estimated the Medicare fee and gave their perceived value of each procedure. Participants recorded their perception of surgeon compensation overall, both before and after revealing the Medicare fee schedule. Most of the 113 participants were physicians (33.6%) and nurses (28.3%). When blinded to the Medicare fee schedules, most felt that reimbursements were too low for all procedures (60–64%) and that surgeons were overall undercompensated (57%). Value predictions for each procedure were discordant from actual Medicare fee schedules, with overestimates up to 374 per cent. After revealing the Medicare fee schedules, 55 per cent of respondents felt that surgeons were undercompensated. Even among health-care workers, a large discrepancy exists between perceived and actual reimbursement. Revealing actual reimbursements did not alter perception on overall surgeon compensation.

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Continuing care for cancer pain relief with oral morphine solution. One-year experience in a regional cancer center

Cancer ◽

10.1002/1097-0142(19901001)66:7<1590::aid-cncr2820660725>3.0.co;2-r ◽

1990 ◽

Vol 66 (7) ◽

pp. 1590-1595 ◽

Cited By ~ 16

Author(s):

S. Vijayaram ◽

P. V. Ramamani ◽

N. S. Chandrashekhar ◽

R. Sudharshan ◽

Roshini Heranjal ◽

...

Keyword(s):

Pain Relief ◽

Cancer Pain ◽

Oral Morphine ◽

Cancer Center ◽

Continuing Care ◽

Morphine Solution ◽

One Year

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Incidence of cutaneous reactions with pemetrexed: Comparison of patients who received three days of oral dexamethasone twice daily to patients who did not

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155218804869 ◽

2018 ◽

Vol 25 (7) ◽

pp. 1645-1650 ◽

Cited By ~ 1

Author(s):

Stefanie K Clark ◽

Lisa M Anselmo

Keyword(s):

New Mexico ◽

Locally Advanced ◽

Intervention Group ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Control Group ◽

University Of New Mexico ◽

Oral Dexamethasone ◽

Significant Difference ◽

Cutaneous Reactions

Pemetrexed is a multitargeted antifolate indicated for locally advanced or metastatic non-squamous non-small-cell lung cancer and malignant pleural mesothelioma. Cutaneous reactions are associated with pemetrexed use. Pemetrexed prescribing information recommends oral dexamethasone 4 mg twice daily for three days starting the day before pemetrexed infusion to prevent cutaneous reactions. Patients receive intravenous dexamethasone before pemetrexed infusion at the University of New Mexico Comprehensive Cancer Center, but the oral dexamethasone recommendation is not always followed. The objective of this study was to determine if there is a difference between patients who received three days of oral dexamethasone starting the day before pemetrexed infusion and patients who did not by determining incidence of cutaneous reactions, delay in therapy, and therapy change due to adverse reactions. Eighty-five patients received at least one dose of pemetrexed between August 1, 2012 and August 31, 2017. Twenty-nine patients did not receive three days of oral dexamethasone 4 mg twice daily and 56 patients did (34.1% vs. 65.9%). There was no statistically significant difference in the incidence of cutaneous reactions between the intervention group and the control group (13.8% vs. 25.0%; p = 0.384), delay in pemetrexed therapy between groups (44.8% vs. 32.1%; p = 0.2), or therapy change due to adverse events (34.5% vs. 23.2%; p = 0.654). Results suggest three days of oral dexamethasone 4 mg twice daily did not significantly affect incidence rates of cutaneous reactions, delay in therapy, or therapy change in patients who received intravenous dexamethasone before pemetrexed infusion at University of New Mexico Comprehensive Cancer Center.

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An epidemiological evaluation of the prevalence of malnutrition in Spanish patients with locally advanced or metastatic cancer

Clinical Nutrition ◽

10.1016/j.clnu.2005.05.001 ◽

2005 ◽

Vol 24 (5) ◽

pp. 801-814 ◽

Cited By ~ 120

Author(s):

Angel Segura ◽

Josep Pardo ◽

Carlos Jara ◽

Luis Zugazabeitia ◽

Joan Carulla ◽

...

Keyword(s):

Metastatic Cancer ◽

Locally Advanced ◽

Epidemiological Evaluation

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Autologous Unilateral Breast Reconstruction with Venous Supercharged IMAP-Flaps: A Step by Step Guide of the Split Breast Technique

Journal of Clinical Medicine ◽

10.3390/jcm9093030 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3030

Author(s):

Kathrin Bachleitner ◽

Laurenz Weitgasser ◽

Amro Amr ◽

Thomas Schoeller

Keyword(s):

Breast Cancer ◽

Surgical Technique ◽

Breast Reconstruction ◽

Donor Site ◽

Operating Time ◽

Cancer Recurrence ◽

Free Tissue Transfer ◽

Donor Site Morbidity ◽

Aesthetic Result ◽

Secondary Operations

Various techniques for breast reconstruction ranging from reconstruction with implants to free tissue transfer, with the disadvantage of either carrying a foreign body or dealing with donor site morbidity, have been described. In patients who had a unilateral mastectomy and offer a contralateral mamma hypertrophy a breast reconstruction can be performed with the excess tissue from the hypertrophic side using the split breast technique. Here a local internal mammary artery perforator (IMAP) flap of the hypertrophic breast can be used for reconstruction avoiding the downsides of implants or a microsurgical reconstruction and simultaneously reducing the enlarged donor breast in order to achieve symmetry. Methods: Between April 2010 and February 2019 the split breast technique was performed in five patients after mastectomy due to breast cancer. Operating time, length of stay, complications and the need for secondary operations were analyzed and the surgical technique including flap supercharging were described in detail. Results: All five IMAP-flaps survived and an aesthetically pleasant result could be achieved using the split breast technique. An average of two secondary corrections to achieve better symmetry were necessary after each breast reconstruction. Complications included venous flap congestion, partial flap necrosis and asymmetry. No breast cancer recurrence was recorded. An overall approval of the surgical technique among patients was observed. Conclusions: The use of the contralateral breast for unilateral total breast reconstruction represents an additional highly useful technique for selected patients, is safe and reliable results can be achieved. Although this technique is carried out as a single-stage procedure, including breast reduction and reconstruction at the same time, secondary operations may be necessary to achieve superior symmetry and a satisfying aesthetic result. Survival of the IMAP-flaps can be improved by venous supercharging of the flaps onto the thoracoepigastric vein.

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