scholarly journals Tracheal surgery

2016 ◽  
Vol 73 (3) ◽  
Author(s):  
A. D'Andrilli ◽  
E.A. Rendina ◽  
F. Venuta
Keyword(s):  
Surgical Resection ◽  
Surgical Techniques ◽  
Treatment Modalities ◽  
Malignant Neoplasms ◽  
New Techniques ◽  
Multidisciplinary Cooperation ◽  
Post Traumatic ◽  
Post Intubation ◽  
Near Future

Surgical resection and reconstruction of the trachea can be performed both for benign and malignant diseases. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, degenerative lesions, benign or malignant neoplasms. Success can be pursued only by accurate patient selection and timing, meticulous surgical techniques, careful follow up and, when required, multidisciplinary cooperation. Although surgical resection has now become part of our surgical practice, other treatment modalities are approaching a new clinical application era, in particular tracheal transplantation and bioengineering. These new techniques will certainly offer, in the near future, improved chances to treat difficult cases.

scholarly journals Soft Tissue Sarcoma Follow-up Imaging: Strategies to Distinguish Post-treatment Changes from Recurrence

2020 ◽  
Vol 24 (06) ◽  
pp. 627-644
Author(s):  
Iris-M. Noebauer-Huhmann ◽  
Snehansh R. Chaudhary ◽  
Olympia Papakonstantinou ◽  
Joannis Panotopoulos ◽  
Marc-André Weber ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Surgical Techniques ◽  
Soft Tissue Sarcomas ◽  
Late Complications ◽  
Treatment Modalities ◽  
Recurrence Rates ◽  
Precise Knowledge ◽  
Inflammatory Pseudotumors

AbstractSoft tissue sarcomas encompass multiple entities with differing recurrence rates and follow-up intervals. The detection of recurrences and their differentiation from post-therapeutic changes is therefore complex, with a central role for the clinical radiologist. This article describes approved recommendations. Prerequisite is a precise knowledge of the current clinical management and surgical techniques. We review recurrence rates and treatment modalities. An adequate imaging technique is paramount, and comparison with previous imaging is highly recommended. We describe time-dependent therapy-related complications on magnetic resonance imaging compared with the spectrum of regular post-therapeutic changes. Early complications such as seromas, hematomas, and infections, late complications such as edema and fibrosis, and inflammatory pseudotumors are elucidated. The appearance of recurrences and radiation-associated sarcomas is contrasted with these changes. This systematic approach in follow-up imaging of soft tissue sarcoma patients will facilitate the differentiation of post-therapeutic changes from recurrences.

Osteoclast-like giant cell tumors of the pancreas: Clinical characteristics, genetic testing, and treatment modalities.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16752-e16752
Author(s):  
Benjamin Edward Ueberroth ◽  
Alex John Liu ◽  
Rondell P. Graham ◽  
Mohamad Bassam Sonbol ◽  
Thorvardur Ragnar Halfdanarson
Keyword(s):  
Genetic Testing ◽  
Cell Carcinoma ◽  
Giant Cell ◽  
Surgical Resection ◽  
Metastatic Disease ◽  
Mayo Clinic ◽  
Treatment Modalities ◽  
Giant Cell Carcinoma ◽  
Carcinoma Of The Pancreas

e16752 Background: Undifferentiated osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy only described by a few case reports in the literature. In this study, we sought to better characterize this entity by examining patients seen at Mayo Clinic. Methods: This study identified patients with osteoclast-like giant cell carcinoma of the pancreas using Mayo Clinic databases (MN, AZ, FL) from the year 2000 to present. Patient demographics, genetic data, and treatment modalities were reviewed. Kaplan-Meier analysis was used to evaluate median overall survival (mOS) for the cohort as well as mOS and mPFS for treatment subgroups. Results: 15 patients were identified (9 female, 6 male). Median age at diagnosis was 59 years and mOS for all patients was 11.0 mos (95% CI 6.2-15.7 mos). 3 patients (20%) had metastatic disease at diagnosis with the liver being the most common site (n = 3). Metastatic disease was associated with significantly shorter OS (3.5 vs. 14.1 mos, p = 0.005; HR 7.98 [95% CI 1.43-44.4]) compared to locoregional disease (LRD). 4 patients underwent genetic testing. The most common mutation was CDKN2A (n = 3), followed by TP53 (n = 2) and KRAS (n = 2). 13/15 patients had detailed follow-up information. 6/7 patients undergoing chemotherapy received a gemcitabine-based regimen as first line: with capecitabine (n = 2), with nab-paclitaxel (n = 2), or as monotherapy (n = 2). 1 patient received FOLFIRINOX. In patients with LRD and adequate follow-up (n = 11), 8/11 underwent surgical resection and had longer OS compared to those without resection (17.0 vs. 8.4 mos, p = 0.09). No surgical patients received neoadjuvant chemotherapy. 5/8 received adjuvant chemotherapy, 2 did not undergo chemotherapy, and 1 was lost to follow-up after surgery. PFS from time of surgery was 15.3mos (95% CI 5.0-25.6mos). 6 patients (40%) were alive at time of analysis; all 6 underwent surgical resection. Conclusions: Osteoclast-like giant cell carcinoma of the pancreas is a rare malignancy with a poor prognosis, even when diagnosed at an early stage. OS for patients of all stages in this study was less than 1 year suggesting prognosis may be even worse than that of pancreatic adenocarcinoma. The optimal therapy remains unknown but most patients received similar chemotherapy as in adenocarcinoma. Patients with LRD amenable to surgical resection experienced a PFS over 1 year from surgery, possibly associated with OS benefit, however overall prognosis is poor. Further study is warranted on a larger scale to better understand disease course and treatment options.

Early experience with robotic radiosurgery for local control of liver metastasis.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 295-295
Author(s):  
Michael Kwiatt ◽  
Francis R. Spitz ◽  
Tamara A. LaCouture
Keyword(s):  
Radiation Therapy ◽  
Liver Metastasis ◽  
Median Time ◽  
Surgical Resection ◽  
Liver Toxicity ◽  
Surgical Techniques ◽  
Local Therapy ◽  
Time To Progression ◽  
Robotic Radiosurgery

295 Background: Liver toxicity limits radiation therapy for liver metastasis; however, robotic radiosurgery delivers effective doses with limited toxicities. Robotic radiosurgery may be an effective treatment for liver metastases in patients with lesions not amenable to surgical resection. Methods: We conducted a retrospective study of patients treated with robotic radiosurgery for liver metastasis at our institution from June 2008 and June 2010. Medical records were reviewed and all cases discussed in multi-disciplinary conference. Preradiosurgery and follow-up abdominal computed tomography (CT) scans reviewed for treatment response. Our primary endpoint was local recurrence, defined as increased enhancement or tumor progression within the treatment field on follow-up CT scan. Results: Thirty-three patients had 37 liver metastasis treated with robotic radiosurgery (17 colorectal, 4 ovarian, 4 breast, 3 melanoma, 2 liver, 2 lung, 1 gastric, 1 cholangiocarcinoma, 1 pancreas, 1 anal, 1 bladder). Eighteen of 33 patients (54.5%) had isolated liver metastasis. Prior to radiosurgery 27 of 33 patients (81.8%) had undergone surgical resection of primary tumor, 26 of 33 patients (78.8%) were treated with chemotherapy for metastatic disease, and 15 of 33 patients (45.5%) had non-liver radiation therapy. Median time from primary diagnosis to radiosurgery treatment was 33.3 months (5.7 to 320 months). Patients received median radiation dose of 30 Gy (22.5 to 42) over 3 to 5 fractions. Median follow up was 8.1 months (1.2 to 23.5). There were no cases of liver failure. Sixteen patients had disease progression outside the treatment field (15 liver, 6 systemic) with a median time to progression of 4.6 months (0.9 to 17.6). Five lesions (13.5%) had in field progression with a median time to progression of 10 months (2.6 to 13.1). Seventeen patients (51.5%) died during follow-up. Conclusions: Robotic radiosurgery offers a potential local therapy for patients with metastatic liver disease with limited toxicity. Longer follow-up and more patients are required to better assess its safety. Robotic radiosurgery may fill a role for patients with lesions not amenable to traditional ablative and surgical techniques.

The correlation between molecular characteristics and treatment outcomes in patients (pts) with grade 2-3 (G2-3) gliomas.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14551-e14551
Author(s):  
Jaleh Fallah ◽  
Vineeth Tatineni ◽  
Martin C. Tom ◽  
Wei Wei ◽  
Deborah Park ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Surgical Resection ◽  
Tumor Grade ◽  
Treatment Modalities ◽  
Rank Test ◽  
Molecular Characteristics ◽  
Idh Mutation ◽  
Kaplan Meier ◽  
History Of

e14551 Background: In a retrospective study, we investigated the correlation between the molecular characteristics and treatment outcomes in pts with G2-3 glioma. Methods: Pts with G2-3 glioma and known IDH mutation status who were diagnosed between 1994 and 2017 were analyzed. In most of the pts, IDH mutation was determined by immunohistochemistry only. Overall survival (OS) was defined as the date of biopsy/surgical resection to the date of last follow up or death. OS was estimated by Kaplan-Meier method and compared by log rank test. Results: 606 pts with G2 (81%) or G3 (19%) glioma were included. The median age at diagnosis was 38 years (Interquartile range 27-52), 55% of the pts were male, 83% were white, 47% had IDH-mt tumor and 67% underwent surgical resection. The median follow-up was 55.6 months (mo). The median OS (mOS) in pts with IDH mutated (mt) and IDH wild type (wt) tumor were 201 and 128 mo, respectively. The predictors of worse OS in pts with IDH-mt tumor included G3, receipt of chemotherapy or radiation therapy (RT), bilateral disease and lack of 1p/19q codeletion. The determinants of worse OS in pts with IDH-wt tumor included male gender, receipt of chemotherapy or RT, history of prior malignancy, smoking, G3, astrocytoma histology, no surgical resection, EGFR amplification, and lack of 1p/19q codeletion. The mOS by IDH, 1p/19q, and MGMT status is summarized in the table. RT and chemotherapy were more commonly used among pts who had G3 glioma and those who underwent biopsy only. Conclusions: Tumor grade continues to be a determinant of pt outcomes in the setting of molecularly defined gliomas. Presence of 1p/19q codeletion is a predictor of favorable OS in pts with G2-3 glioma. Surgical resection is a determinant of OS in pts with IDH-wt G2-3 gliomas, but not in pts with IDH-mt tumor. The worse OS in pts who were treated with RT or chemotherapy is likely due to the use of these treatment modalities in more aggressive tumors and in those who only had biopsy. [Table: see text]

scholarly journals Incidence, Management, and Outcomes of Adult Spinal Chordoma Patients in the United States

2021 ◽  
pp. 219256822199515
Author(s):  
Saavan Patel ◽  
Ravi S. Nunna ◽  
James Nie ◽  
Darius Ansari ◽  
Nauman S. Chaudhry ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Radical Resection ◽  
The United States ◽  
Treatment Modalities ◽  
Malignant Neoplasms ◽  
En Bloc ◽  
Chemotherapy Administration ◽  
Spinal Chordoma ◽  
Diagnosis Codes

Study Design: Retrospective cohort study. Objective: Spinal chordomas are rare primary malignant neoplasms of the primitive notochord. They are slow growing but locally aggressive lesions that have high rates of recurrence and metastasis after treatment. Gold standard treatment remains en-bloc surgical resection with questionable efficacy of adjuvant therapies such as radiation and chemotherapy. Here we provide a comprehensive analysis of prognostic factors, treatment modalities, and survival outcomes in patients with spinal chordoma. Methods: Patients with diagnosis codes specific for chordoma of spine, sacrum, and coccyx were queried from the National Cancer Database (NCDB) during the years 2004-2016. Outcomes were investigated using Cox univariate and multivariate regression analyses, and survival curves were generated for comparative visualization. Results: 1,548 individuals were identified with a diagnosis of chordoma, 60.9% of which were at the sacrum or coccyx and 39.1% at the spine. The mean overall survival of patients in our cohort was 8.2 years. Increased age, larger tumor size, and presence of metastases were associated with worsened overall survival. 71.2% of patients received surgical intervention and both partial and radical resection were associated with significantly improved overall survival ( P < 0.001). Neither radiotherapy nor chemotherapy administration improved overall survival; however, amongst patients who received radiation, those who received proton-based radiation had significantly improved overall survival compared to traditional radiation. Conclusion: Surgical resection significantly improves overall survival in patients with spinal chordoma. In those patients receiving radiation, those who receive proton-based modalities have improved overall survival. Further studies into proton radiotherapy doses are required.

scholarly journals Female Urethroplasty: Outcomes of Different Techniques in a Single Center

2021 ◽  
Vol 10 (17) ◽  
pp. 3950
Author(s):  
Marjan Waterloos ◽  
Wesley Verla ◽  
Michel Wirtz ◽  
Mieke Waterschoot ◽  
Wietse Claeys ◽  
...  
Keyword(s):  
Patency Rate ◽  
Surgical Techniques ◽  
Treatment Modalities ◽  
Urethral Injury ◽  
Urethral Reconstruction ◽  
Wide Range ◽  
Tertiary Center ◽  
Group 2 ◽  
Group 1

Introduction: Female urethral strictures and injuries are relatively uncommon compared to males. A wide range of possible causes and treatment modalities have been described. Lately female urethral reconstruction is gaining attention and is fortunately no longer a neglected topic within the reconstructive urology. As such, we aimed to describe our surgical techniques and outcomes for female urethroplasty from a tertiary center. Materials and Methods: Records of female patients who underwent a urethroplasty between July 2018 and May 2021 in our tertiary referral center were reviewed. Patients were subdivided in two groups: patients who suffered from a urethral injury and received an early repair urethroplasty, and patients with a true urethral stricture who received a delayed urethroplasty. Preprocedural, surgical and postoperative data were collected and analyzed with descriptive statistics. Results: A total of five patients in group 1 and nine patients in group 2 were included. Etiology of the urethral injury in group 1 was iatrogenic in 80% and transitional cell carcinoma of the urethra in 20% of cases. A patency rate of 100% at a follow-up of 30 months was achieved with the different techniques. In group 2 etiology was idiopathic (44%), iatrogenic (44%) and due to external trauma in 12% of cases. Urethroplasty technique consisted of primary repair or dorsal onlay of a buccal mucosal graft. Patency rate was 100% at a median follow-up of 13 months. Three patients suffered from postoperative urinary incontinence, one in group 1 and two in group 2. Conclusion: Female urethroplasty is a relatively rare entity within reconstructive urethral surgery. This case series of 14 patients demonstrates that with appropriate surgical techniques, a high patency rate with a low complication rate can be achieved. Further prospective studies with standardized diagnostic workup and follow-up should be performed in order to optimize management strategy.

scholarly journals P.005 Ovarian resection in anti-NMDAr encephalitis

2021 ◽  
Vol 48 (s3) ◽  
pp. S21-S21
Author(s):  
Y Iyengar ◽  
J Hébert ◽  
SA Climans ◽  
RA Wennberg ◽  
DF Tang-Wai
Keyword(s):  
Surgical Resection ◽  
Symptom Onset ◽  
Functional Outcomes ◽  
Primary Outcome ◽  
Surgical Techniques ◽  
Modified Rankin Scale ◽  
Bilateral Oophorectomy ◽  
Aspartate Receptor ◽  
One Year

Background: Anti-N-methyl-D-aspartate receptor encephalitis (NMDArE) is commonly associated with ovarian teratomas, surgical resection of which can lead to significant neurologic improvement. However, the necessity of aggressive resection at the time of diagnosis is unknown; specifically, whether unilateral or bilateral oophorectomy, versus lesionectomy and partial oophorectomy (ovariotomy), is required. Methods: Eleven patients with NMDArE who underwent ovarian resection between January 1st 2012 and December 31st 2020 were retrospectively identified. Primary outcome was good one-year functional status, defined as modified Rankin Scale (mRS) score of 0-1. Results: Median age at encephalitis onset was 24 years (19–38); median delay from symptom onset to surgery was 39 days (16–129). Six patients (54.5%) had good mRS scores, unrelated to surgical resection type. Conclusions: Added clinical benefit of aggressive ovarian resection techniques at one-year follow-up was not identified in our data. Further longitudinal studies are needed to determine the indications for different surgical techniques in patients with NMDArE. Ovarian resection approaches and associated functional outcomes in patients with NMDArE

Treatment of pediatric stage IA lymphocyte-predominant Hodgkin lymphoma with surgical resection alone: A report from the Children's Oncology Group.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9524-9524 ◽  
Author(s):  
Burton Appel ◽  
Peter Ehrlich ◽  
Lu Chen ◽  
Robert E. Hutchison ◽  
David C. Hodgson ◽  
...  
Keyword(s):  
Overall Survival ◽  
Hodgkin Lymphoma ◽  
Surgical Resection ◽  
Fdg Pet ◽  
Low Risk ◽  
Stage I ◽  
Malignant Neoplasms ◽  
Single Node ◽  
Stage Ia

9524 Background: Lymphocyte-predominant Hodgkin lymphoma (LPHL) is an uncommon histologic subtype comprising up to 10% of cases in pediatric series. Patients with LPHL typically present with low stage disease and are responsive to regimens used for classical HL. Recurrence is uncommon; secondary malignant neoplasms or evolution to non-Hodgkin lymphoma are more common events. Small retrospective studies have suggested that some patients with stage I LPHL can be cured with surgery alone. We report the results of a large prospective study using a treatment algorithm in which a selected subset of patients received surgery alone. Methods: Patients ages 0-21 years with newly-diagnosed, low risk LPHL were eligible for AHOD03P1. Low risk was defined as clinical Stage IA and IIA in the absence of bulk disease (a mediastinal mass > 1/3 of the thoracic diameter or a nodal aggregate > 6 cm). Central pathology review was performed to confirm LPHL histology. Baseline evaluations included CT and FDG-PET. Patients with Stage IA disease in a single node that was completely resected were observed without further therapy. Total resection (TR) was confirmed by rapid central review of CT and FDG-PET. In some cases the extent of resection was equivocal; repeat imaging 6-7 weeks after initial evaluation was used to allocate such patients to either observation or chemotherapy. Patients who recurred were assigned to treatment with 3 cycles of AV-PC (doxorubicin/vincristine/prednisone/cyclophosphamide). Results: Between January 2006 and November 2010, 52 patients with Stage IA, single node LPHL were enrolled with a confirmed TR. Nine patients have experienced a relapse; 8 were Stage I and 1 was Stage II at relapse. The median time to relapse was 10 (range 1-17) months. The median follow up among the 43 remaining patients is 26 (range 4-60) months. The current 2 year EFS estimate among these patients is 80.3% (95% CI: 65.3% -89.3%). Overall survival for the 52 patients is 100%. Conclusions: With this strategy of surgical resection followed by observation in a highly select cohort of pediatric LPHL, up to 80% of patients may be spared chemotherapy. Follow up is limited but overall survival to date is excellent.

scholarly journals Differential Effects of Treatment Strategies in Individuals With Chronic Ocular Surface Pain With a Neuropathic Component

2021 ◽  
Vol 12 ◽  
Author(s):  
Sneh Patel ◽  
Rhiya Mittal ◽  
Elizabeth R. Felix ◽  
Konstantinos D. Sarantopoulos ◽  
Roy C. Levitt ◽  
...  
Keyword(s):  
Ocular Surface ◽  
Marked Improvement ◽  
Pain Treatment ◽  
Pain Clinic ◽  
Treatment Modalities ◽  
Autologous Serum ◽  
Ocular Pain ◽  
Post Traumatic ◽  
Pain Improvement

Background: Dysfunction at the ocular system via nociceptive or neuropathic mechanisms can lead to chronic ocular pain. While many studies have reported on responses to treatment for nociceptive pain, fewer have focused on neuropathic ocular pain. This retrospective study assessed clinical responses to pain treatment modalities in individuals with neuropathic component ocular surface pain.Methods: 101 individuals seen at the University of Miami Oculofacial Pain Clinic from January 2015 to August 2021 with ≥3 months of clinically diagnosed neuropathic pain were included. Patients were subcategorized (postsurgical, post-traumatic, migraine-like, and laterality) and self-reported treatment outcomes were assessed (no change, mild, moderate, or marked improvement). One-way ANOVA (analysis of variance) was used to examine relationships between follow up time and number of treatments attempted with pain improvement, and multivariable logistic regression was used to assess which modalities led to pain improvement.Results: The mean age was 55 years, and most patients were female (64.4%) and non-Hispanic (68.3%). Migraine-like pain (40.6%) was most common, followed by postsurgical (26.7%), post-traumatic (16.8%) and unilateral pain (15.8%). The most common oral therapies were α2δ ligands (48.5%), the m common topical therapies were autologous serum tears (20.8%) and topical corticosteroids (19.8%), and the most common adjuvant was periocular nerve block (24.8%). Oral therapies reduced pain in post-traumatic (81.2%), migraine-like (73%), and unilateral (72.7%) patients, but only in a minority of postsurgical (38.5%) patients. Similarly, topicals improved pain in post-traumatic (66.7%), migraine-like (78.6%), and unilateral (70%) compared to postsurgical (43.7%) patients. Non-oral/topical adjuvants reduced pain in postsurgical (54.5%), post-traumatic (71.4%), and migraine-like patients (73.3%) only. Multivariable analyses indicated migraine-like pain improved with concomitant oral α2δ ligands and adjuvant therapies, while postsurgical pain improved with topical anti-inflammatories. Those with no improvement in pain had a shorter mean follow-up (266.25 ± 262.56 days) than those with mild (396.65 ± 283.44), moderate (652 ± 413.92), or marked improvement (837.93 ± 709.35) (p &lt; 0.005). Identical patterns were noted for number of attempted medications.Conclusion: Patients with migraine-like pain frequently experienced pain improvement, while postsurgical patients had the lowest response rates. Patients with a longer follow-up and who tried more therapies experienced more significant relief, suggesting multiple trials were necessary for pain reduction.

Primary malignant melanoma of the pharynx

2001 ◽  
Vol 115 (11) ◽  
pp. 931-934 ◽  
Author(s):  
Özcan Öztürk ◽  
Hüsnü Özek ◽  
Harun Cansiz ◽  
Bariş Karakullukçu
Keyword(s):  
Malignant Melanoma ◽  
Local Recurrence ◽  
Total Dose ◽  
Surgical Resection ◽  
Interleukin 2 ◽  
Treatment Modalities ◽  
Primary Therapy ◽  
Mucosal Malignant Melanoma ◽  
Primary Mucosal Malignant Melanoma

Primary mucosal malignant melanomas are rare. They appear late in life and their prognosis is grave. Although there is no consensus on therapy, wide surgical resection followed by radiotherapy, chemotherapy and immunotherapy are treatment modalities. In this report we present a case of widespread primary mucosal malignant melanoma located in the pharynx. After immunotherapy (four cycles of interleukin-2 and interferon-alpha) and chemotherapy (four cycles of cisplatin and dacarbazine) has been applied as primary therapy for suppression of the mass, transoral total pharyngeal resection was performed. After surgery three cycles of immunotherapy and three cycles of chemotherapy were administered followed by radiotherapy (total dose of 6600 cGy). An additional three cycles of immunotherapy and chemotherapy were administered. Although no local recurrence was observed during the 14 months of follow-up after the completion of radiotherapy, cranial and lung metastasis were detected in the 12th month.

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