Functional and oncologic outcomes of robot-assisted simple enucleation with and without renal arterial cold perfusion in complex renal tumors: a propensity score-matched analysis

Background To compare robot-assisted simple enucleation with renal arterial cold perfusion (RACP-RASE) and RASE alone in complex renal tumors with regard to perioperative, functional and oncologic outcomes by propensity score-matched analysis. Methods Data from 351 patients who underwent RACP-RASE or RASE for complex renal tumors were recorded between September 2014 and December 2017. Propensity score-matched analysis was performed on age, sex, BMI, ECOG score, tumor side and size, preoperative estimated glomerular filtration rate (eGFR), RENAL score and PADUA score. Results The study included 31 RACP-RASE and 320 RASE procedures. RENAL score and PADUA score were higher and tumor diameter was greater under RACP-RASE than RASE. After matching, the two groups were similar in estimated blood loss (208.3 vs 230.7 ml; p = 0.696) and ischemic time (34.8 vs 32.8 min; p = 0.342). The RACP-RASE group had significantly longer operative time than the RASE group (264.1 ± 55.7 vs 206.9 ± 64.0 min, p = 0.001). There was no difference in the incidence of postoperative complications between the two groups (13.8% vs 24.1%; p = 0.315), as was the overall incidence of positive surgical margins (3.4 vs 0%; p = 1.000). The changes in eGFR significantly differed between the two groups at 3 months (p = 0.018) and 12 months (p = 0.038). More patients in the RASE group were CKD upstaged (p = 0.043). At multivariable analysis, preoperative eGFR and the type of procedure were significant predictive factors for a change of more than 10% in eGFR at 3 months postoperatively. There was no local recurrence or distant metastasis during follow-up. Conclusions RACP-RASE is an effective and safe technique for complex renal tumors that can provide appropriate temporary arterial occlusion and renal hypothermic perfusion. Renal arterial cold perfusion may be helpful in protecting renal function in RASE as compared with warm ischemia.

Factors influencing the recurrence of keratocysts: monocentric study

Introduction: The purpose of the study was to retrospectively analyse the recurrence rate of odontogenic keratocysts and to identify eventual features of the lesions that may influence recurrence. Material and methods: This was a retrospective study carried out for a period of 3 years. The medical records of patients treated in our institution were analysed to identify all the cases of odontogenic keratocysts. Results: A total of 16 odontogenic keratocysts were recorded. These lesions were treated with simple enucleation with or without adjuvant Carnoy's solution. The relapse occurred in 4 patients treated with simple enucleation and in none of the patients that underwent enucleation and Carnoy's solution application. The kind of treatment appeared not to influence recurrence rate at statistical analysis. Conclusions: Odontogenic keratocyst is a lesion with a locally aggressive behavior and a high tendency to relapse. This tendency of recurrence may be greater with syndromic presentation of odontogenic keratocyst, with soft tissue involvement, and with teeth proximity to the lesion. The application of Carnoy's solution may be useful to minimize recurrence rate in those odontogenic keratocysts with an aggressive clinical behavior and secondly may be used for all the other lesions treated with simple enucleation that experienced relapse.

Giant Juvenile Fibroadenoma of Breast

Giant juvenile fibroadenoma occurs in adolescent girls. These tumours become enormous in size and grow rapidly, though these tumours are mostly benign. These patients are almost always treated by breast conserving surgery. Here we present a case having unilateral giant juvenile fibroadenoma with bilateral multiple small fibroadenomas in an adolescent female aged 16years. The diagnosis of the patient was made on clinical examination, USG & FNAC. Confirmatory diagnosis was made by histopathology. We removed the giant one with "Swiss-Roll" procedure and others by simple enucleation. The aesthatic appearence of the breasts were preserved. Journal of Surgical Sciences (2013) Vol. 17 (2) : 99-102

MANDIBULAR AMELOBLASTOMA RECONSTRUCTION: A CASE REPORT WITH 10-YEAR FOLLOW-UP

Ameloblastoma is a benign dental tumor mostly found in the mandible, with several variations. The treatment of this pathology ranges from simple enucleation to resection of large sections of the affected bone. There are several options for correcting the sequelae of ameloblastoma treatment, including the use of grafts and currently microvascular free flaps, which have become the standard treatment. This report describes a clinical case of a large mandibular ameloblastoma, which was resected with safety margins about 10 years ago, reconstructed by free grafts in successive surgical times and rehabilitated using removable prostheses. The question is then what the best option is today in the reconstruction of patients affected by this type of pathologies, taking into account emerging options, the clinicians’ learning curve and the patients’ resources.