Impacto da técnica anestésica no comportamento evolutivo do câncer de mama: uma revisão sistemática de literatura

Apesar de ser uma importante abordagem para o tratamento do câncer de mama, a cirurgia pode paradoxalmente favorecer a progressão tumoral, apesar da intenção curativa. Como as técnicas de anestesia local podem ser uma oportunidade terapêutica para reduzir a manutenção e dispersão neoplásica, o objetivo do estudo foi avaliar seus efeitos no comportamento evolutivo do câncer de mama no contexto clínico. Trata-se de uma revisão sistemática de literatura a partir da base de dados PubMed com os descritores MeSH “mastectomy”, “mastectomy, radical”, “anesthesia, local”, “recurrence”, “neoplasm recurrence, local”. Foram selecionados seis artigos, sendo a maioria retrospectivo e apenas um estudo controlado randomizado. Entre as diferenças discutidas na análise de variáveis, critérios de inclusão e resultados observados, cinco estudos não apresentaram efeito sobre o comportamento evolutivo do câncer de mama. Assim, apesar dos potenciais benefícios da anestesia local sobre o comportamento evolutivo do câncer de mama, essa revisão não encontrou evidência suficiente para apoiar essa intervenção para a prática clínica. Apesar disso, pode reduzir o consumo de opioide e prover uma opção viável para o manejo da dor, que pode melhorar a qualidade de vida das pacientes.

Emerging functions of PRKDC in the initiation and progression of cancer

The DNA-dependent protein kinase catalytic subunit (DNA-PKcs) is encoded by the protein kinase, DNA-activated, catalytic polypeptide ( PRKDC) gene. DNA-PKcs plays a major role in nonhomologous end joining DNA repair, and it has been identified to be an important factor in tumor progression and metastasis. DNA-PKcs may have opposite effects in diseases, depending on the cell and tissue types. In this review, we discuss its role in various tumors. High levels of DNA-PKcs are directly associated with prognosis, neoplasm recurrence rates, and overall survival. Our results suggest that DNA-PKcs may serve as a therapeutic target for advanced malignancies.

LAPAROSCOPIC DISTAL PANCREATECTOMY WITH SPLEEN PRESERVATION

ABSTRACT Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. Methods: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. Results: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. Conclusion: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

Evaluation of a Modified Hemimandibulectomy for Treatment of Oral Neoplasms in Dogs

A modified hemimandibulectomy was performed for treatment of oral neoplasms in 21 dogs. Intra- and postoperative evaluations included assessment of procedure difficulty, complications, mastication, cosmesis, and the time interval between surgery and recurrence of the neoplasm or clinical evidence of metastasis. Malignant melanoma was the most common neoplasm treated using this technique. The modified hemimandibulectomy was uncomplicated with minimal intraoperative hemorrhage. Three dogs had difficult mastication at 24-hours following surgery, while 5 dogs had partial wound dehiscence. Wound infection was diagnosed in 1 dog. All owners considered the postoperative outcome to provide acceptable cosmesis. Local neoplasm recurrence was documented in 5 dogs and distant (pulmonary) metastasis was diagnosed in 5 different dogs following surgery. The technical modification described in this study seemed to provide for improved mastication during the acute postoperative period compared with other hemimandibulectomy techniques performed by the authors.