tumour resection
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2021 ◽  
Vol 11 ◽  
Author(s):  
Aneurin Moorthy ◽  
Aisling Ní Eochagáin ◽  
Donal J. Buggy

BackgroundCancer is a leading cause of mortality worldwide, but death is rarely from the primary tumour: Rather it is multi-organ dysfunction from metastatic disease that is responsible for up to 90% of cancer-related deaths. Surgical resection of the primary tumour is indicated in 70% of cases. The perioperative stress response, tissue hypoxia at the site of surgery, and acute pain contribute to immunosuppression and neo-angiogenesis, potentially promoting tumour survival, proliferation, and metastasis. Poorly controlled acute postoperative pain decreases Natural Killer (NK) immune cell activity, which could potentially facilitate circulating tumour cells from evading immune detection. This consequently promotes tumour growth and distal metastasis.MethodsWe conducted a comprehensive literature search for links between acute pain and cancer outcomes using multiple online databases. Relevant articles from January 1st, 2010 to September 1st, 2021 were analysed and appraised on whether postoperative pain control can modulate the risk of recurrence, metastasis, and overall cancer survival.ResultsAlthough experimental and retrospective clinical data suggest a plausible role for regional anaesthesia in cancer outcome modulation, this has not been supported by the single, largest prospective trial to date concerning breast cancer. While there are mixed results on anaesthesiology drug-related interventions, the most plausible data relates to total intravenous anaesthesia with propofol, and to systemic administration of lidocaine.ConclusionThe hypothesis that anaesthetic and analgesic technique during cancer surgery could influence risk of subsequent recurrence or metastasis has been prevalent for >15 years. The first, large-scale definitive trial among women with breast cancer found robust equivalent findings between volatile anaesthesia with opioid analgesia and regional anaesthesia. Therefore, while regional anaesthesia during tumour resection does not seem to have any effect on cancer outcomes, it remains plausible that other anaesthetic techniques (e.g. total intravenous anaesthesia and systemic lidocaine infusion) might influence oncologic outcome in other major tumour resection surgery (e.g. colorectal and lung). Therefore, another large trial is needed to definitively answer these specific research questions. Until such evidence is available, perioperative analgesia for cancer surgery of curative intent should be based on patient co-morbidity and non-cancer endpoints, such as optimising analgesia and minimising postoperative complications.


Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6162
Author(s):  
Björn Lampe ◽  
Verónica Luengas-Würzinger ◽  
Jürgen Weitz ◽  
Stephan Roth ◽  
Friederike Rawert ◽  
...  

Purpose: The practice of exenterative surgery is sometimes controversial and has garnered a certain scepticism. Surgical studies are difficult to conduct due to insufficient data. The aim of this review is to present the current standing of pelvic exenteration from a surgical, gynaecological and urological point of view. Methods: This review is based upon a literature review (MEDLINE (PubMed), CENTRAL (Cochrane) and EMBASE (Elsevier)) of retrospective studies on exenterative surgery from 1993–2020. Using MeSH (Medical Subject Headings) search terms, 1572 publications were found. These were evaluated and screened with respect to their eligibility using algorithms and well-defined inclusion and exclusion criteria. Therefore, the guidelines for systematic reviews (PRISMA) were used. Results: A complete tumour resection (R0) often represents the only curative option for advanced pelvic carcinomas and their recurrences. A recent systematic review showed significant symptom relief in 80% of palliative patients after pelvic exenteration. Surgical limitations (distant metastases, involvement of the pelvic wall, etc.) are diminished by adequate surgical expertise and close interdisciplinary cooperation. While the mortality rate is low (2–5%), the still relatively high morbidity rate (32–84%) can be minimized by optimizing the perioperative setting. Following exenterations, roughly 79–82% of patients report satisfying results according to PROs (patient-reported outcomes). Conclusion: Due to multimodality treatment strategies combined with extended surgical expertise and patients’ preferences, pelvic exenteration can be offered nowadays with low mortality and acceptable postoperative quality of life. The possibilities of surgical treatment are often underestimated. A multi-centre database (PelvEx Collaborative) was established to collect data and experiences to optimize the research in this field.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  

Abstract Background Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting. Methods Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%). Results This study included 2,159 patients with oesophageal cancer, of whom 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had the greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender, increasing Charlson comorbidity index, and higher AJCC T and N staging to be associated with a significantly lower likelihood of TO. After accounting for these factors, high volume centres (>50 cases/year; OR: 1.36, CI95%: 1.06 - 1.75, p = 0.015), presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.11, CI95%: 1.33 - 3.35, p = 0.001) and radiology (OR: 1.56, CI95%: 1.08 - 2.26, p = 0.019), total minimally invasive esophagectomies (OR: 1.60, CI95%: 1.25 - 2.05, p < 0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58 - 2.98, p < 0.001) were independently associated with a significantly increased likelihood of TO.  Conclusions TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.


2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Thomas Thorne ◽  
Simon Hughes ◽  
Rupaly Pande ◽  
Samuel Ford

Abstract Background Hepatic burden is a significant confounder in the assessment of impact of primary tumour resection in metastatic small bowel neuroendocrine tumours (SI-NET). For SI-NET metastatic hepatic burden >10% disease replacement or > 5 hepatic metastases are known prognostic markers, though nomograms and scores do not adequately account for this. Most trials do not adequately account for hepatic burden when assessing the survival difference between SI-NET primary tumour resection and no resection. We propose a sampling methodology to more accurately assess metastatic liver burden in SI-NET and correlate with delayed resection vs. upfront primary tumour resection at a specialist NET surgical unit. Methods Patients referred for metastatic SI-NET between January 2003 and February 2020 were identified from a prospective dataset. The earliest CT scan after diagnosis was used. The axial, coronal and sagittal slice position limits of the whole liver were recorded. These limits allowed equitable slice position of the liver, with 8 equally distributed axial, 4 equally distributed coronal and 4 equally distributed sagittal slices. Each slice was used to define the liver and metastatic area as assessed using liver CT windows. Liver burden was estimated as percentage total metastatic area summed from all 8 axial, 4 coronal and 4 sagittal slices. Results 157 total patients were on the collated data base and 46 patients were identified with an appropriate CT. Liver burden was positively skewed. Liver burden was significantly higher for delayed resection vs. upfront resection in all planes of assessment (axial: 11.61% vs. 0.14%, p = 0.003; coronal: 13.46% vs. 0.33%, p = 0.006; sagittal: 10.46% vs. 0.16%, p = 0.008). All planar assessments correlated well with one another (all Kendall’s tau ≥0.851, all p < 0.001). Liver metastatic burden correlated with total liver volume (Kendall’s tau 0.549-0.573, all p < 0.001). Conclusions Hepatic burden differs between resection groups in a small sample at our centre, highlighting the unmeasured confounders favouring primary tumour resection via positive bias. Therefore, hepatic burden needs quantifying in prospective studies that assess primary tumour resection in SI-NET. This is to ensure comparable groups after randomisation. Our method provides an assessment of this metastatic SI-NET liver burden.


2021 ◽  
Author(s):  
Basil Zia Khan ◽  
Oluwaseun Akinjise-ferdinand ◽  
Bhaskar Kumar

A 78 year old male was admitted with a history of a fall following seizures. This occurred 2 years post curative treatment (minimally invasive oesophagectomy with neo adjuvant chemotherapy) for an oesophageal adenocarcinoma staged T3N0M0. On examination, patient had left-sided hemiparesis. A Computed Tomography (CT) and Magnetic Resonance Image (MRI) of the head confirmed a right frontotemporal meningioma with features suggestive of internal haemorrhage or calcification and mild local mass effect. A joint decision was made between the local neuro-surgical and neurology departments to manage this conservatively. However, due to progressive neurological deterioration and a concomitant increase in the size of the haemorrhagic lesion, emergent surgical intervention was indicated. The patient underwent a Simpson one complete resection (complete tumour resection including associated dura matter and abnormal underlying bone). Postoperative histology confirmed a rare case of metastatic oesophageal adenocarcinoma to a microcystic meningioma (World Health Organization Grade I). The meningioma was the only known site of distant metastasis for the oesophageal adenocarcinoma. Our case highlights the only documented case of the adenocarcinoma subtype of oesophageal tumour metastasizing to a meningioma. This case demonstrates the rare but well documented occurrence of tumour to tumour metastasis. It highlights the importance played by imaging and clinical correlation when assessing progressively growing meningiomas in patients with a history of or underlying malignancy.


Author(s):  
J Daly ◽  
P Gearing ◽  
N Tang ◽  
A Ramakrishnan ◽  
K P Singh

Abstract Background Adherence to guidelines for antibiotic prophylaxis is often poor and is an important target for antimicrobial stewardship programs. Prescribing audits that suggested poor adherence to guidelines in a plastic surgery department led to a targeted education program to bring antibiotic prescriptions in line with hospital guidelines. We reviewed whether this intervention was associated with changed perioperative prescribing and altered surgical outcomes, including the rate of surgical site infections, specifically looking at clean-contaminated head and neck tumour resections with free flap reconstruction. Methods A retrospective cohort study was performed on 325 patients who underwent clean-contaminated head and neck tumour resection and free flap reconstruction from January 1, 2013 to February 19, 2019. Patients were divided into two groups, those before (pre-intervention) and after (post-intervention) the education campaign. We analysed patient demographic and disease characteristics, intraoperative and postoperative factors and surgical outcomes. Results Patients pre-intervention were prescribed longer courses of prophylactic antibiotics (median = 9 [interquartile range = 8] vs. median = 1 [interquartile range = 1], p < 0.001), more topical chloramphenicol ointment (21.82% vs. 0%, p < 0.001) and more oral nystatin (36.9% vs. 12.2%, p < 0.001). Patients post-intervention had higher rates of recipient infections (36.11% vs. 17.06%, p < 0.001) and donor site infections (6.94% vs. 1.19%, p = 0.006). Conclusion Following the education campaign, patients were prescribed shorter courses of prophylactic antibiotics, more of the recommended cefazolin-metronidazole regimen and less use of topical antibiotics. However, patients also had a higher rate of surgical site infections.


Materials ◽  
2021 ◽  
Vol 14 (22) ◽  
pp. 7066
Author(s):  
Leonid Maslov ◽  
Alexey Borovkov ◽  
Irina Maslova ◽  
Dmitriy Soloviev ◽  
Mikhail Zhmaylo ◽  
...  

The aim of this paper is to investigate and compare the stress distribution of a reconstructed pelvis under different screw forces in a typical walking pattern. Computer-aided design models of the pelvic bones and sacrum made based on computer tomography images and individually designed implants are the basis for creating finite element models, which are imported into ABAQUS software. The screws provide compression loading and bring the implant and pelvic bones together. The sacrum is fixed at the level of the L5 vertebrae. The variants of strength analyses are carried out with four different screw pretension forces. The loads equivalent to the hip joint reaction forces arising during moderate walking are applied to reference points based on the centres of the acetabulum. According to the results of the performed analyses, the optimal and critical values of screw forces are estimated for the current model. The highest stresses among all the models occurred in the screws and implant. As soon as the screw force increases up to the ultimate value, the bone tissue might be locally destroyed. The results prove that the developed implant design with optimal screw pretension forces should have good biomechanical characteristics.


2021 ◽  
Vol 14 (11) ◽  
pp. e245769
Author(s):  
Abhijith Bhaskaran ◽  
Pooja Sethi ◽  
Kumar Muthulingesh ◽  
Ramesh Ananthakrishnan

We present a case of a 48-year-old man diagnosed with parasagittal atypical meningioma (AM) involving biparietal bones with intracranial and extracranial extension up to galea aponeurotica of the scalp. The patient underwent Simpson’s grade 2 resection (GTR (gross total tumour resection) with coagulation of dural attachment). Currently, in AMs, the role of adjuvant radiotherapy is controversial after GTR. Here, through this case, we have discussed in detail issues related to tumour origin, that is, primary versus secondary extradural meningioma and controversial topics regarding the role of adjuvant radiotherapy in the management of AMs. We have presented our radiation treatment strategy addressing the high-risk zones related to tumour extension in this case.


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