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BACKGROUND: Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. METHODS: This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. RESULTS: Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53-0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. CONCLUSIONS: RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.
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BACKGROUND: A growing number of centers worldwide are preserving testicular tissue (TT) of young boys at risk of fertility loss to preserve their fertility. Data in this regard are scarce and experience sharing is essential to the optimization of the process. OBJECTIVES: This report of our 10-year activity of pediatric fertility preservation (FP) has the objective to (1) improve knowledge regarding the feasibility, acceptability, safety, and potential usefulness of the procedure; (2) analyze the impact of chemotherapy on spermatogonia in the cryopreserved TT. MATERIALS AND METHODS: For this retrospective study of data prospectively recorded, we included all boys under 18 years of age referred to the FP consultation of our academic network between October 2009 and December 2019. Characteristics of patients and cryopreservation of testicular tissue (CTT) were extracted from the clinical database. Univariate and multivariate analyses were used to assess factors associated with the risk of absence of spermatogonia in the TT. RESULTS: Three hundred and sixty-nine patients (7.2 years; 0.5-17.0) were referred to the FP consultation for malignant (70%) or non-malignant (30%) disease, of whom 88% were candidates for CTT, after a previous chemotherapy exposure (78%). The rate of recorded immediate adverse events was 3.5%, with painful episodes dominating. Spermatogonia were detected in the majority of TTs: 91.1% of those exposed to chemotherapy and 92.3% of those not exposed (p = 0.962). In multivariate analysis, the risk of absence of spermatogonia was almost three-fold higher in boys > 10 years of age ([OR] 2.74, 95% CI 1.09-7.26, p = 0.035) and four-fold higher in boys exposed to alkylating agents prior to CTT ([OR] 4.09, 95% CI 1.32-17.94, p = 0.028). DISCUSSION/CONCLUSION: This large series of pediatric FP shows that this procedure is well accepted, feasible, and safe in the short term, strengthening its place in the clinical care pathway of young patients requiring a highly gonadotoxic treatment. Our results demonstrate that CTT post-chemotherapy does not impair the chance to preserve spermatogonia in the TT except when the treatment includes alkylating agents. More data on post-CTT follow-up are still required to ensure the long-term safety and usefulness of the procedure.
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Preservação da Fertilidade , Neoplasias , Masculino , Humanos , Criança , Adolescente , Testículo , Estudos Retrospectivos , Criopreservação/métodos , Preservação da Fertilidade/métodos , Alquilantes/uso terapêutico , Neoplasias/complicaçõesRESUMO
Bernard-Soulier syndrome (BSS), also known as hemorrhagiparous thrombocytic dystrophy (OMIA 002207-9615), is a rare defect in platelet function recognized in both dogs and humans. It is caused by a deficiency in glycoprotein 1b-IX-V, the platelet surface protein which acts as a receptor for the von Willebrand factor. The characteristic features of BSS in humans and dogs include macrothrombocytes and mild-to-moderate thrombocytopenia with a bleeding tendency. This condition has previously been reported in European Cocker Spaniel dogs; however, the results of platelet function tests in these animals have not been reported. This case report describes a European Cocker Spaniel dog with spontaneously occurring Bernard-Soulier syndrome and the results of point-of-care platelet function tests, including a prolonged buccal mucosal bleeding time (>8 min), prolongation (>300 s) of PFA-200 COL/ADP, COL/EPI, and P2Y closure times, and reduced aggregation (15%-48%) with Plateletworks ADP, but with normal aggregation (92%) with Plateletworks AA. This is the first description of the results of platelet function tests in canine Bernard-Soulier syndrome.
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Síndrome de Bernard-Soulier , Doenças do Cão , Transtornos Hemorrágicos , Humanos , Cães , Animais , Síndrome de Bernard-Soulier/diagnóstico , Síndrome de Bernard-Soulier/veterinária , Síndrome de Bernard-Soulier/metabolismo , Sistemas Automatizados de Assistência Junto ao Leito , Plaquetas/metabolismo , Hemostasia , Complexo Glicoproteico GPIb-IX de Plaquetas , Transtornos Hemorrágicos/veterinária , Doenças do Cão/diagnóstico , Doenças do Cão/metabolismoRESUMO
We describe clinical semiology in 6 cases of METS-Stanmore distal femoral Morse taper impaction failure: from obvious forms with intraprosthetic dislocation to chronic forms with less obvious symptoms: instability, piston sensation, rotational disorder in gait. The diagnostic procedure in chronic forms is described, notably with dynamic examination under fluoroscopy. Reduction and re-impaction by external maneuver can be attempted; in case of failure or of any suspicion of taper disassembly, the 2 modular implant components have to be replaced. Finally, we provide a review of the literature on this rare but serious complication. LEVEL OF EVIDENCE: IV.
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Artroplastia de Quadril , Prótese de Quadril , Humanos , Fêmur , Reoperação , Desenho de Prótese , Falha de PróteseRESUMO
OBJECTIVES: Low-viscosity bone cement impregnated with gentamicin is frequently used to fix femoral prostheses. Three cardiac arrests occured successively during cementoplasty oh hip replacements, leading to the death of two patients. The objective of this study is to describe the actions undertaken to establish a potential link between the use of the bone cement and the occurrence of these serious adverse events (SAE). METHODS: A mortality and morbidity review was organised in order to study the causality of bone cement and to propose improvement actions, following 3 considered SAE associated to materiovigilance reporting. RESULTS: All three SAE occurred following the injection of the same reference of bone cement. The incriminated batches were rapidly placed in quarantine. Analysis by the manufacturer revealed no defects in production quality requirements but suggested the possibility of Bone Cement Implantation Syndrome (BCIS). A literary review on BCIS confirmed that this rare intraoperative complication was plausible in all three cases. Management of these SAE via a health care safety process enabled to provide a rapid answer concerning the causality of the cement and practice deviations of its use. CONCLUSIONS: Systemic analysis completed by the manufacturer's analysis provided corrective actions for professional practices. Implementation and efficacy of these actions will be monitored as part of the facility's programme for the improvement of quality and patient safety.
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INTRODUCTION: Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumour of indeterminate malignant potential. The mainstay treatment for DFSP is surgical resection. Given the reported high local recurrence rate, the ideal resection margin for DFSP is unclear. The purpose of this study was to ascertain the local recurrence and metastatic rate of DFSP and DFSP with fibrosarcomatous degeneration (FS-DFSP), with specific attention to margin status in an attempt to address the issue of margin adequacy. METHODS: Patients treated for DFSP at a single sarcoma centre were identified from a prospective database. DFSP and FS-DFSP patients with and without prior surgery were included. Patients were followed after surgery to monitor complications, local recurrence and metastasis. RESULTS: The study included 200 patients: 166 patients with DFSP and 34 patients with FS-DFSP. In the DFSP group, nine patients (5.4%) had positive margins, one case (0.6%) developed local recurrence (LR) and no patients developed distant metastases. In the FS-DFSP group, seven patients (20.6%) had positive margins, six patients (17.6%) developed local recurrence (LR) and eight patients (23.5%) developed distant metastases, of which three (37.5%) were in the lungs, one (12.5%) in bone and four (50%) in other soft tissue sites. DISCUSSION AND CONCLUSION: Local recurrence and metastases are extremely rare in patients with DFSP. Achieving a negative as opposed to a wide surgical margin may be sufficient to avoid local recurrence of most DFSP. We suggest that no ongoing surveillance for local or systemic relapse is required for DFSP patients after negative margin resection. For FS-DFSP, we recommend the same surveillance schedule, based on tumour grade, as other soft tissue sarcoma.
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Dermatofibrossarcoma , Sarcoma , Neoplasias Cutâneas , Neoplasias de Tecidos Moles , Humanos , Dermatofibrossarcoma/cirurgia , Dermatofibrossarcoma/patologia , Margens de Excisão , Seguimentos , Prognóstico , Recidiva Local de Neoplasia/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologiaRESUMO
BACKGROUND: This French nationwide NETSARC exhaustive prospective cohort aims to explore the impact of systematic re-excision (RE) as adjuvant care on overall survival (OS), local recurrence free survival (LRFS), and local and distant control (RFS) in patients with soft tissue sarcoma (STS) with positive microscopic margins (R1) after initial resection performed outside of a reference center. METHODS: Eligible patients had experienced STS surgery outside a reference center from 2010 to 2017, and had R1 margins after initial surgery. Characteristics and treatment comparisons used chi-square for categorical variables and Kruskall-Wallis test for continuous data. Survival distributions were compared in patients reexcised (RE) or not (No-RE) using a log-rank test. A Cox proportional hazard model was used for subgroup analysis. RESULTS: A total of 1,284 patients had experienced initial STS surgery outside NETSARC with R1 margins, including 1,029 patients with second operation documented. Among the latter, 698 patients experienced re-excision, and 331 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, tumor size, tumor depth, and histotype in the population of patients re-excised (RE) or not (No-RE). The study identified RE as an independent favorable factor for OS (HR 0.36, 95%CI 0.23-0.56, p<0.0001), for LRFS (HR 0.45, 95%CI 0.36-0.56, p<0.0001), and for RFS (HR 0.35, 95%CI 0.26-0.46, p<0.0001). CONCLUSION: This large nationwide series shows that RE improved overall survival in patients with STS of extremities and trunk wall, with prior R1 resection performed outside of a reference center. RE as part of adjuvant care should be systematically considered.
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Sarcoma , Neoplasias de Tecidos Moles , Estudos de Coortes , Extremidades/patologia , Extremidades/cirurgia , Humanos , Margens de Excisão , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgiaRESUMO
Background: Bone metastases in thyroid cancer impair the patient's quality of life and prognosis. Interestingly, wide margins resection as the surgical treatment of bone metastases might improve the overall survival (OS). Nonetheless, data are lacking regarding the potential benefits of this strategy. Methods: In order to assess the OS of patients with thyroid cancer after a bone metastases carcinologic resection, a retrospective multicentric study was performed, evaluating the 1, 5, 10 and 15 years-OS along with the potential prognosis associated factors. Results: 40 patients have been included in this multicentric study, with a mean follow-up after surgery of 46.6 ± 58 months. We observed 25 (62.5%) unimestastatic patients and 15 multimetastatic patients (37.5%). The median overall survival after resection was 48 ± 57.3 months. OS at 1, 5, 10, and 15 years was respectively 76.2%, 63.6%, 63.6%, and 31.8%. Survival for patients with a single bone metastasis at 15 year was 82.3%, compared with 0.0% (Log Rank, p = 0.022) for multi-metastatic bone patients. Conclusions: This study advocates for an increased long term 10-year OS in patients with thyroid cancer, after resection of a single bone metastasis, suggesting the benefits of this strategy in this population.
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The propagation of sonic boom through kinematic turbulence is known to have an important impact on the noise perceived at the ground. In this work, a recent numerical method called FLHOWARD3D based on a one-way approach is used to simulate the propagation of classical and low-boom waveforms. Kinematic turbulence is synthesized following a von Kármán energy spectrum. Two- and three-dimensional (2D and 3D) simulations are compared to experimental measurements, and 2D simulations are found to be slightly less accurate than 3D ones but still consistent with experimental levels around 98% of the time. A stochastic study is carried out on the 2D simulation using the generalized polynomial chaos method with parameters of the von Kármán spectrum as uncertain parameters. Differences between the propagation of a classical N-wave and low booms are observed: the classical N-wave shows higher peak pressure and variations than low-boom signatures. The standard deviation for the peak pressure, the D-weighted sound exposure level (D-SEL), and the perceived level in dB (PLdB) metrics all show a linear increase with the distance, with a faster increase for the classical N-wave for the peak pressure and D-SEL and a similar increase between the different booms for PLdB. In general, it is found that low-boom waveforms show less sensitivity to turbulence.
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Background Cryoablation is playing an increasing role in the percutaneous treatment of bone tumors. However, despite its potential advantages over heat-based ablation techniques, the clinical safety and efficacy of cryoablation have not been established for osteoid osteoma treatment. Purpose To evaluate percutaneous CT-guided cryoablation for the treatment of osteoid osteoma in young patients and adults. Materials and Methods This retrospective study reviewed data from 50 consecutive patients who underwent percutaneous CT-guided cryoablation for the treatment of osteoid osteoma between January 2013 and June 2019 in a single institution. In 30 of 50 patients (60%), the procedure was carried out with the patient under local anesthesia and conscious sedation, with the cryoprobe covering the lesion from an extraosseous position, avoiding direct penetration of the nidus. Clinical and radiologic features, procedure-related data, visual analog scale (VAS) pain scores, complications, and overall success rate were evaluated. Statistical analyses were performed by using the nonparametric Friedman test and Wilcoxon signed rank test for repeated measures. Results Fifty patients (median age, 24 years; interquartile range [IQR], 19-38 years; 31 men) underwent CT-guided cryoablation for the treatment of osteoid osteoma, with a 96% (48 of 50 patients) overall clinical success rate. Of the two patients without clinical success, one patient had incomplete pain relief and the other experienced a recurrence of osteoid osteoma at 11 months, which was successfully treated with a second cryoablation procedure. The median VAS pain score was 8 (IQR, 7-8) before the procedure and 0 (IQR, 0-1; P < .001) after the procedure at both primary (6 weeks) and secondary (18-90 months) follow-up. Three of the 50 patients had minor complications (6%); no major complications were reported. Conclusion Osteoid osteoma was safely, effectively, and durably treated with CT-guided percutaneous cryoablation. In the majority of patients, treatment could be performed without general anesthesia, with the cryosphere covering the nidus from an extraosseous position. © RSNA, 2021.
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Criocirurgia/métodos , Osteoma Osteoide/cirurgia , Radiografia Intervencionista , Tomografia Computadorizada por Raios X , Adulto , Feminino , Humanos , Masculino , Medição da Dor , Complicações Pós-Operatórias , Estudos RetrospectivosRESUMO
Liposarcomas are a heterogeneous group of sarcomas, including well-differentiated and dedifferentiated liposarcoma, myxoid/round cell liposarcoma, and pleomorphic liposarcoma. Complete surgical resection is the key of treatment. Radiotherapy, based on the tumor grade and the vicinity of critical structures with the tumor, can be used to prevent local recurrence. The group of dedifferentiated liposarcomas (DDLS) is poorly sensitive to adjuvant chemotherapy. Improved understanding of the genetic aberrations that lead to liposarcoma initiation is necessary for the development of targeted therapies to improve tumor control and survival. DDLS share genetic abnormalities with other groups, exhibiting high-level amplifications of chromosome 12, including the MDM2 and CDK4 genes, and harbor additional amplifications of chromosomes 6 and 1. Novel therapies targeted at the gene products of chromosome 12 are currently considered in clinical trials. Our work consisted in a genomic characterization of DDLS to draw up a complete picture of alterations, including genomic signatures, tumor mutation burden, gene mutations, copy number variations, translocations, gene fusions and methylation modifications. Analysis of translocations helped to understand the mechanisms underlying the amplification processes. Combination of mutations and loss of heterozygosity or homozygous deletions were detected and led to inactivate tumor suppressor genes (TSG). In contrast, methylation anomalies seemed not linked to any particular genomic profile. All identified anomalies, whether amplifications and/or TSG inactivation, involve genes playing a role in p53 regulation, that appears to be the epicenter of the initiation process in DDLS tumorigenesis, as is also known to be responsible for Li-Fraumeni syndrome, a family cancer syndrome highly predisposing to sarcomas.
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BACKGROUND: Unlike other sarcoma subtypes, myxoid liposarcoma (MLS) has a propensity for extra-pulmonary metastases. Computed tomography (CT) scan of the chest, abdomen, and pelvis has become an accepted practice for surveillance. However, recent literature suggests that this may be inadequate. This study aimed to assess the ability of current imaging methods to detect metastases adequately in this population. METHODS: The study identified 169 patients with MLS diagnosed between 2000 and 2016. The timing and location of metastases, the reasons leading to the MLS diagnosis, and the imaging methods were recorded. The locations of metastases were classified into the following categories: pulmonary, soft tissue, bone, retroperitoneal, intraperitoneal, solid organ, and lymph node. RESULTS: An initial diagnosis of metastasis was made at presentation with staging CT scan for 3 (10 %) of 31 patients, with a follow-up surveillance CT scan for 15 (48 %) of the patients or with subsequent imaging obtained in response to patient-reported symptoms for 13 (42 %) of the patients. The proportions of patients who had metastases in each location were as follows: soft tissue (84 %), pulmonary (68 %), intraabdominal (48 %), solid organ (48 %), bone (45 %), lymph node (32 %), and retroperitoneal (29 %). Although 14 patients had bone metastases, only 1 patient had a sclerotic/blastic presentation visualized on CT scan, and the diagnosis for the remaining 13 patients was determined by magnetic resonance imaging (MRI). CONCLUSION: Due to metastatic disease identified outside surveillance imaging for 58 % of the patients, the diversity of locations, and the significant failure of CT and bone scan to identify bone metastases, this study questioned the adequacy of CT scan for surveillance of MLS. Consideration should be given to the use of whole-body MRI for detection of metastasis in MLS.
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Neoplasias Ósseas , Lipossarcoma Mixoide , Neoplasias de Tecidos Moles , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Seguimentos , Humanos , Lipossarcoma Mixoide/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Imagem Corporal TotalRESUMO
INTRODUCTION: The scarf osteotomy is a reliable surgical technique for treating hallux valgus. The aim of our study was to analyze the occurrence of transfer metatarsalgia after surgery on the first ray using a screwless Scarf osteotomy technique that we have been using in our department since 1995, which consists of stabilization by axial impaction without internal fixation. We hypothesized that the alleged shortening of the first metatarsal produced by this technique may be at the origin of postoperative metatarsalgia. PATIENTS AND METHODS: This was a case series of first ray metatarsal screwless Scarf osteotomies reviewed in the medium term. We did a clinical and radiological review of all patients operated using this technique between 2012 and 2017 who did not meet the following exclusion criteria: procedure on the other lateral metatarsals, concurrent hindfoot pathology, incomplete medical records. RESULTS: Of 114 feet, 96 were included in the study and 18 were excluded. The mean follow-up was 1 year and 8 months [1-4years]. The mean AOFAS score was 90.3 and 96% of patients were either satisfied or very satisfied with the outcome. All the parameters improved significantly: shoe wearing, pain, function, alignment. Fourteen feet had transfer metatarsalgia, which appeared during the first year postoperative (AOFAS 75/100). Ten other complications occurred: two Morton's neuromas, three cases of complex regional pain syndrome, one superficial infection, one paresthesia, two recurrences with surgical revision, one nonunion. No general complications were found. Based on radiographs, the mean M1 shortening was 3.3mm (6.3mm in metatarsalgia group versus 3.0 mm in the non-metatarsalgia group, P=0.2) and the mean angular correction was 16.2° (±6°). DISCUSSION: The overall results of screwless Scarf osteotomy are comparable and satisfactory, allowing large deformities to be corrected (28°±8° preoperatively in our cohort). M1 shortening and the transfer metatarsalgia rate appear to be higher than with other techniques. CONCLUSION: Screwless scarf osteotomy of M1 yields good functional and radiological outcomes in the medium term. However, it appears to cause more shortening and transfer metatarsalgia. LEVEL OF EVIDENCE: IV Retrospective, non-interventional in current practice (Recommendation grade C, low level of scientific proof).
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Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Metatarsalgia/diagnóstico por imagem , Metatarsalgia/etiologia , Metatarsalgia/cirurgia , Metatarso , Osteotomia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Additive manufacturing (AM) brings new design potential compared with traditional manufacturing. Nevertheless, traditional manufacturing knowledge remains embedded in the minds of designers and is a real cognitive barrier to design in AM. Design for Additive Manufacturing (DfAM) provides tools, techniques, and guidelines to optimize design with the specifics of AM. These methods are usable at different moments of the design process. Only few DfAMs focus on the early stages of design, the ideation phase, which allows for the most innovation. The literature highlights the effectiveness of methodologies based on tangible tools, such as cards or objects, to generate creativity. The difficulty with such tools is to be inspirational as well as formative. Therefore, this article presents a method to help designers capture the design potential of AM to design creative solutions at the early stages of product design, named the Augmented Design with AM Methodology (ADAM2). This methodology relies on the potential of AM, defined in 14 opportunities and a set of 14 inspirational objects, each representing an opportunity. Dedicated to creativity sessions, this methodology allows forcing the association between knowledge of a company's sector and the design potential of AM. To validate the effectiveness of the ADAM2 methodology, we use it for an industrial application in a jewelry and watchmaking company. The results showed that ADAM2 promote the generation of creative solutions and the exploitation of the design potential of AM during the early design stages.
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Hematoma , Doenças da Unha , Drenagem , Hematoma/etiologia , Hematoma/cirurgia , Humanos , Doenças da Unha/cirurgiaAssuntos
Anemia Falciforme/tratamento farmacológico , Antidrepanocíticos/efeitos adversos , Hidroxiureia/efeitos adversos , Puberdade , Espermatogônias/patologia , Fatores Etários , Anemia Falciforme/patologia , Antidrepanocíticos/uso terapêutico , Criança , Pré-Escolar , Humanos , Hidroxiureia/farmacologia , Hidroxiureia/uso terapêutico , Masculino , Tamanho da Amostra , Espermatogônias/efeitos dos fármacos , Testículo/efeitos dos fármacos , Testículo/patologiaRESUMO
BACKGROUND: Lymph node metastases (LNM) rarely occur in adult extremity soft-tissue sarcoma (STS), affecting approximately 5% of patients. To the authors' knowledge, few studies to date have evaluated the prognosis and survival of patients with LNM. METHODS: A retrospective review was performed of a single-center, prospectively collected STS database. Demographic, treatment, and oncologic data for patients with STS of the extremity with LNM were obtained from clinical and radiographic records. RESULTS: Of 2689 patients with extremity STS, a total of 120 patients (4.5%) were diagnosed with LNM. LNM occurred most frequently among patients diagnosed with clear cell sarcoma (27.6%), epithelioid sarcoma (21.9%), rhabdomyosarcoma (17.3%), angiosarcoma (14.0%), and extraskeletal myxoid chondrosarcoma (9.3%). A total of 98 patients (81.7%) underwent LNM surgical resection. Patients with isolated LNM had a greater 5-year overall survival (57.3%) compared with patients with American Joint Committee on Cancer (AJCC) eighth edition stage IV STS with only systemic metastases (14.6%) or both LNM and systemic disease (0%; P < .0001). Patients with isolated LNM had an overall survival rate (52.9%) similar to that of patients with localized AJCC stage III tumors (ie, large, high-grade tumors) (49.3%) (P = .8). Patients with late, isolated, metachronous LNM had a 5-year overall survival rate (61.2%) that was similar to that of patients with isolated synchronous LNM at the time of presentation (53.6%) (P = .4). CONCLUSIONS: Many different types of STS develop LNM. Patients with extremity STS with isolated LNM should not be considered as having stage IV disease as they are according to the current AJCC eighth edition classification because they have significantly better survival than those with systemic metastases. Patients with isolated, late, metachronous LNM have a survival similar to that of patients with isolated synchronous LNM at the time of presentation. LAY SUMMARY: The results of the current study demonstrated that patients diagnosed with isolated lymph node metastases have a prognosis similar to that of patients diagnosed with localized American Joint Committee on Cancer stage III soft-tissue sarcomas, which also equates to a significantly better overall survival compared with patients with systemic metastases. Therefore, the authors recommend modifications to the most recent eighth edition of the American Joint Committee on Cancer staging system to clearly distinguish patients with isolated lymph node metastases to acknowledge their better prognosis compared with those with systemic metastases.
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Metástase Linfática/patologia , Sarcoma/mortalidade , Sarcoma/patologia , Neoplasias de Tecidos Moles/mortalidade , Neoplasias de Tecidos Moles/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extremidades/patologia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Taxa de Sobrevida , Adulto JovemRESUMO
INTRODUCTION: Bone defects are challenging to treat surgically. The primary objective of our study was to compare the union rate and time to union between the tibia and femur when using the induced membrane technique. The secondary objective was to document how failures were managed. MATERIAL AND METHODS: This retrospective, single-center study involved 33 patients (23 men, 10 women) who were older than 18 years of age. They were treated surgically for a leg fracture or long bone nonunion (22 tibia, 11 femur) using the induced membrane technique between January 2011 and December 2016 and had a complete follow-up. The minimum follow-up was 1 year for fractures and 2 years for non-union cases. Bone union was defined as the presence of at least two cortices with bridging on two radiographic views and return to full weight bearing. RESULTS: The mean patient age was 38.3±15.5 years (18-72). The mean bone defect size was 7.9±5.0cm (2.3-18.0). The mean follow-up was 3.3±1.8 years (1-7.2). The union rate was 61% (20 patients). The mean time to union was 10±6.4 months (3-23). The time to union was significantly longer in the tibia (11.6±6.9 months [3-23]) than in the femur (6.3±2.9 months [3.4-10.3]) (p=0.025). The failure rate did not differ between the tibia and femur. Nine of the 13 patients (69%) in which the treatment failed were reoperated; 7 of them underwent nonunion treatment (78%) and 2 underwent amputation (22%). The other 4 patients were waiting for an infection to resolve before being reoperated. CONCLUSION: The induced membrane technique is an effective surgical procedure for large bone defects in both the tibia and femur. However, the time to union was shorter in the femur than the tibia in our cohort. LEVEL OF EVIDENCE: IV, retrospective study.
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Fêmur , Tíbia , Adolescente , Adulto , Idoso , Transplante Ósseo , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Consolidação da Fratura , Fraturas não Consolidadas , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Reconstruction by endoprosthesis is widespread after bone tumor resection. The design and type of fixation and of hinge remain a matter of debate. The aim of the present study was to assess survival, complications and functional results in a homogeneous series of adult patients undergoing bone defect reconstruction following distal femoral tumor resection, using a single model of fixed-hinge cemented endoprosthesis, at a minimum 5 years' follow-up. HYPOTHESIS: The study hypotheses were that loosening and infection are the main causes of failure, and that this type of reconstruction is reliable following distal femoral resection. PATIENTS AND METHODS: All patients aged over 17 years undergoing reconstruction using the Stanmore Mets® fixed-hinge cemented modular endoprosthesis following distal femoral resection for primary bone tumor in 4 French reference centers between 2004 and 2013 were included. Epidemiological data, MSTS functional score, clinical and radiological examination results, complications and survival with types of failure according to the Henderson classification were assessed. RESULTS: One hundred and thirty-six patients (68 male, 68 female; mean age, 41.2 years [range, 17-77 years]) were included. Mean follow-up was 81 months [range, 61-134 months]. Thirty-two patients (38%) experienced a total 67 complications requiring surgical revision: mainly infection (n=28) or mechanical failure (n=26). Overall implant survival was 78% at 5 years. There were 30 implant failures on the Henderson classification. Mean MSTS score was 82%. DISCUSSION: The present results are comparable to those of the literature and for other types of reconstruction. Recent meta-analyses suggest that type of hinge and of stem fixation have little effect on implant survival. International comparative studies are needed to determine the exact role of each type of reconstruction according to the patient profile. LEVEL OF EVIDENCE: IV, multicenter retrospective series.