ABSTRACT
Esophageal cancer (EC) patients are living longer due to enhanced screening and novel therapeutics, however, the post-esophagectomy long-term management remains challenging for patients, caregivers, and providers. Patients experience significant morbidity and have difficulty managing symptoms. Providers struggle to manage symptoms, affecting patients' quality of life and complicating care coordination between surgical teams and primary care providers. To address these patient unique needs and create a standardized method for evaluating patient reported long-term outcomes after esophagectomy for EC, our team developed the Upper Digestive Disease Assessment tool, which evolved to become a mobile application. This mobile application is designed to monitor symptom burden, direct assessment, and quantify data for patient outcome analysis after foregut (upper digestive) surgery, including esophagectomy. It is available to the public and enables virtual and remote access to survivorship care. Patients using the Upper Digestive Disease Application (UDD App) must consent to enroll, agree to terms of use, and acknowledge use of health-related information prior to gaining access to the UDD App. The results of patients scores can be utilized for triage and assessment. Care pathways can guide management of severe symptoms in a scalable and standardized method. Here we describe the history, process, and methodology for developing a patient-centric remote monitoring program to improve survivorship after EC. Programs like this that facilitate patient-centered survivorship should be an integral part of comprehensive cancer patient care.
ABSTRACT
Augmented or hybrid reality is a display technology that combines the real world with the virtual world; it permits digital images of preoperative planning information to be combined with the surgeon's view of the real world. Augmented reality (AR) can increase the surgeon's intraoperative vision by providing virtual transparency of the real patient and has been applied to a wide spectrum of orthopedic procedures, such as tumor resection, fracture fixation, arthroscopy, and component's alignment in total joint arthroplasty. We present a case of a male patient who presented with pain in the medial aspect of his left foot after he underwent an incomplete mass excision elsewhere where it turned out to be synovial sarcoma. Because the mass was small, impalpable, and deeply positioned beneath both the plantar and the medial plantar aponeuroses, it was impossible to preoperatively decide a plan for resection. We opted to use the aid of AR in the form of an application using the camera of a smartphone. We were able to excise the tumor with negative surgical margins. On 12-month follow-up, the patient is in complete remission and has optimal mobility and functionality of his foot. In conclusion, AR holds great potential for use in the future of orthopedic surgical oncology. We emphasize using it via a handheld device that we found to be optimal for planning resection of the small and relatively fixed tumor. Based on our literature review, this is the first case describing the surgical planning in resecting an impalpable synovial sarcoma of the foot using AR technology.
