Surgery in reference centers improves survival of sarcoma patients: a nationwide study.

BACKGROUND: NETSARC (netsarc.org) is a network of 26 sarcoma reference centers with specialized multidisciplinary tumor boards (MDTB) aiming to improve the outcome of sarcoma patients. Since 2010, presentation to an MDTB and expert pathological review are mandatory for sarcoma patients nationwide. In the present work, the impact of surgery in a reference center on the survival of sarcoma patients investigated using this national NETSARC registry. PATIENTS AND METHODS: Patients' characteristics and follow-up are prospectively collected and data monitored. Descriptive, uni- and multivariate analysis of prognostic factors were conducted in the entire series (N = 35 784) and in the subgroup of incident patient population (N = 29 497). RESULTS: Among the 35 784 patients, 155 different histological subtypes were reported. 4310 (11.6%) patients were metastatic at diagnosis. Previous cancer, previous radiotherapy, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndrome were reported in 12.5%, 3.6%, 0.7%, and 0.1% of patients respectively. Among the 29 497 incident patients, 25 851 (87.6%) patients had surgical removal of the sarcoma, including 9949 (33.7%) operated in a NETSARC center. Location, grade, age, size, depth, histotypes, gender, NF1, and surgery outside a NETSARC center all correlated to overall survival (OS), local relapse free survival (LRFS), and event-free survival (EFS) in the incident patient population. NF1 history was one of the strongest adverse prognostic factors for LRFS, EFS, and OS. Presentation to an MDTB was associated with an improved LRFS and EFS, but was an adverse prognostic factor for OS if surgery was not carried out in a reference center. In multivariate analysis, surgery in a NETSARC center was positively correlated with LRFS, EFS, and OS [P < 0.001 for all, with a hazard ratio of 0.681 (95% CI 0.618-0.749) for OS]. CONCLUSION: This nationwide registry of sarcoma patients shows that surgical treatment in a reference center reduces the risk of relapse and death.

[A lumbar vertebral eosinophilic granuloma with spinal instability in an adolescent]. / Granulome éosinophile vertébral lombaire isolé avec instabilité rachidienne chez un adolescent.

This is a case report of a rare isolated eosinophilic granuloma of vertebra L3, in a 15-year-old adolescent. Vertebral instability, due to aggravation of the osteolysis, occurred without neurological symptoms despite orthopedic treatment. Surgery was necessary to correct and stabilize the spinal deformation. Postoperative chemotherapy (vinblastine and corticoids) was given as recommended for Langerhans cell histiocytosis (HL2010). No recurrence was observed after 5 years of follow-up.

[Avulsion fracture of the posterior cruciate ligament in a child: surgical treatment. a case report]. / Fracture avulsion du ligament croisé postérieur chez l'enfant : prise en charge chirurgicale. A propos d'un cas.

Avulsion fracture of the posterior cruciate ligament (PCL) is a less frequent injury in children than in adults. Directed by a meticulous clinical examination, magnetic resonance imaging confirms the diagnosis. Surgical treatment provides good functional results in the majority of cases. We report a case of avulsion fracture of the PCL treated with a standard Twinfix surgical anchor.

[Hallux valgus treated by Scarf osteotomy of the first metatarsus and the first phalanx associated with an adductor plasty. Apropos of 50 cases with a 2-year follow up]. / Hallux valgus traité par une ostéotomie de Scarf du premier métatarsien et de la première phalange associée à une plastie de l'adducteur. A propos de 50 cas avec 2 ans de recul.

PURPOSE OF THE STUDY: Fifty hallux-valgus were treated with Scarf Osteotomy of the first metatarsal, associated to a phalangeal varisation or shortening osteotomy and an adductor plasty. Patients were evaluated with a minimum follow-up of two years. MATERIAL AND METHODS: Forty five females and two males were operated with an average age of fifty years. The pre operative metatarsus varus was of 15 degrees 8. Mean alignment of metatarsal bar was 31 degrees 4. The cuneo-metatarsal joint was twenty two times spheric and twenty eight times plane. The average metatarso-phalangeal great toe valgus was 39 degrees 8. RESULTS: They were appreciated with a minimal follow-up of two years, according to the 3 Groulier's criteria: correction of deformation, statics troubles, functional activity. The metatarsus varus improved with an average of 10 degrees 4, as well as the alignment of the metatarsal bar (25 degrees). The post operative average phalangeal valgus was 22 degrees 7. These results were statistically significant. Cuneo-metatarsal joint type did not influenced final result. Articular joint line was normal in 64% of cases. Global result was excellent or good in 70%, passable in 22%, and bad in 8% of cases. DISCUSSION: Scarf Osteotomy of the first metatarsal allows complete correction of metatarsus varus. The surgical approach can be proposed at every age. There are no vascular trouble or arthrosis worsening. It must be completed with a phalangeal varisation or shortening osteotomy and adductor plasty.

[Simplified technique for thoracic drainage in anterior surgery of scoliosis in the child]. / Technique simplifiée de drainage thoracique dans la chirurgie antérieure de la scoliose chez l'enfant.

The authors describe a technique of thoracic drainage after anterior surgery of the spine in a pediatric population. A comparative study of drainage using the standard chest tube in one group of patients and small multiperforated vacuum drainage do not show any difference in term of morbidity. As the modified drainage is best tolerated in term of pain, easier to take care of and costless, the authors recommand this technique in children when hermetic closing of the pleura is possible and in absence of air-leakage.

[Importance of arthrodesis of the big toe combined with a metatarsal alignment according to Lelièvre in the surgery of the rheumatoid forefoot. Apropos of 70 observations]. / Intérêt de l'arthrodèse du gros orteil associée à un alignement métatarsien selon Lelièvre dans la chirurgie de l'avant pied rhumatoïde. A propos de 70 observations.

PURPOSE OF THE STUDY: The authors reviewed 70 cases of rheumatoid forefoot treated by Lelièvre, lateral metatarsal resection alignment, associated to first metatarsophalangeal joint arthrodesis. MATERIAL: Rheumatoid arthritis evolution was 20 years an average. It involved cortico-dependent polyarthritis in 48 per cent cases. Metatarsalgia were always present. METHODS: Mean follow up was 44 months (minimum 24 months) Results were analyzed according to Gainor. RESULTS: Foot pain disappeared in thirty two cases. Shoe wearing was normal 50 times. Arthrodesis fused 55 times. Lateral toes metatarsophalangeal joint space was satisfactory 28 times. Metatarsal divergence improved, 80 per cent of patients were satisfied in a subjective estimation and 85 per cent using Gainor's criteria. DISCUSSION: First-Metatarsophalangeal joint arthrodesis ensures permanent stability of the first ray and therefore an harmonious support distribution. The dorsal surgical approach allows an early weight bearing in cortico or immuno dependent patients. CONCLUSION: This technique keeps a low morbidity and ensures stable mid term results.