ABSTRACT
INTRODUCTION: Primary benign right ventricular tumours are rare. They can cause significant mortality without appropriate and timely treatment. We investigated surgical treatment and survival characteristics for right ventricular tumours. MATERIALS AND METHODS: From 2007 to 2017, 21 patients with primary benign right ventricular tumours who underwent tumour resection were retrospectively reviewed. Clinical findings and follow-up results were analysed. RESULTS: Thirteen men and eight women were enrolled, with a mean age of 42.3 ± 15.3 years. The most frequent histotypes were myxoma, haemangioma and papillary fibroelastoma. Eight patients underwent concomitant tricuspid valvuloplasty and one had tricuspid valve replacement. No major adverse events or death occurred during the perioperative period. One patient with haemangioma underwent partial tumour resection; however, the tumour regressed gradually during follow-up. Within the 10-year follow-up period (mean 4.8 ± 2.6 years), the recurrence-free and overall survival rates were 81.0% and 85.7%, respectively. CONCLUSIONS: Tumour resection for primary benign right ventricular tumours is safe and effective, and has a good prognosis. Tricuspid valvuloplasty or tricuspid valve replacement may be necessary for the resection of right ventricular tumours to improve the haemodynamics. Haemangiomas naturally undergo spontaneous regression.
Subject(s)
Cardiac Papillary Fibroelastoma/surgery , Cardiac Surgical Procedures/methods , Heart Neoplasms/surgery , Hemangioma/surgery , Myxoma/surgery , Neoplasm Recurrence, Local/epidemiology , Adult , Asymptomatic Diseases/mortality , Asymptomatic Diseases/therapy , Cardiac Papillary Fibroelastoma/mortality , Cardiac Papillary Fibroelastoma/pathology , Disease-Free Survival , Female , Follow-Up Studies , Heart Neoplasms/mortality , Heart Neoplasms/pathology , Heart Ventricles/pathology , Hemangioma/mortality , Hemangioma/pathology , Humans , Male , Middle Aged , Myxoma/mortality , Myxoma/pathology , Neoplasm Recurrence, Local/prevention & control , Remission, Spontaneous , Retrospective StudiesABSTRACT
PURPOSE: Primary vascular bone tumors of the spine represent a challenge for oncology surgeons, due to the need of planning a surgical strategy appropriate to the tumor behavior. But these tumors represent a challenge also for pathologists, as immunohistochemical and molecular analyses have recently refined the terminology. METHODS: A cohort of 81 cases was retrospectively reviewed, targeting the evolution of diagnoses and the treatment-related outcome. Sixty-six cases (including one case originally diagnosed as chordoma) were diagnosed before 2011, and 15 were diagnosed and treated in the period 2011-2017. Fully documented outcome studies are available for 46 patients whose immunohistochemical and molecular analyses were available. The follow-up ranges from 6 months of the early patient death to 300 months of the longest disease-free survival. RESULTS: The outcome was related not only to the treatment performed, but also to the evolution of diagnoses. The term Hemangioendothelioma that defined a benign aggressive (Enneking stage 3) tumor is now obsolete and replaced by the diagnosis of Epithelioid Hemangioma for benign aggressive tumor and Epithelioid Hemangioendothelioma for low-grade malignant tumor. En bloc resection was appropriate for local control, but 2 out of 7 cases of epithelioid Hemangioendotheliomas died due to the spread of the disease None of the Hemangiomas recurred after intralesional excision with or without radiotherapy, or after vertebroplasty. Both cases of Angiosarcoma had a fast and lethal evolution. CONCLUSIONS: Surgeons must be aware of the evolution of terminology to decide the most appropriate treatment options. These slides can be retrieved from Electronic Supplementary Material.
Subject(s)
Bone Neoplasms/pathology , Hemangioendothelioma, Epithelioid/pathology , Hemangioma/pathology , Hemangiosarcoma/pathology , Spinal Neoplasms/pathology , Adult , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/mortality , Bone Neoplasms/therapy , Cohort Studies , Female , Hemangioendothelioma, Epithelioid/diagnostic imaging , Hemangioendothelioma, Epithelioid/mortality , Hemangioendothelioma, Epithelioid/therapy , Hemangioma/diagnostic imaging , Hemangioma/mortality , Hemangioma/therapy , Hemangiosarcoma/diagnostic imaging , Hemangiosarcoma/mortality , Hemangiosarcoma/therapy , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Retrospective Studies , Spinal Neoplasms/diagnostic imaging , Spinal Neoplasms/mortality , Spinal Neoplasms/therapy , Tomography, X-Ray ComputedABSTRACT
Objective: To evaluate the clinicopathological characteristics of foot and ankle soft tissue and bone tumor, and to analyze the prognosis and the related factors of malignant tumors in this site. Methods: 74 patients with soft tissue and bone tumors of foot and ankle from January 2006 to February 2017 were retrospectively analyzed. The clinicopathological characteristics, the treatment and survival status of malignant tumors were followed up, and the clinical and therapeutic factors related to prognosis were analyzed. Results: Of the 74 patients, 34 were males and 40 were females. The male to female ratio was 1â¶1.18; the age ranged from 12 to 64 years and the median age was 42 years. Tumors located in forefoot of 22 cases, 22 in midfoot, 10 in hind foot, 14 in ankle joint and 6 in multiple sites. 14 cases were bone tumors, including 7 benign and 7 malignant, and 60 cases were soft tissue tumors, including 14 benign and 46 malignant. The most common malignant soft tissue tumors were synovial sarcomas (13 cases), and the most common benign soft tissue tumors were hemangiomas (4 cases). 44 cases of malignant tumors underwent surgery were followed up, of which were 7 bone and 37 soft tissue malignant tumors. Limb salvage surgeries were performed in 33 cases and amputation in 11 cases. The median follow-up time was 69.8 months, and the median survival time was 40.7 months. The 1-year, 3-year and 5-year survival rate of soft tissue malignant tumors was 88.0%, 73.0%, and 63.0%, respectively. The 1-year, 3-year and 5-year survival rate of bone malignant tumors was 86.0%, 57.0% and 57.0%, respectively. Univariate analysis showed that the prognostic factors affecting 5-year survival rate were tumor size and adjuvant therapy (P<0.05). Patient's gender, age, tumor location, histological type and surgical procedure had no effect on overall survival(P>0.05). Multivariate analysis showed that tumor size was an independent prognostic factor (RR=7.262, P=0.005). Conclusions: Forefoot and midfoot are more common in foot and ankle soft tissue and bone tumors. Synovial sarcoma is the most common diagnosis in malignant soft tissue tumors, and hemangioma is the most common diagnosis in benign soft tissue tumors. The prognostic factor of malignant soft tissue and bone tumors in foot and ankle is tumor size. Patients with the tumor size of 5 cm or more have a worse prognosis.
Subject(s)
Ankle , Bone Neoplasms , Foot Diseases , Soft Tissue Neoplasms , Adolescent , Adult , Bone Neoplasms/epidemiology , Bone Neoplasms/mortality , Bone Neoplasms/pathology , Child , Combined Modality Therapy , Female , Foot Diseases/epidemiology , Foot Diseases/mortality , Foot Diseases/pathology , Hemangioma/epidemiology , Hemangioma/mortality , Hemangioma/pathology , Humans , Limb Salvage/statistics & numerical data , Male , Middle Aged , Prognosis , Retrospective Studies , Sarcoma , Sarcoma, Synovial/epidemiology , Sarcoma, Synovial/mortality , Sarcoma, Synovial/pathology , Soft Tissue Neoplasms/epidemiology , Soft Tissue Neoplasms/mortality , Soft Tissue Neoplasms/pathology , Survival Rate , Tumor Burden , Young AdultABSTRACT
Recent studies have shown that radiofrequency (RF) ablation therapy is a safe, feasible, and effective procedure for hepatic hemangiomas, even huge hepatic hemangiomas. RF ablation has the following advantages in the treatment of hepatic hemangiomas: minimal invasiveness, definite efficacy, high safety, fast recovery, relatively simple operation, and wide applicability. It is necessary to formulate a widely accepted consensus among the experts in China who have extensive expertise and experience in the treatment of hepatic hemangiomas using RF ablation, which is important to standardize the application of RF ablation for the management of hepatic hemangiomas, regarding the selection of patients with suitable indications to receive RF ablation treatment, the technical details of the techniques, therapeutic effect evaluations, management of complications, etc. A final consensus by a Chinese panel of experts who have the expertise of using RF ablation to treat hepatic hemangiomas was reached by means of literature review, comprehensive discussion, and draft approval.
Subject(s)
Catheter Ablation , Hemangioma/surgery , Liver Neoplasms/surgery , Catheter Ablation/adverse effects , Catheter Ablation/mortality , China , Consensus , Hemangioma/mortality , Hemangioma/pathology , Humans , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Postoperative Complications/etiology , Risk Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To conduct a meta-analysis of reported evidence on surgical management for symptomatic giant liver hemangiomas. METHODOLOGY: A systematic literature search was conducted to identify studies on adult patient surgeries for symptomatic giant liver hemangiomas from January 2009 to July 2015. The primary outcome measures included postoperative symptom resolution, mortality, complications, and blood transfusions. Quality of life after surgery was taken as a secondary outcome. Meta-analysis was performed using a random-effect model with comprehensive meta-analysis software. RESULTS: Fourteen studies with 1,557 patients were included. There were only two mortalities. Overall event rate for minor and major complications was low as 0.15 and 0.14, respectively, with a high symptom resolution rate of 0.69 (95%, CI 0.64-0.73). Pooled analysis for blood transfusion stayed insignificant due to high calculated heterogeneity across studies. Quality of life results after surgery are reported good by three studies, in most of their patients. The adverse outcome rate between enucleation and resection was comparable. CONCLUSION: Liver hemangioma surgery is a safe treatment option with negligible mortality and low morbidity. It is effective in terms of symptom control and overall quality of life.
Subject(s)
Hemangioma/surgery , Hepatectomy/psychology , Liver Neoplasms/surgery , Quality of Life , Hemangioma/complications , Hemangioma/mortality , Humans , Liver Neoplasms/complications , Liver Neoplasms/mortality , Postoperative Complications , Treatment OutcomeABSTRACT
BACKGROUND: It has been reported that multifocal and diffuse hepatic hemangiomas are true infantile hemangiomas for which a continuum probably exists. We determined the similarities and fine differences between the two types of hemangioma and identified the multifocal subgroup of type, which needs timely treatment. MATERIAL AND METHODS: Twenty-four patients (4 males and 20 females; age 114±142days) with multifocal or diffuse hepatic hemangiomas who were treated between January 2000 and June 2015 were studied. For the multifocal type, patients were divided into countable (MC) and uncountable (MU) subgroups. The medical data were analyzed retrospectively. RESULTS: The clinical presentations included hepatomegaly (n=11), dyspnea (n=7), heart failure (n=9), hypothyroidism (n=6), and anemia (n=1). There were 19 and 5 patients with multifocal and diffuse types, and 6 and 13 patients in the MC and MU groups, respectively. There were significant differences between the multifocal and diffuse types with respect to hepatomegaly, heart failure, dyspnea, and hypothyroidism. However, there was no difference between the MU group and the diffuse type except for hypothyroidism. Observation was commonly recommended for patients with the multifocal type, and their survival rate was clearly higher than for patients with the diffuse type. Both the MU and diffuse-type groups needed treatment, unlike MC patients. The complete remission rate was higher in the MC group than in the MU and diffuse-type groups. Patients with the diffuse type were more likely to die. CONCLUSIONS: Patients with diffuse-type hepatic hemangioma are at high risk and need active treatment. The MU group for the multifocal type is unique and has high similarities to the diffuse type with respect to clinical presentation and treatment, which suggests that a continuum of the disease phenotypes exists. LEVEL OF EVIDENCE: Case-control study, level III.
Subject(s)
Hemangioma/diagnosis , Liver Neoplasms/diagnosis , Neoplasm Staging , Case-Control Studies , China/epidemiology , Female , Hemangioma/mortality , Humans , Infant , Infant, Newborn , Liver Neoplasms/mortality , Male , Retrospective Studies , Survival Rate/trendsABSTRACT
Multifocal hepatic hemangioma (MHH) is a benign hepatic tumor that is commonly diagnosed in children with multiple cutaneous infantile hemangiomas (IHs). We present a review of all children with MHH at our institutions. Of the 42 patients, the median age at presentation of MHH was 2.5 months. Thirty-six (85.7%) patients had cutaneous IHs. Twelve (28.6%) patients were symptomatic at presentation. There was no significant association between the number of hepatic hemangiomas and the number of cutaneous IHs. Fourteen (33.3%) patients received some form of treatment for hepatic hemangiomas. The most common type of treatment was oral prednisone in 8 patients, followed by oral propranolol in 6 patients. Two patients were totally resistant to prednisone treatment. They died from congestive heart failure or respiratory distress and coagulopathy. Two patients with problematic facial IH were treated with intralesional triamcinolone injection. The remaining 26 patients were managed with imaging surveillance. On follow-up, all of the survivors had a favorable outcome. Our study suggests that the clinical features of MHH are variable. Our data emphasize the treatment strategy that aggressive treatment is indicated in symptomatic or progressive MHHs, whereas observation management of asymptomatic patients with a few small lesions is safe and appropriate.
Subject(s)
Hemangioma , Liver Neoplasms , Prednisolone/administration & dosage , Propranolol/administration & dosage , Skin Neoplasms , Triamcinolone/administration & dosage , Administration, Oral , Child, Preschool , Female , Hemangioma/drug therapy , Hemangioma/mortality , Hemangioma/pathology , Humans , Infant , Liver Neoplasms/drug therapy , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Retrospective Studies , Skin Neoplasms/drug therapy , Skin Neoplasms/mortality , Skin Neoplasms/pathologyABSTRACT
UNLABELLED: In the last few years propranolol has revolutionized infantile hemangioma therapy. This nonselective ß bloker has been proven to be safe and effective but the molecular bases of its actions remain unclear. One of debated theories holds that propranolol may inhibit angiogenesis and induce apoptosis. To investigate this claim, this study aims to analyze the serum and tissue profiles of VEGF and VEGRR1/2 in patients treated with propranolol. MATERIALS AND METHODS: To assess the expression if VEGF and VEGRR1/2 we used three independent methods. First we analyzed serum VEGF levels in 50 children with IH before and 3 months after the therapy using ELISA test (I.). Then we used immunohistochemistry to evaluate tissue expression of VEGF and VEGFR1/2 in IH treated (n=27) and not treated (n=45) with propranolol (II.). Finally we assessed mRNA of VEGF and VEGFR1/2 in the same patients as in part II (III.). RESULTS: (I) There was no distinct decrease of VEGF level in children with IH after propranolol treatment. (II) We found no significant difference in VEGFR1 and VEGFR2 expression in hemangiomas from the study and control group. The expression of VEGF was even higher than before therapy. (III) VEGF and VEGFR1 mRNA expression was significantly lower in IH tissue after propranolol treatment compared to those without treatment. VEGFR2 demonstrated no differences in expression between the two groups. CONCLUSIONS: The obtained results show distinct discrepancies between in vitro and clinical studies as well as among different methods used for analyzing the same phenomenon. Only VEGF and VEGFR1 expression in mRNA studies may prove the proposed theory of antiangiogenic properties of propranolol. Other results do not confirm it and remain inconsistent with the fantastic clinical response to this medication.
Subject(s)
Angiogenesis Inhibitors/therapeutic use , Hemangioma/drug therapy , Parotid Neoplasms/drug therapy , Propranolol/therapeutic use , Vascular Endothelial Growth Factor A/metabolism , Vascular Endothelial Growth Factor Receptor-1/metabolism , Vascular Endothelial Growth Factor Receptor-2/metabolism , Female , Gene Expression Profiling , Hemangioma/diagnosis , Hemangioma/mortality , Humans , Immunohistochemistry , Infant , Male , Parotid Neoplasms/diagnosis , Parotid Neoplasms/mortality , Survival Analysis , Treatment OutcomeABSTRACT
BACKGROUND: This study compared the morbidity and mortality following hepatectomy for benign liver tumors and hepatic metastases. METHODS: This retrospective cohort study compared patients who underwent hepatectomy for benign liver tumors and metastases reported to National Surgical Quality Improvement Program between 2005 and 2011. RESULTS: A total of 5,542 patients underwent hepatectomy: 1,164 (21%) for benign and 4,378 (79%) for metastatic diseases. Patients with benign tumors were younger, predominantly female, and were less likely to have preoperative comorbidities (all P < .037). Rates of major complications including infections, embolism, renal failure, stroke, coma, cardiac arrest, reoperation, and ventilator dependence were similar between the 2 groups (all P ≥ .05). Thirty-day mortality was .9% among patients with benign tumors and 1.4% among patients with metastases (P = .128). After adjusting for significant effects of age and major complications (both P ≤ .007), benign vs malignant diagnosis and extent of hepatectomy was not associated with 30-day survival (both P ≥ .083). CONCLUSIONS: Despite patients with benign disease being younger and healthier, risks of major complications are similar after hepatectomy for benign and metastatic disease. Hepatectomy should be offered selectively for patients with benign liver tumors.
Subject(s)
Adenoma/surgery , Hemangioma/surgery , Hepatectomy/mortality , Liver Neoplasms/surgery , Postoperative Complications/epidemiology , Adenoma/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Cystadenoma/mortality , Cystadenoma/surgery , Female , Hemangioma/mortality , Humans , Liver Neoplasms/mortality , Liver Neoplasms/secondary , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
STUDY DESIGN: Multicenter, ambispective observational study. OBJECTIVE: To quantify local recurrence and mortality rates after surgical treatment of symptomatic spinal hemangiomas and identify prognostic variables for local disease control. SUMMARY OF BACKGROUND DATA: Spinal hemangiomas are the most common primary tumors of the spine and are generally benign and usually asymptomatic. Because of the rarity of symptomatic spinal hemangiomas, optimal surgical treatment remains unclear. METHODS: AOSpine Knowledge Forum Tumor Investigators created a multicenter database of primary spinal tumors including demographics, presentation, diagnosis, treatment, survival, and recurrence data. Tumors were classified according to Enneking and Weinstein-Boriani-Biagini. Descriptive statistics were summarized and time to mortality and recurrence was determined. RESULTS: Between 1996 and 2012, 68 patients (mean age = 51 yr, SD = 16) underwent surgical treatment of a spinal hemangioma. Epidural disease was present in 55% of patients (n = 33). Pain and neurological compromise were presenting symptoms in 82% (n = 54) and 37% (n = 24) of patients, respectively. Preoperative embolization was performed in 35% of patients (n = 23), 10% (n = 7) had adjuvant radiotherapy, and 81% (n = 55) underwent posterior-alone surgery. The local recurrence rate was 3% (n = 2). Mortality secondary to spinal hemangioma was not observed (mean follow-up = 3.9 yr, SD = 3.8). CONCLUSION: This is the largest multicenter surgical cohort of spinal hemangiomas. Symptomatic spinal hemangiomas are a benign tumor despite frequently presenting with epidural disease and neurological compromise. Thus, formal en bloc resection is not required, and excellent rates of local control and long-term survival can result from aggressive intralesional resection during index surgery. LEVEL OF EVIDENCE: 3.
Subject(s)
Hemangioma , Neoplasm Recurrence, Local , Spinal Neoplasms , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hemangioma/epidemiology , Hemangioma/mortality , Hemangioma/surgery , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/epidemiology , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/surgery , Retrospective Studies , Spinal Neoplasms/epidemiology , Spinal Neoplasms/mortality , Spinal Neoplasms/surgery , Young AdultABSTRACT
Salivary gland neoplasms are rare in children. In infants most tumors are benign hemangiomas, with some notable exceptions, such as sialoblastomas. An asymptomatic swelling in the periauricular region is the most common presenting complaint in older children. Approximately 50% of these lesions are malignant, which dictates a thorough diagnostic evaluation by a head and neck surgeon. Surgical excision is the primary treatment modality. Prognosis is primarily determined by histopathologic findings. This review discusses neoplastic lesions of the salivary glands in children, and malignant epithelial tumors in particular.
Subject(s)
Diagnostic Imaging/methods , Head and Neck Neoplasms/pathology , Head and Neck Neoplasms/surgery , Salivary Gland Neoplasms/pathology , Salivary Gland Neoplasms/surgery , Biopsy, Needle , Child , Child, Preschool , Female , Follow-Up Studies , Head and Neck Neoplasms/mortality , Hemangioma/mortality , Hemangioma/pathology , Hemangioma/surgery , Humans , Immunohistochemistry , Infant , Magnetic Resonance Imaging/methods , Male , Otorhinolaryngologic Surgical Procedures/methods , Parotid Neoplasms/mortality , Parotid Neoplasms/pathology , Parotid Neoplasms/surgery , Rare Diseases , Risk Assessment , Salivary Gland Diseases/mortality , Salivary Gland Diseases/pathology , Salivary Gland Diseases/surgery , Salivary Gland Neoplasms/mortality , Survival Rate , Tomography, X-Ray Computed/methods , Treatment Outcome , Ultrasonography, Doppler/methodsABSTRACT
BACKGROUND: The management of hepatic hemangiomas remains ill defined. This study sought to investigate the indications, surgical management and outcomes of patients who underwent a resection for hepatic hemangiomas. METHODS: A retrospective review from six major liver centres in the United States identifying patients who underwent surgery for hepatic hemangiomas was performed. Clinico-pathological, treatment and peri-operative data were evaluated. RESULTS: Of the 241patients who underwent a resection, the median age was 46 years [interquartile range (IQR): 39-53] and 85.5% were female. The median hemangioma size was 8.5 cm (IQR: 6-12.1). Surgery was performed for abdominal symptoms (85%), increasing hemangioma size (11.3%) and patient anxiety (3.7%). Life-threatening complications necessitating a hemangioma resection occurred in three patients (1.2%). Clavien Grade 3 or higher complications occurred in 14 patients (5.7%). The 30- and 90-day mortality was 0.8% (n = 2). Of patients with abdominal symptoms, 63.2% reported improvement of symptoms post-operatively. CONCLUSION: A hemangioma resection can be safely performed at high-volume institutions. The primary indication for surgery remains for intractable symptoms. The development of severe complications associated with non-operative management remains a rare event, ultimately challenging the necessity of additional surgical indications for a hemangioma resection.
Subject(s)
Hemangioma/surgery , Hepatectomy , Liver Neoplasms/surgery , Adult , Female , Hemangioma/complications , Hemangioma/mortality , Hemangioma/pathology , Hospitals, High-Volume , Humans , Liver Neoplasms/complications , Liver Neoplasms/mortality , Liver Neoplasms/pathology , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , Tumor Burden , United StatesABSTRACT
BACKGROUND/AIMS: To conduct a systematic review of observational studies to evaluate effectiveness of surgery for liver hemangioma. METHODOLOGY: Related studies were identified using different searching engines. Two reviewers independently extracted data on mortality, morbidity and symptoms recurrence and/or aggravation. RESULTS: Sixteen studies with a total of 1485 patients (402 in surgery and 1085 in observation group) were included in the analysis. Two deaths in surgical group (8.0%, 2/25) and two deaths in observation group (1.4%, 2/143) were reported. The RRs for mortality were not homogeneous (χ2=3.40, 1 d.f., P=0.07, I2=71 per cent). The RRs for morbidity were homogeneous across studies (x2=5.55, 12 d.f., P=0.94, I2=0 per cent). Morbidity in surgery group was significantly higher than that in observation group (RR=14.7, 95 per cent c.i. 9.56 to 45.63). Eight studies reported the symptom aggravation and RRs were heterogeneous (x2=31.03, 7 d.f., P<0.0001, I2=77 per cent), However, showed no statistical difference. CONCLUSION: The currently involved retrospective cohort studies of surgical series were likely to imply that surgery may take more risks than the benefits for non-emergency hemangioma patients.
Subject(s)
Hemangioma/surgery , Liver Neoplasms/surgery , Hemangioma/mortality , Humans , Liver Neoplasms/mortality , MorbidityABSTRACT
BACKGROUND: Laparoscopic liver resection (LLR) is proposed as an alternative to open liver resection (OLR) for treatment of liver tumors. The aim of this study was to compare the surgical and oncological outcomes of LLR versus OLR in benign and malignant solid liver tumors. STUDY DESIGN: In this case-matched study, charts of 497 patients with liver lesions who had LLR or OLR in our center were retrospectively reviewed. Among them, 54 consecutive patients with benign or malignant solid liver tumors who had LLR were matched with a similar number of patients with OLR based on the pathology and extent of liver resection. Additionally, the surgical and oncological outcomes such as operating room time, amount of blood transfusion requirement, free resection margin rate, length of hospital stay, complication rate, perioperative mortality, and survival were compared between the two groups. RESULTS: Demographics, pathological characteristics of the tumor, and extent of liver resection were similar between the two groups. Twenty-nine (54%) patients in each group had malignant lesions. There were no statistically significant differences between the two groups in terms of operating room time, amount of blood transfusion requirement, free resection margin, or postoperative complication rate or survival. However, hospital stay was significantly shorter in the laparoscopic group (5.9 versus 9 days, P=.006). Although no perioperative mortality was observed in patients with benign tumors, among the patients with malignant tumors, 2 died perioperatively in each group. CONCLUSIONS: Our results in accordance with previous studies demonstrated that although the oncological outcomes of LLR and OLR were comparable, LLR patients had a shorter hospital stay.
Subject(s)
Carcinoma/surgery , Hepatectomy , Laparoscopy , Liver Neoplasms/pathology , Liver Neoplasms/surgery , Adenoma/mortality , Adenoma/pathology , Adenoma/surgery , Aged , Carcinoma/mortality , Carcinoma/pathology , Female , Focal Nodular Hyperplasia/mortality , Focal Nodular Hyperplasia/pathology , Focal Nodular Hyperplasia/surgery , Hamartoma/mortality , Hamartoma/pathology , Hamartoma/surgery , Hemangioma/mortality , Hemangioma/pathology , Hemangioma/surgery , Humans , Length of Stay , Liver Neoplasms/mortality , Male , Middle Aged , Neuroendocrine Tumors/mortality , Neuroendocrine Tumors/pathology , Neuroendocrine Tumors/surgery , Operative Time , Retrospective Studies , Survival Rate , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Female , Infant , Sudden Infant Death/diagnosis , Sudden Infant Death/pathology , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Cardiomyopathies/mortality , Cardiomyopathy, Hypertrophic/complications , Cardiomyopathy, Hypertrophic/diagnosis , Systolic Murmurs/complications , Systolic Murmurs , Hemangioma/complications , Hemangioma/mortality , Cardiomyopathy, Hypertrophic/mortality , Cardiomyopathy, Hypertrophic , Wolff-Parkinson-White Syndrome/diagnosis , Wolff-Parkinson-White Syndrome , Ventricular Fibrillation/diagnosis , Ventricular FibrillationABSTRACT
Hepatic hemangiomas are the most common benign tumors of the liver. Surgical treatment can be difficult as a result of the high risk of intraoperative hemorrhage. The present study reviewed clinical features of patients with hepatic hemangioma and surgical techniques used in their treatment. Eight patients with giant hepatic hemangiomas underwent hepatectomies at the Asan Medial Center between January 2006 and March 2009. Patient demographic, clinical, and surgical characteristics and outcomes were reviewed retrospectively. Seven females and one male patient underwent hepatectomies during the study period. The median age was 48.5 years (range, 33 to 58 years). Indications for surgical interventions were abdominal pain (62.5%), an abdominal mass (37.5%), Kasabach-Merritt syndrome (25%), and increased hemangioma size (25%). The hemangiomas were usually multiple (87.5%) and bilobar (75%) and had a median size of 14.5 cm (range, 7 to 29 cm). All patients underwent major hepatic resection with early vascular control using the Glissonean pedicle transection method (GPTM), the liver hanging maneuver (LHM), and preparation for total vascular exclusion (TVE). There was no major morbidity or mortality. The minor morbidity rate was 25 per cent with transfusion rate of 37.5 per cent. Early vascular control using the GPTM, the LHM, and preparation for TVE is essential for safe resection of large hepatic hemangiomas.
Subject(s)
Hemangioma/surgery , Hemostasis, Surgical/methods , Hepatectomy/methods , Liver Neoplasms/surgery , Blood Loss, Surgical/prevention & control , Cohort Studies , Female , Follow-Up Studies , Hemangioma/diagnosis , Hemangioma/mortality , Hepatectomy/adverse effects , Humans , Liver Neoplasms/diagnosis , Liver Neoplasms/mortality , Male , Middle Aged , Neoplasm Staging , Postoperative Complications/mortality , Postoperative Complications/physiopathology , Retrospective Studies , Risk Assessment , Survival Rate , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
OBJECTIVE: To study the effectiveness of propranolol in infantile airway haemangiomas and compare the effectiveness of propranolol vs. different therapies. METHODS: A literature search of Ovid, Embase, the Cochrane database, Google™ Scholar, and Medline using PubMed as the search engine was performed to identify studies that analysed the effect of propranolol treatment in children with airway haemangiomas. Random-effect meta-analytical techniques were conducted for the outcome measures. RESULTS: Thirteen studies, comprising 36 patients were included in the analysis. Propranolol was found to be an effective intervention for the resolution of infantile airway haemangiomas (P<0.00001). Meta-analysis of effectiveness of propranolol vs. steroids, CO(2) laser, or vincristine showed that propranolol is the most effective treatment. CONCLUSIONS: This meta-analysis demonstrated that propranolol should be recommended as a first-line treatment in infantile airway haemangiomas. However, because of the possible side effects of propranolol, current infantile haemangioma treatment centres recommend a full cardiovascular and respiratory review be performed prior to initiation of therapy.
Subject(s)
Hemangioma/drug therapy , Hemangioma/mortality , Laryngeal Neoplasms/drug therapy , Propranolol/administration & dosage , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Hemangioma/congenital , Hemangioma/pathology , Humans , Infant , Infant, Newborn , Laryngeal Neoplasms/congenital , Laryngeal Neoplasms/mortality , Laryngeal Neoplasms/pathology , Low-Level Light Therapy/methods , Male , Prognosis , Propranolol/adverse effects , Risk Assessment , Steroids/therapeutic use , Survival Rate , Treatment Outcome , Vincristine/administration & dosageABSTRACT
BACKGROUND: Kaposiform hemangioendothelioma (KHE) and tufted angioma (TA) are rare, locally aggressive vascular tumors. Although currently classified as separate entities, they are becoming increasingly recognized as a spectrum of the same pathology. There is a well-recognized association with Kasabach-Merritt phenomenon KHE and TA are considered neoplasms of intermediate malignancy because of infiltrative growth, local aggressiveness, and variable prognosis. To date, definitive treatment for these vascular tumors has had limited success. AIM: To evaluate the safety, efficacy, and role of vincristine in the treatment of KHE and TA. METHODS: Case review of patient files and pathology reports at The Children's Hospital at Westmead from 1995 to 2009. RESULTS: Twelve cases with KHE or TA were identified. Seven cases were treated with vincristine. The survival rate in the vincristine group was 100%. Mean age of diagnosis was 30 months (range birth to 9 y). 6 patients were female (85.7%). Mean time of the follow-up was 4 years (range 4 mo to 8 y). Out of the 7 cases treated with vincristine, 3 patients had associated Kasabach-Merritt phenomenon (43%). Complete resolution, regression in size, and improvement in analgesia were found in 1 case (14%), 3 cases (43%) and 2 cases (29%), respectively. Vincristine related side effects occurred in 2 cases (29%). CONCLUSIONS: Vincristine is an effective treatment option for KHE/TA. It is associated with a low side effect profile and should be considered as the first-line agent.
Subject(s)
Antineoplastic Agents/therapeutic use , Hemangioendothelioma/drug therapy , Hemangioma/drug therapy , Vincristine/therapeutic use , Child , Child, Preschool , Female , Hemangioendothelioma/mortality , Hemangioendothelioma/pathology , Hemangioma/mortality , Hemangioma/pathology , Humans , Infant , Male , Retrospective StudiesABSTRACT
PURPOSE: Stereotactic radiotherapy using the CyberKnife has become a key treatment in the multidisciplinary management of secondary tumours, as well as primary benign or malignant tumours located within or adjacent to vertebral bodies and the spinal cord. The aim of this treatment is to improve local control and clinical response, including previously irradiated cases. PATIENTS AND METHODS: In this study, we present the first patients treated with CyberKnife between December 2006 and December 2007 for spinal or paraspinal tumours. The primary aim was to assess the feasibility and tolerance of stereotactic radiotherapy using the CyberKnife. Secondary aims were to establish the short-term local control, to calculate the local progression-free survival and overall survival. Clinical examination and imaging procedures were performed every three months. Response was assessed according to RECIST criteria. RESULTS: During that period, 16 patients were treated with CyberKnife. Thirteen patients had been pre-treated, three of whom had received spinal cord doses considered to be maximal. Three patients did not receive previous irradiation. The median age was 59 (36-74). The most frequent symptoms were pain (n = 8) and motor weakness (n = 4). The median dose was 30 Gy (16-50). The median number of fractions was 3 (1-5). No patient developed acute myelitis. Three patients developed acute reaction. Overall survival at 18 months was 72.4%, with a mean survival of 18.2 months (95% CI: 15.4-20.9). Local progression-free survival at 18 months was 58.4%, with a mean value of 16.9 months (95% CI: 13.6-20.2). CONCLUSION: The use of stereotactic radiotherapy with CyberKnife represents a major progress in the management of paraspinal tumours. The main advantages are better sparing of the spinal cord and the possibility of increasing the dose to the tumour target volume.
Subject(s)
Radiosurgery , Spinal Neoplasms/mortality , Spinal Neoplasms/surgery , Adult , Aged , Chordoma/mortality , Chordoma/surgery , Disease-Free Survival , Feasibility Studies , Female , Hemangioma/mortality , Hemangioma/surgery , Humans , Male , Meningeal Neoplasms/mortality , Meningeal Neoplasms/surgery , Meningioma/mortality , Meningioma/surgery , Middle Aged , Neoplasm Metastasis , Neurilemmoma/mortality , Neurilemmoma/surgery , Osteosarcoma/mortality , Osteosarcoma/surgery , Radiation Dosage , RadiometryABSTRACT
OBJECTIVE: Characterize and compare care in children with hemangiomas, who do or do not undergo airway procedures. METHODS: National retrospective cohort study of patients aged 0-18 with hemangiomas, from 33 freestanding United States pediatric hospital discharge records, 2001-2005. The main outcome measures were therapy, readmission and mortality. RESULTS: Of 2890 patients diagnosed with hemangiomas, 337 (12%) underwent airway procedures. Most airway procedures were for patients between ages 1 and 11 months. Patients with hemangiomas and airway procedures had more steroid use (80%), increased readmission (30%), and increased mortality (2%) compared to hemangioma patients without airway procedures. Procedures (i.e. laser, open surgery, tracheotomy) and age over 4 months in airway procedure patients were associated with decreased readmission. Increased readmissions were associated with systemic steroid administration. CONCLUSION: Hemangioma patients who undergo airway procedures experience increased medical and surgical therapy compared to those who do not. Readmission is increased in patients with hemangiomas and airway procedures, but surgical intervention and age greater than 4 months decreased readmission.