Quality of life after robotic versus conventional minimally invasive cancer surgery: a systematic review and meta-analysis.

Optimizing postoperative quality of life (QoL) is an essential aspect of surgical oncology. Minimally invasive surgery (MIS) decreases surgical morbidity and improves QoL outcomes. This meta-analysis aimed to compare post-operative QoL after oncologic resections using different MIS modalities. The PubMed, Embase, Scopus, and CENTRAL databases were searched for articles that compared post-operative QoL in patients undergoing video-assisted thoracoscopic (VATS) or laparoscopic surgery (LS) versus robotic surgery (RS) for malignancy. Quality assessment was performed using the ROBINS-I and Cochrane Risk of Bias 2 (RoB-2) tools. Meta-analysis was performed using an inverse-variance random effects model. 27 studies met the inclusion criteria, including 5 randomized controlled trials (RCTs). 15 studies had a low risk of bias, while 11 had a moderate risk of bias and 1 had serious risk of bias. 8330 patients (RS: 5090, LS/VATS: 3240) from across 25 studies were included in the meta-analysis. Global QoL was significantly better after robotic surgery in the pooled analysis overall (SMD: - 0.28 [95% CI: - 0.49, - 0.08]), as well as in the prostatectomy and gastrectomy subgroups. GRADE certainty of evidence was low. Analysis of EPIC-26 subdomains also suggested greater sexual function after robotic versus laparoscopic prostatectomy. Robotic and conventional MIS approaches produce similar postoperative QoL after oncologic surgery for various tumor types, although advantages may emerge in some patient populations. Our results may assist surgeons in counseling patients who are undergoing oncologic surgery.

Determining a multidisciplinary intraoperative strategy in emergency surgery for bowel obstruction and its impact on outcomes.

PURPOSE: Bowel obstruction accounts for around 50% of all emergency laparotomies. A multidisciplinary (MDT) standardized intraoperative model was applied (definitive, palliative, or damage control surgery) to identify patients suitable for a one-step, definitive surgical procedure favoring anastomosis over stoma, when undergoing surgery for bowel obstruction. The objective was to present mortality according to the strategy applied and to compare the rate of laparoscopic interventions and stoma creations to a historic cohort in surgery for bowel obstruction. METHODS: In a retrospective cohort study, we included patients undergoing emergency surgery for bowel obstruction during a 1-year period at two Copenhagen University Hospitals (2019 and 2021). The MDT model consisted of a 30- and 60-min time-out with variables such as functional and hemodynamic status, presence of malignancy, and surgical capabilities (lap/open). Pre-, intra-, and postoperative data were collected to investigate associations to postoperative complications and mortality. Stoma creation rates and laparoscopies were compared to a historic cohort (2009-2013). RESULTS: Three hundred sixty-nine patients underwent surgery for bowel obstruction. Intraoperative surgical strategy was definitive in 77.0%, palliative in 22.5%, and damage control surgery in 0.5%. Thirty-day mortality was significantly lower in the definitive patient population (4.6%) compared to the palliative population (21.7%) (p < 0.000). Compared to the historic cohort, laparoscopic surgery for bowel obstruction increased from 5.0 to 26.4% during the 10-year time span, the rate of stoma placements was reduced from 12.0 to 6.1%, p 0.014, and the 30-day mortality decreased from 12.9 to 4.6%, p < 0.000. CONCLUSION: An intraoperative improvement strategy can address the specific surgical interventions in patients undergoing surgery for bowel obstruction, favoring anastomosis over stoma whenever resection was needed, and help adjust specific postoperative interventions and care pathways in cases of palliative need.

Advancements in fertility preservation strategies for pediatric male cancer patients: a review of cryopreservation and transplantation of immature testicular tissue.

Recently, there has been increasing emphasis on the gonadotoxic effects of cancer therapy in prepubertal boys. As advances in oncology treatments continue to enhance survival rates for prepubertal boys, the need for preserving their functional testicular tissue for future reproduction becomes increasingly vital. Therefore, we explore cutting-edge strategies in fertility preservation, focusing on the cryopreservation and transplantation of immature testicular tissue as a promising avenue. The evolution of cryopreservation techniques, from controlled slow freezing to more recent advancements in vitrification, with an assessment of their strengths and limitations was exhibited. Detailed analysis of cryoprotectants, exposure times, and protocols underscores their impact on immature testicular tissue viability. In transplantation strategy, studies have revealed that the scrotal site may be the preferred location for immature testicular tissue grafting in both autotransplantation and xenotransplantation scenarios. Moreover, the use of biomaterial scaffolds during graft transplantation has shown promise in enhancing graft survival and stimulating spermatogenesis in immature testicular tissue over time. This comprehensive review provides a holistic approach to optimize the preservation strategy of human immature testicular tissue in the future.

[Pre-rehabilitation of oncological patients before extensive abdominal and thoracic surgery: a literature review]. / Prereabilitatsiya onkologicheskikh patsientov pered obshirnym khirurgicheskim vmeshatel'stvom v bryushnoi i grudnoi polostyakh: obzor literatury.

Surgery is one of the leading treatment methods of patients with primary or recurrent malignant neoplasms in the thoracic or abdominal cavity. Extensive abdominal interventions are accompanied by such adverse outcomes as blood loss, hypoxia, inflammation, blood clotting abnormality, emotional and cognitive disorders, that increases the incidence of serious complications and worsens the treatment outcome and life quality in weakened oncological patients. Multimodal pre-rehabilitation before surgery can significantly decrease the incidence and severity of postoperative complications. The rehabilitation complex includes exercise therapy, nutritional and psychological support, smoking cessation and pharmacotherapy. Currently, there are a number of questions facing rehabilitation specialists and oncologists, that are related to the determination of pre-rehabilitation optimal timing and process duration, the choice of specific physical exercises, determining the load intensity. This review presents a current view on understanding of surgical stress in extensive abdominal interventions, its effect on the oncological process course, summarizes the experience of last years in choosing pre-rehabilitation program taking into account pathogenetic mechanisms of surgical stress and individual patient's characteristics. Special attention is paid to the comparison of physical exercises' various types, their action mechanisms at different stages of pathological process, the issues of load dosing during pre-rehabilitation activities.

The N-LVA Study: effectiveness and cost-effectiveness of lymphaticovenous anastomosis (LVA) for patients with cancer who suffer from chronic peripheral lymphoedema - study protocol of a multicentre, randomised sham-controlled trial.

INTRODUCTION: Cancer-related lymphoedema is one of the most debilitating side-effects of cancer treatment with an overall incidence of 15.5%. Patients may suffer from a variety of symptoms, possibly resulting in a diminished health-related quality of life (HRQoL). A microsurgical technique known as lymphaticovenous anastomosis (LVA) might be a promising treatment option. The objective of this study is to evaluate whether LVA is effective and cost-effective compared with sham surgery in improving the HRQoL. METHODS AND ANALYSIS: A multicentre, double-blind, randomised sham-controlled trial conducted in three university hospitals in the Netherlands. The study population comprises 110 patients over the age of 18 years with unilateral, peripheral cancer-related lymphoedema, including 70 patients with upper limb lymphoedema and 40 patients with lower limb lymphoedema. A total of 55 patients will undergo the LVA operation, while the remaining 55 will undergo sham surgery. The follow-up will be at least 24 months. Patients are encouraged to complete the follow-up by explaining the importance of the study. Furthermore, patients may benefit from regular monitoring moments for their lymphoedema. The primary outcome is the HRQoL. The secondary outcomes are the limb circumference, excess limb volume, changes in conservative therapy, postoperative complications, patency of the LVA and incremental cost-effectiveness. ETHICS AND DISSEMINATION: The study was approved by the Medical Ethical Committee of Maastricht University Medical Center on 20 September 2023 (NL84169.068.23). The results will be presented at scientific conferences and published in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: NCT06082349.

Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania.

PURPOSE: Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania. METHODS: Operative logbooks were reviewed at all national referral hospitals that offer surgery, all zonal referral hospitals in Mainland Tanganyika and Zanzibar, and a convenience sampling of regional referral hospitals in 2022. Cancer cases were identified by postoperative diagnosis and deidentified data were abstracted for each cancer surgery. The proportion of the procedures conducted for patients with cancer and the total number of cancer surgeries done within the public sector were calculated and compared with a previously published estimate of the surgical oncology need for the country. RESULTS: In total, 69,195 operations were reviewed at 10 hospitals, including two national referral hospitals, five zonal referral hospitals, and three regional referral hospitals. Of the cases reviewed, 4,248 (6.1%) were for the treatment of cancer. We estimate that 4,938 cancer surgeries occurred in the public sector in Tanzania accounting for operations conducted at hospitals not included in our study. Prostate, breast, head and neck, esophageal, and bladder cancers were the five most common diagnoses. Although 387 (83%) of all breast cancer procedures were done with curative intent, 506 (87%) of patients with prostate and 273 (81%) of patients with esophageal cancer underwent palliative surgery. CONCLUSION: In this comprehensive assessment of surgical oncology service delivery in Tanzania, we identified 4,248 cancer surgeries and estimate that 4,938 likely occurred in 2022. This represents only 25% of the estimated 19,726 cancer surgeries that are annually needed in Tanzania. These results highlight the need to identify strategies for increasing surgical oncology capacity in the country.

Everything old is new again. revisiting hypophysectomy for the treatment of refractory cancer-related pain: a systematic review.

Cancer-related pain is a common and debilitating condition that can significantly affect the quality of life of patients. Opioids, NSAIDs, and antidepressants are among the first-line therapies, but their efficacy is limited or their use can be restricted due to serious side effects. Neuromodulation and lesioning techniques have also proven to be a valuable instrument for managing refractory pain. For patients who have exhausted all standard treatment options, hypophysectomy may be an effective alternative treatment. We conducted a comprehensive systematic review of the available literature on PubMed and Scielo databases on using hypophysectomy to treat refractory cancer-related pain. Data extraction from included studies included study design, treatment model, number of treated patients, sex, age, Karnofsky Performance Status (KPS) score, primary cancer site, lead time from diagnosis to treatment, alcohol injection volume, treatment data, and clinical outcomes. Statistical analysis was reported using counts (N, %) and means (range). The study included data from 735 patients from 24 papers treated with hypophysectomy for refractory cancer-related pain. 329 cancer-related pain patients were treated with NALP, 216 with TSS, 66 with RF, 55 with Y90 brachytherapy, 51 with Gamma Knife radiosurgery (GK), and 18 with cryoablation. The median age was 58.5 years. The average follow-up time was 8.97 months. Good pain relief was observed in 557 out of 735 patients, with complete pain relief in 108 out of 268 patients. Pain improvement onset was observed 24 h after TSS, a few days after NALP or cryoablation, and a few days to 4 weeks after GK. Complications varied among treatment modalities, with diabetes insipidus (DI) being the most common complication. Although mostly forgotten in modern neurosurgical practice, hypophysectomy is an attractive option for treating refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications.

Characteristics of gastrointestinal stromal tumors associated to other tumors / Características de los tumores del estroma gastrointestinal asociados a otras neoplasias

Introduction: Our aim is to analyze the differences between sporadic gastrointestinal stromal tumors and those associated with other tumors. Methods: Retrospective cohort study including patients with diagnosis of gastrointestinal stromal tumors operated at our center. Patients were divided into two groups, according to whether or not they had associated other tumors, both synchronously and metachronously. Disease free survival and overall survival were calculated for both groups. Results: 96 patients were included, 60 (62.5%) were male, with a median age of 66.8 years (35–84). An association with other tumors was found in 33 cases (34.3%); 12 were synchronous (36.3%) and 21 metachronous (63.7%). The presence of mutations in associated tumors was 70% and in non-associated tumors 75%. Associated tumors were classified as low risk tumors based on Fletcher's stratification scale (p=0.001) as they usually were smaller in size and had less than ≤5 mitosis per 50 HPF compared to non-associated tumors. When analyzing overall survival, there were statistically significant differences (p=0.035) between both groups. Conclusion: The relatively high proportion of gastrointestinal stromal tumors cases with associated tumors suggests the need to carry out a study to rule out presence of a second neoplasm and a long-term follow-up should be carried out in order to diagnose a possible second neoplasm. Gastrointestinal stromal tumors associated with other tumors have usually low risk of recurrence with a good long-term prognosis.(AU)

Introducción: El objetivo de este estudio es analizar si existen diferencias entre los GIST esporádicos y los que se presentan asociados a otros tumores. Métodos: Estudio de cohorte retrospectivo de pacientes operados de tumores del estroma gastrointestinal (GIST) en nuestro centro. Se dividió a los pacientes en función de si presentaban otros tumores asociados o no, de forma sincrónica o metacrónica. La supervivencia libre de enfermedad y la supervivencia global se calcularon en ambos grupos. Resultados: Se incluyeron un total de 96 pacientes, 60 (62,5%) eran hombres con una media de edad de 66,8 años (35-84). Se encontró una asociación con otros tumores en 33 casos (34,3%); 12 de manera sincrónica (36,3%) y 21 metacrónica (63,7%). La presencia de mutaciones en el grupo de tumores asociados fue de 70% y en el de no asociados de 75%. Los tumores asociados se clasificaron como tumores de bajo riesgo según la escala de Fletcher (p = 0,001), ya que fueron de menor tamaño y presentaron menos de ≤ 5 mitosis por 50 HPF en comparación con los no asociados. Al analizar la supervivencia global, hubo diferencias estadísticamente significativas entre ambos grupos (p = 0,035). Conclusión: La proporción relativamente alta de casos de GIST con tumores asociados sugiere la necesidad de realizar un estudio para descartar la presencia de una segunda neoplasia y, tras el tratamiento de GIST, elaborar un seguimiento a largo plazo para diagnosticar una posible segunda neoplasia. Los GIST asociados a otros tumores suelen tener un riesgo bajo de recurrencia con un buen pronóstico a largo plazo.(AU)

Biomimetic Tertiary Lymphoid Structures with Microporous Annealed Particle Scaffolds for Cancer Postoperative Therapy.

Immunotherapy plays a vital role in cancer postoperative treatment. Strategies to increase the variety of immune cells and their sustainable supply are essential to improve the therapeutic effect of immune cell-based immunotherapy. Here, inspired by tertiary lymphoid structures (TLSs), we present a microfluidic-assisted microporous annealed particle (MAP) scaffold for the persistent recruitment of diverse immune cells for cancer postoperative therapy. Based on the thermochemical responsivity of gelatin methacryloyl (GelMA), the MAP scaffold was fabricated by physical cross-linking and sequential photo-cross-linking of GelMA droplets, which were prepared by microfluidic electrospraying. Due to the encapsulation of liquid nitrogen-inactivated tumor cells and immunostimulant, the generated MAP scaffold could recruit a large number of immune cells, involving T cells, macrophages, dendritic cells, B cells, and natural killer cells, thereby forming the biomimetic TLSs in vivo. In addition, by combination of immune checkpoint inhibitors, a synergistic anticancer immune response was provoked to inhibit tumor recurrence and metastasis. These properties make the proposed MAP scaffold-based artificial TLSs of great value for efficient cancer postoperative therapy.

International consensus is needed on a core outcome set to advance the evidence of best practice in cancer prehabilitation services and research.

Prehabilitation aims to optimise patients' physical and psychological status before treatment. The types of outcomes measured to assess the impact of prehabilitation interventions vary across clinical research and service evaluation, limiting the ability to compare between studies and services and to pool data. An international workshop involving academic and clinical experts in cancer prehabilitation was convened in May 2022 at Sheffield Hallam University's Advanced Wellbeing Research Centre, England. The workshop substantiated calls for a core outcome set to advance knowledge and understanding of best practice in cancer prehabilitation and to develop national and international databases to assess outcomes at a population level.

Physical activity for cancer prehabilitation: A scoping review.

This scoping review aims to synthesize the current landscape of physical activity in cancer prehabilitation and identify knowledge gaps. We searched MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCE for exercise interventions and observational studies that measured exercise or physical activity before cancer treatment from inception to January 20, 2023. Fifty-one articles from 44 unique studies were reviewed, including 32 intervention and 12 observational studies. Surgery is the only treatment modality that has been investigated. Included studies used heterogeneous exercise interventions and measures for physical activity. Colorectal and other gastrointestinal, lung, and urologic cancers are the most studied cancer types. Exercise intervention in cancer prehabilitation is highly feasible. The evidence for improved fitness, functional, psychosocial, and clinical outcomes is promising yet limited. Although research has increased recently, prehabilitation exercise remains a relatively under-investigated area in oncology. We have provided research directions towards an ideal cancer prehabilitation design in the real-world setting.

Effect of Behavioral Health Disorders on Surgical Outcomes in Cancer Patients.

BACKGROUND: Behavioral health disorders (BHDs) can often be exacerbated in the setting of cancer. We sought to define the prevalence of BHD among cancer patients and characterize the association of BHD with surgical outcomes. STUDY DESIGN: Patients diagnosed with lung, esophageal, gastric, liver, pancreatic, and colorectal cancer between 2018 and 2021 were identified within Medicare Standard Analytic Files. Data on BHD defined as substance abuse, eating disorder, or sleep disorder were obtained. Postoperative textbook outcomes (ie no complications, prolonged length of stay, 90-day readmission, or 90-day mortality), as well as in-hospital expenditures and overall survival were assessed. RESULTS: Among 694,836 cancer patients, 46,719 (6.7%) patients had at least 1 BHD. Patients with BHD were less likely to undergo resection (no BHD: 23.4% vs BHD: 20.3%; p < 0.001). Among surgical patients, individuals with BHD had higher odds of a complication (odds ratio [OR] 1.32 [1.26 to 1.39]), prolonged length of stay (OR 1.36 [1.29 to 1.43]), and 90-day readmission (OR 1.57 [1.50 to 1.65]) independent of social vulnerability or hospital-volume status resulting in lower odds to achieve a TO (OR 0.66 [0.63 to 0.69]). Surgical patients with BHD also had higher in-hospital expenditures (no BHD: $16,159 vs BHD: $17,432; p < 0.001). Of note, patients with BHD had worse long-term postoperative survival (median, no BHD: 46.6 [45.9 to 46.7] vs BHD: 37.1 [35.6 to 38.7] months) even after controlling for other clinical factors (hazard ratio 1.26 [1.22 to 1.31], p < 0.001). CONCLUSIONS: BHD was associated with lower likelihood to achieve a postoperative textbook outcome, higher expenditures, as well as worse prognosis. Initiatives to target BHD are needed to improve outcomes of cancer patients undergoing surgery.

Barriers and facilitators to giving prehabilitation advice by clinical nurse specialists and advanced nurse practitioners in oncology patients.

PURPOSE: This is the second article in this series on the knowledge, attitudes and beliefs of clinical nurse specialists (CNSs) and ANPs (advanced nurse practitioners) regarding prehabilitation advice in oncology patients, exploring the barriers and facilitators to giving prehabilitation advice by CNSs and ANPs in oncology patients. METHODS: A Cross-sectional online questionnaire opens for 3 months to establish the knowledge, attitudes and beliefs of ANPs and CNSs to prehabilitation disseminated through professional organisations and social media. RESULTS: The questionnaire gained (n = 415) responses. Prehabilitation advice was routinely given by 89% (n = 371) of respondents. Many (60%) identified a lack of guidance and referral processes as a barrier to giving prehabilitation advice; this corresponded between respondents' confidence to give prehabilitation advice and subsequent referrals (< 0.001). Other factors included time (61%), a lack of patient interest (44%) and limited relevance to patients (35%). CONCLUSION: The implementation of standardised nurse prehabilitation advice resources would enable CNSs and ANPs to provide personalised prehabilitation advice in their consultations.

Comparison of complications and functional outcomes following total or subtotal glossectomy with laryngeal preservation using a deep inferior epigastric artery perforator free flap versus a rectus abdominis musculocutaneous free flap.

OBJECTIVE: Wide defects resulting from subtotal or total glossectomy are commonly reconstructed using a bulk flap to maintain oral and speech functions. The flap, including muscle tissue, diminishes with time. This study aimed to compare the surgical outcomes of deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions after glossectomy with laryngeal preservation. METHODS: Medical records of 13 and 26 patients who underwent deep inferior epigastric artery perforator and rectus abdominis musculocutaneous free flap reconstructions, respectively, from 2014 to 2022 at our institution were reviewed. Patients who underwent middle pharynx resection except for the base of the tongue, mandibular bone resection, and sensory reinnervation were excluded. RESULTS: The rectus abdominis musculocutaneous groups showed a higher number of lymph node dissection and shorter operative time than the deep inferior epigastric artery perforator groups. No significant differences in postoperative complications or functional oral intake scale scores at 6 months were observed. Volumetric changes on computed tomography images at 6 and 12 months were significantly lower in the deep inferior epigastric artery perforator group. Cancer recurrence was significantly associated with reduced oral function. CONCLUSIONS: Oral function in patients with cancer is influenced by various other factors. However, the deep inferior epigastric artery perforator flap may be suitable for tongue reconstruction because of the minimal postoperative changes in flap volume, easy adjustment of flap thickness, elevation of multiple flaps, and minimal complications at the donor site.

Resección no planificada en sarcomas de partes blandas del aparato locomotor / Unplanned excision of soft tissue sarcomas of the musculoskeletal system

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

[Translated article] Unplanned excision of soft tissue sarcomas of the musculoskeletal system / Resección no planificada en sarcomas de partes blandas del aparato locomotor

Introducción: El proceso diagnóstico de los sarcomas de partes blandas del aparato locomotor (SPBAL) sigue siendo comprometido, con casos de resecciones no planificadas (cirugías «whoops»). Este estudio evalúa la frecuencia de este tipo de procedimientos, tratando de identificar características de los pacientes, tumores, tratamiento quirúrgico y resultados. Material y métodos: Se revisan de forma retrospectiva 131 pacientes tratados de forma quirúrgica en nuestro centro entre octubre de 2018 y diciembre de 2021 de un SPBAL. Se excluyen los pacientes con SPBAL localizados en vísceras, mediastino, corazón, retroperitoneo, peritoneo y aparato genital. Las diferencias entre pacientes con resecciones planificadas y no planificadas fueron evaluadas con pruebas χ2 y un modelo de regresión multivariado de Cox. Resultados: Las resecciones no planificadas de SPBAL han tenido lugar en 18% de los pacientes de nuestra área, principalmente en tumores menos de 5 cm y localizados superficiales a la fascia; 29,2% de estos pacientes no disponían de una prueba de imagen previa. No se ha demostrado que una cirugía «whoops» pueda suponer una disminución de la supervivencia o una mayor tasa de recidivas. Conclusiones: Recomendamos la realización de una prueba de imagen siempre previa a la extirpación de cualquier tipo de tumoración de tejidos blandos, así como la adherencia a las guías de remisión a centros de referencia.(AU)

Introduction: The diagnosis process of soft tissue sarcomas of the musculoskeletal system (SPBAL) continues to be complex, with cases of unplanned excisions (“whoops” surgeries). This study evaluates the frequency of these type of procedures, trying to indentify patient characteristics, tumors, surgical treatment and final results. Material and methods: 131 patients treated surgically between October 2018 and December 2021 of a SPBAL were retrospectively reviewed. Patients with SPBAL located in the viscera, mediastinum, heart, retroperitoneum, peritoneum and genital tract were excluded. Differences between patients with planned and unplanned excisions were assessed with chi2 tests and a Cox multivariate regression model. Results: Unplanned excisions of SPBAL have taken place in 18% of the patients in our área, mainly in tumors of less than 5 cm and located superficial to the fascia. 29,2% of these patients did not have a previous imaging test. It has not been shown that a “whoops” surgery can lead to a decrease in survival or a higher rate of recurrences. Conclusions: We recommend carrying out an imaging test always prior to the removal of any type of soft tissue tumor, as well as adherence to the referral guidelines to reference centers.(AU)

Non-metastatic hip fractures surgery in patients with active cancer: benefit and risk.

PURPOSE: Although rare, non-metastatic proximal femoral fracture (PFF) can develop in patients with active cancer. However, little data are available regarding the risks and benefits of surgical treatment in such patients. The purpose of his study was to investigate the risks and benefits of surgical treatment of PFF in patients with and without cancer. METHODS: We retrospectively examined the medical records of all patients treated for PFF, excluding those with pathological fracture, at our hospital from July 2013 to December 2020. The patients were divided into two groups; The active cancer group and the standard group. We investigated in both groups about surgical and medical complications during the perioperative period, walking ability two weeks postoperatively, and one-year postoperative mortality rate. RESULT: After the inclusion and exclusion criteria, 39 patients in the active cancer group and 331 patients in the standard group were finally investigated. There were no statistically significant differences between the two groups. The complication rate did not appear statistical significance between two groups (16.7% in active cancer group vs 10.7% in standard group: p = 0.272). Walking ability was also similar in two groups. Mortality rate at one year was significantly higher in the active cancer group. (41.2% in active cancer group vs 6.0% in standard group: p < 0.05). CONCLUSION: Although the active cancer group had a higher mortality rate at one year, which was influenced by the prognosis of the cancer, the benefits of surgical intervention, such as regaining walking ability, were the same in patients with and without active cancer.