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1.
Am Surg ; 85(9): 1056-1060, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638524

RESUMO

Skin substitutes have shown success in complex wound reconstruction. We evaluate the use of a human acellular dermal matrix (ADM) as a viable alternative to autologous skin grafting for defects secondary to skin cancer excision. An institutional review board-approved, retrospective review of ADM-reconstructed defects secondary to skin cancer excision between 2012 and 2018 was conducted. ADM was indicated in patients with preclusive factors for general anesthesia, protracted procedure time, reluctance for additional donor site wound, and personal choice. We reviewed defect characteristics, healing time, postoperative outcomes, and patient demographics. The 228 participants (151 males, 77 females) had a median age of 72 years (range, 29-95 years), with melanoma diagnosed in 113 (49.6%), squamous cell carcinoma in 61 (26.8%), and basal cell carcinoma in 28 (12.2%) patients. The median interval to complete epidermal coverage was 42 days, with graft failure evident in six patients (2.6%). ADM is a viable, low-morbid alternative for reconstruction of defects secondary to skin cancer excision, with no donor site morbidity. With exception to complete healing time, outcomes are similar to those of autologous grafting.


Assuntos
Derme Acelular , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Sobrevivência de Enxerto , Custos de Cuidados de Saúde , Humanos , Masculino , Melanoma/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Cicatrização
2.
Zhonghua Fu Chan Ke Za Zhi ; 54(10): 666-672, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31648442

RESUMO

Objective: To analyze the 13 years trend in proportion, risks factors and clinicopathological characteristics of young women with stage Ⅰa2 to Ⅱa2 cervical cancer by using multi-center data of cervical cancer in China. Methods: The clinicopathological data of 46 313 patients with cervical cancer treated from 37 hospitals in China were obtained from January 2004 to December 2016. Using clinical and pathologic data, each patient's stage was reclassified by the 2018 International Federation of Gynecology and Obstetrics (FIGO) staging system. A total of 19 041 patients were selected according to the following criteria: FIGO stage Ⅰa2 to Ⅱa2, underwent type B or C radical hysterectomy and pelvic lymphadenectomy. All the patients were divided into two groups: the study group of 1 888 patients aged 35 years or younger and the control group of 17 153 patients aged over 35 years. The 13 years trend in proportion of young women with stage Ⅰa2 to Ⅱa2 cervical cancer, risks factors and clinicopathological characteristics of two groups were retrospectively analyzed. Results: (1) The total number of hospitalized patients with stage Ⅰa2 to Ⅱa2 cervical cancer increased annually. However, a downward trend of patients aged 35 years or younger was observed (P<0.01) . The constituent ratio of patients aged 35 years or younger was significantly greater during 2004-2010 than that during 2011-2016 [12.6% (820/6 484) and 8.5% (1 068/12 557) , respectively; χ(2)=82.101, P<0.01]. (2) Compared with patients aged over 35 years, patients aged 35 years or younger had an earlier age at menarche, a later age at marriage, lesser gravida and parity (all P<0.01). The positive rate of high-risk HPV infection was not statistically different between two groups (all P>0.05). (3) The proportions of stage Ⅰ, exophytic type and non-squamous histological type in patients aged 35 years or younger were clearly higher than those in patients aged over 35 years (83.4% vs 68.5%, P<0.01; 63.2% vs 56.2%, P<0.01; 13.9% vs 12.0%, P<0.05, respectively). Whereas the poor differentiation ratios of the two groups had no statistical significance (P>0.05). (4) As for the postoperative pathological risk factors, the rate of surgical margin involvement in patients aged 35 years or younger was lower than that aged over 35 years (1.1% vs 1.8%, P<0.05), and the rate of depth of stromal invasion >1/2 in patients aged 35 years or younger was lower than that in patients aged over 35 years (40.1% vs 50.9%, P<0.01). In addition, there were no significant difference in parametrial margin involvement, tumor size and lymph vascular space invasion between two groups (all P>0.05). Conclusions: The trend in proportion among hospitalized patients for stage Ⅰa2 to Ⅱa2 cervical cancer in young women is decreasing yearly. Compared with cervical cancer in middle-aged and elderly women, cervical cancer in young women have an earlier age at menarche, a higher proportion of stage Ⅰ patients and non-squamous histological type. In terms of the postoperative pathological risk factors, the rate of surgical margin involvement and depth of stromal invasion >1/2 in young women with cervical cancer are lower than in middle-aged and elderly women.


Assuntos
Hospitalização/estatística & dados numéricos , Histerectomia , Excisão de Linfonodo , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , China/epidemiologia , Feminino , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/epidemiologia
3.
Acta Gastroenterol Belg ; 82(3): 355-358, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566321

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of endoscopic submucosal multi-tunnel dissection (ESMTD) for early esophageal cancer lesions larger than 3 cm in diameter or cumulatively greater than 1/2 lumen size. METHOD: Early esophageal cancer lesions in 15 patients were detected by endoscopy and endoscopic ultrasonography in our endoscopy center from December 2012 to June 2015. All lesions were successfully resected by ESMTD and diagnosed by pathology, and therapeutic efficiency and safety were followed after surgery. RESULTS: All 15 of the early esophageal cancer lesions were resected by ESMTD. The pathological results showed 9 moderately differentiated and 6 highly differentiated squamous cell carcinomas. En bloc resection was achieved in 13 lesions, with negative lateral and basal margins on pathology, whereas the other 2 required additional surgery. The average diameter of the resected lesions was 4.2±0.9 cm. The mean procedure time was 94.7±52.9 min. Esophageal stenosis was observed in 7 patients for whom esophageal water balloon dilatation was performed. No residual or recurrent lesion was found during the 6-36-month follow-up period. CONCLUSION: ESMTD is a safe and efficient technique for treating large early esophageal cancer lesions. Grasping the key techniques of this procedure can reduce operating difficulty and shorten the operating time.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Endossonografia/métodos , Neoplasias Esofágicas/cirurgia , Estenose Esofágica , Esofagoscopia , Humanos
4.
Medicine (Baltimore) ; 98(43): e17688, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651897

RESUMO

RATIONALE: Oral adenosquamous carcinoma (ASC) is rare and its origins are controversial. We here present a patient with oral ASC that developed after surgery for oral squamous cell carcinoma (SCC). PATIENT CONCERNS: A 70-year-old man with SCC on the oral floor underwent surgical resection. However, the enlarged ulcer presented on the oral floor 9 month after surgery. DIAGNOSES: The biopsy of the ulcer revealed a SCC. Imaging examinations detected enhancement of a large lesion expanded to the tongue, but no evidence of regional lymph node or distant metastasis was shown. Based on these results, local recurrence of the cancer was diagnosed (cT4aN0M0). INTERVENTIONS: The surgery for the recurrent tumor was performed. OUTCOMES: The pathological examination of the surgical specimen indicated recurrent tumor was ASC. Thus, histopathological and immunohistochemical analyses of both the initial SCC and the subsequent ASC were performed in an attempt to explore the origin of the ASC. As the results, pathological review of both tumors suggested the subsequent ASC was developed from the tumor cells with adenoid phenotype in the initial SCC. LESSONS: This report suggests that the oral ASC was origin from the oral SCC, which can contribute to new knowledge for pathogenesis of oral cancer.


Assuntos
Carcinoma Adenoescamoso/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/patologia , Idoso , Carcinoma Adenoescamoso/cirurgia , Carcinoma de Células Escamosas/cirurgia , Evolução Fatal , Humanos , Masculino , Neoplasias Bucais/cirurgia , Recidiva Local de Neoplasia/cirurgia
5.
Medicine (Baltimore) ; 98(36): e17049, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490399

RESUMO

RATIONALE: Although chronic pyelonephritis and urolithiasis are established risk factors for squamous cell carcinoma (SCC), only a minority of patients with chronic urolithiasis eventually develop SCC. It is believed that the chronic irritation leads to squamous cell metaplasia that may subsequently develop into SCC. Although studies show that SSC generally spreads locally with associated symptoms of lymphadenopathy, metastasis to the lungs and liver have also been reported. However, cases spreading to the flank have yet to be reported. Therefore, the use of reconstructive techniques for the repair of extensive soft tissue defects in the flank region after extended retroperitoneal resection, is unknown. PATIENT CONCERNS: We report a 54-year-old man who presented with a 1-month history of an enlarged skin mass on the right flank. DIAGNOSES: The patient was subsequently diagnosed with metastatic SCC involving the patient's integumentary system near the flank region proximal to the right kidney following percutaneous nephrostomy. INTERVENTIONS: The skin mass and the surrounding muscle tissue of the right flank were excised with a wide resection margin including radial nephrectomy. The soft tissue defect after resection was reconstructed using a unilateral gluteus maximus myocutaneous V-Y advancement flap. OUTCOMES: No recurrence of the SSC was found on follow-up CT performed 12 months postoperatively. LESSONS: In patients with long-standing nephrolithiasis complicated by staghorn stone-related infections, biopsies from suspicious lesions detected during percutaneous nephrolithotomy may facilitate early diagnosis. The modified gluteus maximus V-Y advancement flap may be a useful technique for the reconstruction of extensive soft-tissue defects involving the flank region.


Assuntos
Carcinoma de Células Escamosas/secundário , Neoplasias Renais/patologia , Rim/patologia , Neoplasias Cutâneas/secundário , Cálculos Coraliformes/complicações , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Renais/cirurgia , Masculino , Pessoa de Meia-Idade , Nefrectomia , Neoplasias Cutâneas/cirurgia , Cálculos Coraliformes/diagnóstico por imagem , Retalhos Cirúrgicos
7.
Kyobu Geka ; 72(9): 669-672, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31506407

RESUMO

We report a case of lung cancer with chest wall invasion resected with the posterior paramedian incision. A man in his 60s exhibited hemosputum and cough. Chest X-ray revealed a large mass below the right hilum. A 6.3 cm soft tissue mass with central cavity invading to the lower posterior chest wall was found on chest computed tomography( CT). The tumor was diagnosed as squamous cell carcinoma by transcutaneous lung biopsy( TCLB). Thoracoscopic hilar dissection of the right lower lobe with dissection of the mediastinal lymph nodes were preceded to the en-bloc resection of the invaded chest wall with less invasive manner by the posterior paramedian incision.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Pulmonares , Parede Torácica , Carcinoma de Células Escamosas/cirurgia , Humanos , Neoplasias Pulmonares/cirurgia , Masculino , Invasividade Neoplásica , Tomografia Computadorizada por Raios X
8.
Gan To Kagaku Ryoho ; 46(8): 1295-1297, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501373

RESUMO

Herein, we report a case of lymph node recurrence 7 years after curative esophagectomy for T1a(LPM)upper thoracic esophageal cancer. A 70's man underwent radical esophagectomy by using video-assisted thoracic surgery and hand-assisted laparoscopic surgery(VATS and HALS)with gastric tube reconstruction via a posterior mediastinal route for upper thoracic esophageal cancer cT1bN0M0, cStageⅠ in August 2010. The pathological diagnosis was pT1a(LPM), w/d, scc, ly0, v0, ie (+), inf b, pIM0, pPM0, pDM0, pRM0, pN0, pM0, pStage 0. Moreover, he was followed-up without treatment after surgery. In November 2017, 7 years after esophagectomy, follow-up CT revealed left supraclavicular lymph node swelling. FDG-PET revealed high uptake of FDG, and lymph node recurrence was suspected. In January 2018, we performed lymph node biopsy. We could not remove the lymph node completely, because the lt common carotid artery and lt jugular vein were associated with the metastatic lymph node. The pathological diagnosis was squamous cell carcinoma. Chemoradiation therapy was performed after surgery, and patient recovery was uneventful.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Esofágicas , Idoso , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Excisão de Linfonodo , Linfonodos , Masculino , Recidiva Local de Neoplasia
9.
Zhonghua Yi Xue Za Zhi ; 99(32): 2516-2520, 2019 Aug 27.
Artigo em Chinês | MEDLINE | ID: mdl-31484279

RESUMO

Objective: To evaluate the clinical effects of functional neck dissection (FND) and supraomohyoid neck dissection (SOND) in patients with cN0/N1 oral squamous cell carcinoma (OSCC). Methods: A total of 210 patients with stage cN0/N1 OSCC underwent FND and SOND between January 2012 and May 2015 were retrospectively reviewed, among which, 147 patients were male and 63 were female, with an age range of 23-82 years and mean age of (62.2±10.2) years. There were 112 and 98 patients in FND and SOND groups, respectively. The follow-up data included cervical lymph node metastasis, movement of shoulder joint, great auricular nerve function, recurrence rate of cervical lymph nodes. Results: There was no significant difference in gender, age, tumor location, T stage, N stage, histological grades between the two groups (all P>0.05). Compared to patients in FND group, the activities of shoulder joint and earlobe numbness improved significantly in SOND group. Of the 210 patients, 17 patients (8.1%) had cervical recurrence, with 9 patients (8.0%) in FND group and 8 patients (8.2%) in SOND group. No significant difference was observed for neck recurrence between the two groups (P=0.973). Conclusion: SOND can be safely performed in cN0 or cN1 OSCC patients, which avoids major complications of FND, and improves postoperative quality of life in those patients.


Assuntos
Carcinoma de Células Escamosas , Neoplasias Bucais , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Esvaziamento Cervical , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Qualidade de Vida , Estudos Retrospectivos , Adulto Jovem
10.
Magy Seb ; 72(3): 98-102, 2019 Sep.
Artigo em Húngaro | MEDLINE | ID: mdl-31544482

RESUMO

Introduction: Authors present their 7-year experience since the introduction of minimal-invasive (VATS) lobectomies for lung cancer in regard to their surgical technique, results and oncological follow-up. Method: 173 VATS lobectomies were performed between June 2011 and December 2017, 105 men and 68 women. The mean age of patients was 64.1 years. Duration of surgery was 130 minutes on average. Results: Conversion to thoracotomy was required in 8 cases (3 bleedings, 3 pulmonary vessel lymph node infiltrations, 2 bronchial suture insufficiencies). Twenty persistent air leaks developed postoperatively, requiring 10 re-drainages and 10 re-operations: 7 re-VATS and 3 thoracotomies. Two hematomas were evacuated by re-VATS, 1 postoperative atrial fibrillation required cardioversion. There were no perioperative deaths. The 164 malignant cases were: 110 adenocarcinomas, 32 squamous cell carcinomas, 6 small cell neuroendocrine carcinomas, 4 undifferentiated carcinomas, 4 carcinoid tumours, 1 synchronous adenocarcinoma and squamous cell carcinoma, 1 synchronous adenocarcinoma and small cell carcinoma, 1 carcinosarcoma and 5 metastasis from other primary tumours. 118 patients received adjuvant chemotherapy. Tumour staging distribution was: IA 40, IB 53, IIA 29, IIB 16 and IIIA 21 cases. During an average follow-up time of 19.5 months, 9 local tumour recurrence and 27 distant metastasis evaluated, of which 11 were pulmonary (3 multiplex), 10 bone, 6 cerebral, 3 hepatic (1 multiplex), and 3 suprarenal gland. Conclusion: Our results correlate with published literature. During the period of this review, VATS lobectomies became a routine surgical technique in our department. Our experience proved that axillary thoracotomy is an advantage to learn the anterior VATS lobectomy technique.


Assuntos
Tumor Carcinoide/cirurgia , Carcinoma de Células Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Pulmonares/cirurgia , Pulmão/cirurgia , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/estatística & dados numéricos , Toracotomia/métodos , Adenocarcinoma de Pulmão/patologia , Adenocarcinoma de Pulmão/cirurgia , Analgesia Controlada pelo Paciente , Tumor Carcinoide/patologia , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Escamosas/patologia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/patologia , Masculino , Recidiva Local de Neoplasia , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Cirurgia Torácica Vídeoassistida/métodos , Resultado do Tratamento
11.
J Surg Oncol ; 120(4): 707-714, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31364178

RESUMO

BACKGROUND: The subclavicular pedicled flap is based on the thoracic branch of the supraclavicular artery, and it represents a versatile reconstructive option for low-middle third face defects. Since its use in head and neck surgical oncology has not been popularized yet, we propose its application for oral cavity reconstruction after cancer resection by showing favorable results. METHODS: Eighteen subclavicular pedicled flaps were used to treat intraoral defects after oral squamous-cell cancer resection between June 2015 and December 2018. Tumor dissection type, complications, donor and reconstructed area results, and functional and aesthetic outcomes were assessed. RESULTS: No major complications were observed and all of the flaps survived. Adjuvant therapy was administered without delay when needed, and all of the patients had normal functional outcomes and good aesthetic results. CONCLUSIONS: The subclavicular flap is an excellent choice for the reconstruction of oral cavity defects. Selection of patients should exclude positive lower-third neck node and include appropriate informed consent for women due to the possibility of deformity of the breast. In our opinion, this flap has the potential for common application given its consistent anatomy and donor site advantages, including long pedicle, high pivot point, and relatively unlimited flap width.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Bucais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Parede Torácica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Prognóstico , Taxa de Sobrevida , Parede Torácica/patologia
12.
J Cancer Res Clin Oncol ; 145(11): 2771-2777, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31428933

RESUMO

PURPOSE: N2 lymph-node metastases occur in approximately 6-17% of the patients with T1-2 non-small cell lung cancer (NSCLC). However, the clinical characteristics of N2 patients are not fully understood. METHODS: This retrospective, multi-center analysis included T1 NSCLC patients receiving surgical resection during a period from Jan 2nd, 2014 to Dec 27th, 2017. The diagnosis was pathologically verified in all cases. Univariate and multivariate logistic regression analyses were conducted to analyze the factors that are associated with pN2 lymph-node metastases. RESULTS: A total of 10,885 patients (48.4% men; 84.7% adenocarcinoma) were included in the analysis. The mean age was 59.0 ± 9.9 years. The mean tumor size was 1.8 ± 0.8 cm. Of the patients, 3260 (29.9%) were smokers or ex-smokers. Lymph-node metastases were verified in 1808 (16.6%) patients, and 1167 (10.7%) patients had N2 lymph-node metastases. The multivariate analyses indicated that larger tumor size, lower differentiation, CEA level ≥ 5 ng/mL, vascular invasion (+), and pleural involvement (+) were associated with higher percentages of N2 lymph-node metastases (p < 0.001 for all). CONCLUSIONS: This study demonstrated the significant association between N2 lymph-node metastases and tumor size and differentiation, CEA levels, and status of vascular invasion and pleural involvement.


Assuntos
Adenocarcinoma/secundário , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma de Células Escamosas/secundário , Neoplasias Pulmonares/patologia , Linfonodos/patologia , Medição de Risco/métodos , Adenocarcinoma/cirurgia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Carcinoma de Células Escamosas/cirurgia , China , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Fatores de Risco
14.
Medicine (Baltimore) ; 98(33): e16728, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415367

RESUMO

The hemi or subtotal/total glossectomy is usually approached by lip-jaw splitting procedure for advanced tongue cancer ablation. This highly invasive procedure can cause facial disfiguration, bone malunion, and osteoradionecrosis. The aim of this study is to compare the surgical outcome in free flap tongue reconstruction between novel parachute technique in an intact jaw and the conventional lip-jaw splitting procedure after tongue cancer ablation.In this study, parachute technique was adopted for free flap inset in patients without mandibulotomy. We retrospectively reviewed patients who have received primary advanced tongue cancer resection and free flap reconstruction during April, 2008 to January, 2015. Patients were divided into 2 groups. Group A was undergoing parachute technique without lip-jaw splitting. We sutured all the strings through the edges of defect in the first step and through the matching points of flap margin in the second step from outside the oral cavity. Then, the strings were pulled and the flap was parachuted down on the defects after all the matching points were tied together. In group B, the patients received conventional lip-jaw splitting procedure. Student t test was used for results analysis.There were 15 patients (n = 15) in group A and 15 patients (n = 15) in group B. In the patients receiving parachute technique, operation time showed 34 minutes (P = .49) shorter, hospital stay showed 4 days (P = .32) shorter, and the infection rate of surgical site showed 6.6% (P = .64) less than with conventional technique. The survival rates of the flaps were both 100% without revision.The parachute technique is an effective and more accessible method for free flap setting in cases of tongue reconstruction without lip-jaw splitting, and provides patients with better aesthetic appearance.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/normas , Neoplasias da Língua/cirurgia , Feminino , Humanos , Masculino , Osteotomia Mandibular , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
15.
An Bras Dermatol ; 94(3): 304-312, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31365659

RESUMO

BACKGROUND: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). OBJECTIVES: To evaluate QoL in patients with primary cutaneous SCC. METHODS: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. RESULTS: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). Study limitations: There is no gold standard instrument for assessing QoL in dermatological patients. CONCLUSION: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.


Assuntos
Carcinoma de Células Escamosas/psicologia , Carcinoma de Células Escamosas/cirurgia , Qualidade de Vida , Neoplasias Cutâneas/psicologia , Neoplasias Cutâneas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Carcinoma de Células Escamosas/diagnóstico , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Neoplasias Cutâneas/diagnóstico , Inquéritos e Questionários
16.
Medicine (Baltimore) ; 98(34): e16923, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441877

RESUMO

RATIONALE: There are already several reports concerning the occurrence of urethral diverticulum (UD) in female patients, but only rarely has a article describing UD combined with UD calculi or squamous carcinoma been published. Moreover, a case with squamous carcinoma and UD calculi at the same time has never been reported, making this the first case report about this condition. PATIENT CONCERNS: A 43-year-old woman presented to the gynaecology department with a complaint of a hard mass beneath the anterior vaginal wall. DIAGNOSES: Transvaginal ultrasound (TVU) revealed a UD. INTERVENTIONS: We performed a standard urethral diverticular excision. Intraoperatively, we identified and removed a stone from the diverticulum. The intraoperative finding of a stone challenged the diagnosis of UD, with subsequent histological examination of biopsy tissue from the mass demonstrating broadly squamous metaplasia. OUTCOMES: The broadly squamous metaplasia predominantly originated from the stone, and the stone was entirely removed. No complications occurred during the whole follow-up period. Moreover, after the 12-month follow-up, there was no diverticular recurrence or carcinoma metastasis. LESSONS: UD calculi may be considered a risk factor for female urethra squamous metaplasia, which with the potential of squamous carcinoma, so patients will be advised to treat this condition immediately.


Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Uretrais/diagnóstico , Adulto , Biópsia , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/cirurgia , Divertículo/complicações , Divertículo/diagnóstico por imagem , Divertículo/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Metaplasia , Neoplasias Uretrais/complicações , Neoplasias Uretrais/patologia , Neoplasias Uretrais/cirurgia , Cálculos Urinários/complicações , Cálculos Urinários/diagnóstico por imagem , Cálculos Urinários/cirurgia
17.
Gynecol Oncol ; 155(1): 83-87, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31451293

RESUMO

BACKGROUND: Lymph node metastasis is the most important prognostic factor in patients with vulvar squamous cell carcinoma (SCC). Previous excision of the vulvar tumor may disrupt lymphatic channels and alter the accuracy of the sentinel lymph node (SLN) biopsy. The purpose of this study was to measure outcomes after SLN biopsy in patients with and without previous excision of the vulvar tumor. METHODS: Retrospective study of patients at a single institution with primary vulvar cancer, clinically negative nodes, and vulvar tumors < 4 cm treated with surgical excision who had SLN biopsy (2008-2015). RESULTS: There were 106 cases of concomitant wide local excision (WLE) and SLN biopsy and 24 additional cases of patients who had previous vulvar surgery and no visible tumor; these patients underwent scar re-excision and SLN biopsy. Median follow-up was 31 months. Patients who had previous tumor excision were more likely to be of younger age (p = 0.0001), have a smaller tumor (p = 0.002), and less depth of invasion (p = 0.02). In the wide local excision of the scar specimen, 11 patients (46%) had no residual disease left, 8 patients (33%) had only vulvar intraepithelial neoplasia (VINIII), 4 patients (17%) had carcinoma in situ with focal invasion and 1 patient (4%) had invasive carcinoma within the second specimen, resected with clear margins. There were no groin recurrences in patients who underwent scar re-excision and who had a negative SLN biopsy. CONCLUSION: SLN biopsy is feasible and safe in patients who have had previous excision of the vulvar tumor and present with a scar. When a SLN is detected by injecting the remaining scar, this accurately reflects the nodal status and does not negatively impact oncologic outcomes.


Assuntos
Carcinoma de Células Escamosas/patologia , Linfonodo Sentinela/patologia , Neoplasias Vulvares/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/cirurgia , Cicatriz/patologia , Estudos de Coortes , Coloides , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Prognóstico , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Linfonodo Sentinela/diagnóstico por imagem , Biópsia de Linfonodo Sentinela/métodos , Neoplasias Vulvares/diagnóstico por imagem , Neoplasias Vulvares/cirurgia
19.
J Surg Oncol ; 120(4): 698-706, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31273803

RESUMO

BACKGROUND: This study aimed to create a nomogram for postoperative prediction of the risk of recurrence in laryngeal squamous cell carcinoma patients who received laryngectomy alone and to assess indications for postoperative adjuvant treatments (POAT). METHODS: A retrospective analysis of 1571 newly diagnosed laryngeal carcinoma patients was conducted. Those patients were divided into two groups-the development cohort (n = 1102) and the validation cohort (n = 469). Patients were classified into three subgroups according to their individual points calculated from the nomogram. The efficiency of POAT was examined among various subgroups. RESULTS: Five variables, including pT classification, pN classification, surgical margin, tumor differentiation, and primary location, were included in the nomogram. The C-index was 0.753 in development cohort and 0.744 in validation cohort. Patients were classified into three subgroups with incremental risks of recurrence. In the high-risk group, patients receiving POAT showed significantly better recurrence-free survival (RFS) than did those receiving surgery alone, while POAT was not significantly associated with RFS in either the low- or moderate-risk groups. CONCLUSIONS: The risk of tumor recurrence in patients with laryngeal carcinoma was quantified by our newly constructed nomogram. Patients categorized as high-risk were found to benefit from POAT in RFS.


Assuntos
Carcinoma de Células Escamosas/secundário , Tomada de Decisões , Neoplasias Laríngeas/patologia , Recidiva Local de Neoplasia/patologia , Nomogramas , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/terapia , Quimiorradioterapia Adjuvante , Terapia Combinada , Feminino , Seguimentos , Humanos , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/terapia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Recidiva Local de Neoplasia/terapia , Período Pós-Operatório , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
20.
J Surg Oncol ; 120(4): 661-669, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31292967

RESUMO

BACKGROUND: Anastomotic leak is the most common major complication after esophagectomy. We investigated the 2016 American College of Surgeons National Surgical Quality Improvement Program esophagectomy targeted database to identify risk factors for anastomotic leak. METHODS: Patients who underwent esophagectomy for cancer were included. Patients experiencing an anstomotic leak were identified, and univariate and multivariable logistic regression was performed to identify variables independently associated with anastomotic leak. RESULTS: Of 915 patients included, 83% were male and the median age was 64 years. Patients with anastomotic leak more frequently had additional complications (87% vs 36%, P < .001). Rates of reoperation (64% vs 11%, P < .001) and mortality (8% vs 2%, P = .001) were higher in patients with anastomotic leak. After adjusting for patient and procedure characteristics, prolonged operative time (for each additional 30-minutes; adjusted odds ratios (AOR) 1.068, 95% CI, 1.022-1.115, P = .003), increased preoperative WBC count (for each 3000/µL increase; AOR 1.323, 95% CI, 1.048-1.670, P = .019), pre-existing diabetes (AOR 1.601, 95% CI, 1.012-2.534, P = .045), and perioperative transfusion (AOR 1.777, 95% CI, 1.064-2.965, P = .028) were independently associated with anastomotic leak. CONCLUSION: Both patient and procedure-related factors are associated with anastomotic leak. Though frequently non-modifiable, these findings could facilitate risk stratification and early detection of anastomotic leak to reduce associated morbidity.


Assuntos
Adenocarcinoma/cirurgia , Fístula Anastomótica/etiologia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Medição de Risco/métodos , Adenocarcinoma/patologia , Idoso , Fístula Anastomótica/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias Esofágicas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
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