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1.
BMC Surg ; 21(1): 155, 2021 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-33745452

RESUMO

INTRODUCTION: Disturbance in the lymphatic drainage during D2 dissection is associated with significant morbidity. We aimed to assess the effect of fibrin glue on the reduction of postoperative lymphatic leakage. METHODS: Prospective double-blinded randomized clinical trial with forty patients in each study arm was conducted. All patients diagnosed, staged, and became a candidate for D2 dissection based on NCCN 2019 guideline for gastric cancer. The intervention group received 1 cc of IFABOND® applied to the surgical bed. RESULTS: The difference between study groups regarding age, gender, tumor stage was insignificant. (All p-values > 0.05). The median daily drainage volume was 120 ml with the first and the third interquartile being 75 and 210 ml, respectively for the intervention group. The control group had median, the first, and the third interquartile of 350, 290, and 420 ml. The difference between daily drainage volumes was statistically significant (p-value < 0.001). The length of hospital stay was significantly different between the two groups. Notably, the intervention group was discharged sooner (median of 7 Vs 9 days, p-value: 0.001). CONCLUSION: This study showed the possible role of fibrin glue in reducing postoperative lymphatic leakage after gastrectomy and D2 dissection. Registration trial number: IRCT20200710048071N1, 2020.08.16.


Assuntos
Adesivo Tecidual de Fibrina/uso terapêutico , Gastrectomia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Gástricas/cirurgia , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
3.
Rev. enferm. UERJ ; 28: e49435, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1146262

RESUMO

Objetivo: identificar e mapear estratégias preconizadas para prevenção de linfedema em pacientes submetidas a esvaziamento axilar em tratamento do câncer de mama. Método: revisão de escopo realizada em agosto de 2019 considerando oito bases de dados e oito bases da literatura cinzenta. A amostra final foi composta por 13 artigos, selecionados de acordo com critérios de elegibilidade. Resultados: os estudos foram predominantemente randomizados, com nível de evidência 1a, e realizados na América do Norte. Medidas preventivas tradicionalmente utilizadas, como limitar exercícios com carga ou evitar punção venosa e aferição de pressão arterial, não se demonstraram efetivas em nenhum dos estudos encontrados. Foi evidenciado como medida preventiva o controle dos fatores de risco modificáveis associados ao linfedema: IMC elevado (> 25 kg/m2 ) e quimioterapia administrada no braço ipsilateral. Conclusões: não foram apresentadas evidências significativas para medidas cotidianamente preconizadas na prevenção do linfedema, e fatores de risco modificáveis se destacaram entre os riscos para seu desenvolvimento.


Objective: to identify and map strategies recommended for prevention of lymphedema in patients after axillary dissection during breast cancer treatment. Method: this scoping review was conducted in August 2019 across eight databases and eight gray literature data sources. The final sample comprised 13 journal articles that met eligibility criteria. Results: the studies, most of which were randomized, conducted in North America, and offered Level 1a evidence. None of the studies reviewed found traditionally employed preventive measures, such as limiting weight training or avoiding venipuncture and blood pressure measurements, to be effective. Evidence indicated that controlling modifiable lymphedema-related risk factors ­ namely high BMI (> 25 kg/m²) and chemotherapy administration in the ipsilateral arm ­ was a preventive measure. Conclusion: no significant evidence was reported for traditionally recommended preventive measures against lymphedema, and modifiable factors figured prominently among risk factors for lymphedema.


Objetivo: identificar y mapear las estrategias recomendadas para la prevención del linfedema en pacientes después de una disección axilar durante el tratamiento del cáncer de mama. Método: esta revisión de alcance se realizó en agosto de 2019 en ocho bases de datos y ocho fuentes de datos de literatura gris. La muestra final comprendió 13 artículos de revistas que cumplieron con los criterios de elegibilidad. Resultados: los estudios, la mayoría de los cuales fueron aleatorios, se realizaron en Norteamérica y ofrecieron evidencia de Nivel 1a. Ninguno de los estudios revisados encontró que las medidas preventivas empleadas tradicionalmente, como limitar el entrenamiento con pesas o evitar la punción venosa y las mediciones de la presión arterial, sean efectivas. La evidencia indicó que el control de los factores de riesgo relacionados con el linfedema modificables, a saber, un IMC alto (> 25 kg / m²) y la administración de quimioterapia en el brazo ipsilateral, era una medida preventiva. Conclusión: no se informó evidencia significativa de las medidas preventivas recomendadas tradicionalmente contra el linfedema, y los factores modificables figuraron de manera prominente entre los factores de riesgo para el linfedema.


Assuntos
Humanos , Feminino , Axila , Neoplasias da Mama/terapia , Excisão de Linfonodo/efeitos adversos , Linfedema/prevenção & controle , Índice de Massa Corporal , Fatores de Risco , Controle , Pressão Arterial
5.
Khirurgiia (Mosk) ; (10): 23-28, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047582

RESUMO

OBJECTIVE: To study the immediate results of surgical treatment of advanced age patients with non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: We included 190 elderly and senile patients with NSCLC who underwent surgery at the thoracic department of the Tomsk Regional Clinical Hospital in 2010-2018. There were 149 men and 41 women. Cancer stage I was observed in 67 (35%) cases, stage II - 49 (26%) patients, stage III - 69 (37%) patients, stage IV - 5 (2%) patients. Squamous cell cancer was diagnosed in 94 patients, adenocarcinoma - 78 patients, large cell lung cancer - 18 patients. Paraneoplastic inflammatory complications occurred in 26% of patients, concomitant diseases - in 99% of patients. The research included anatomic lung resection with systematic mediastinal lymph node dissection and the absence of tumor at the resection line. There were 118 lobectomies and 47 pneumonectomies. In 74 cases, combined procedures were carried out. Lobectomy with pulmonary artery resection was performed in 18 patients, lobectomy with bronchial resection - in 10 cases. Twenty-five patients underwent video-assisted lobectomy. CONCLUSION: An acceptable morbidity and mortality allow you to expand the indications for radical surgery in geriatric patients with NSCLC. However, we must establish strict indications for pneumonectomy. Bronchial and angioplastic lobectomy may be an alternative to pneumonectomy in NSCLC patients.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Idoso , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Masculino , Pneumonectomia/efeitos adversos
6.
Anticancer Res ; 40(10): 5351-5354, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988853

RESUMO

BACKGROUND/AIM: The treatment of breast cancer has progressed considerably over the years, with a significant de-escalation from radical mastectomies to the current paradigm of breast conserving surgery (BCS) and neoadjuvant chemotherapy (NACT). We aimed to appraise the literature regarding the feasibility of de-escalation of treatment of axillary disease in the context of NACT. MATERIALS AND METHODS: We appraised studies and guidelines published regarding this topic and discussed them in this mini-review. RESULTS AND CONCLUSION: The SNB following NACT is oncologically safe in patients with clinically node negative disease and in patients with biopsy proven axillary node involvement at presentation provided that the dual technique is used and the clipped pathological node is harvested.


Assuntos
Axila/cirurgia , Neoplasias da Mama/cirurgia , Mastectomia Segmentar/efeitos adversos , Axila/patologia , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática , Mastectomia Radical/efeitos adversos , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela
7.
PLoS One ; 15(9): e0238284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32966294

RESUMO

PURPOSE: Restricted shoulder mobility is a major upper extremity dysfunction associated with lower quality of life and disability after breast cancer surgery. We hypothesized that a poloxamer and sodium alginate mixture (Guardix-SG®) applied after axillary lymph node dissection (ALND) would significantly improve shoulder range of motion (ROM) in patients with breast cancer. METHODS: We conducted a double-blind, randomized, prospective study to evaluate the clinical efficacy and safety of Guardix-SG® for the prevention of upper extremity dysfunction after ALND. The primary outcome measure was shoulder ROM at baseline (T0) and 3 (T1), 6 (T2), and 12 months (T3) after surgery. Secondary outcome measures were the Disabilities of the Arm, Shoulder, and Hand score(DASH), pain associated with movement, which was assessed using a numeric rating scale, and lymphedema assessed using body composition analyzer. RESULTS: A total of 83 women with breast cancer were randomly assigned to either the Guardix-SG® group or the control group. In the Guardix-SG® group (n = 37), Guardix-SG® was applied to the axillary region after ALND. In the control group (n = 46), ALND was performed without using Guardix-SG®. Comparing ROM for shoulder flexion before surgery (178.2°) and 12 months after surgery (172.3°), that was restored 12 months after surgery in the Guardix-SG® group, and there was no statistically significant difference between that at before surgery and 12 months after surgery (p = 0.182). No adverse effect was observed in either group. CONCLUSIONS: The results of this study have shown that Guardix-SG® help improve shoulder ROM without causing adverse effects in patients who underwent breast cancer surgery. However, there was no statistically significant difference from the control group. A further large-scale study is needed to obtain a more conclusive conclusion. TRIAL REGISTRATION: CRISKCT0003386; https://cris.nih.go.kr (20181207).


Assuntos
Neoplasias da Mama/cirurgia , Carboximetilcelulose Sódica/administração & dosagem , Ácido Hialurônico/administração & dosagem , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Poloxâmero/administração & dosagem , Amplitude de Movimento Articular/efeitos dos fármacos , Ombro/patologia , Axila , Neoplasias da Mama/patologia , Estudos de Casos e Controles , Método Duplo-Cego , Combinação de Medicamentos , Feminino , Seguimentos , Humanos , Metástase Linfática , Pessoa de Meia-Idade , Projetos Piloto , Prognóstico , Estudos Prospectivos , Tensoativos/administração & dosagem
8.
Plast Reconstr Surg ; 146(2): 402-407, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740596

RESUMO

BACKGROUND: Obesity is a risk factor for the development of secondary lymphedema after axillary lymphadenectomy and radiation therapy. The purpose of this study was to determine whether obesity influences the morbidity of lymphedema in patients who have the condition. METHODS: Two cohorts of patients were compared: group 1, normal weight (body mass index ≤25 kg/m); and group 2, obese (body mass index ≥30 kg/m). Inclusion criteria were patients aged 21 years or older with lymphedema confirmed by lymphoscintigraphy. Covariates included age, sex, lymphedema type (primary or secondary), location, comorbidities, lymph node dissection, radiation therapy, lymphoscintigram result, and disease duration. Outcome variables were infection, hospitalization, and degree of limb overgrowth. The cohorts were compared using the Mann-Whitney U test, Fisher's exact test, and multivariable logistic regression. RESULTS: Sixty-seven patients were included: group 1, n = 33; and group 2, n = 34. Disease duration did not differ between groups (p = 0.72). Group 2 was more likely to have an infection (59 percent), hospitalization (47 percent), and moderate or severe overgrowth (79 percent), compared to group 1 (18, 6, and 40 percent, respectively; p < 0.001). Multivariable logistic regression showed that obesity was an independent risk factor for infection (OR, 7.9; 95 percent CI, 2.5 to 26.3; p < 0.001), hospitalization (OR, 30.0; 95 percent CI, 3.6 to 150.8; p < 0.001), and moderate to severe limb overgrowth (OR, 6.7; 95 percent CI, 2.1 to 23.0; p = 0.003). CONCLUSIONS: Obesity negatively affects patients with established lymphedema. Obese individuals are more likely to have infections, hospitalizations, and larger extremities compared to subjects with a normal body mass index. Patients with lymphedema should be counseled about the negative effects of obesity on their condition. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Mastectomia/efeitos adversos , Obesidade/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Axila , Índice de Massa Corporal , Neoplasias da Mama/terapia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Linfedema/diagnóstico , Linfedema/etiologia , Linfedema/terapia , Linfocintigrafia , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Obesidade/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Radioterapia Adjuvante/efeitos adversos , Medição de Risco , Fatores de Risco , Adulto Jovem
9.
Anesth Analg ; 131(3): 928-934, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32701547

RESUMO

BACKGROUND: Pectoralis I and II (Pecs I/Pecs II) blocks are modern regional anesthetic techniques performed in combination to anesthetize the nerves involved in breast surgery and axillary node dissection. Pecs II spread and clinical efficacy is thought to be independent of whether injection occurs between pectoralis minor and serratus anterior or deep to serratus anterior. Injecting deep to serratus anterior onto the rib may be technically easier; however, our clinical experience suggests that this approach may be less effective for axillary dissection. We undertook a cadaveric study to evaluate a subserratus plane approach for use in breast and axillary surgery. METHODS: Ultrasound-guided blocks using methylene blue dye were performed on 4 Genelyn-embalmed cadavers to assess and compare dye spread after a conventional Pecs II and a subserratus plane block at the third rib. RESULTS: Conventional Pecs II injection demonstrated staining of the intercostobrachial nerve, third intercostal nerve, thoracodorsal nerve, long thoracic nerve, medial pectoral, and lateral pectoral nerve. The subserratus plane produced significantly less axillary spread, incomplete staining of the medial pectoral, and very minimal staining of the lateral pectoral nerve. Dye spread was limited to the lateral cutaneous branches of the intercostal nerves in both injections. CONCLUSIONS: In our cadaveric study, injecting deep to serratus plane produced significantly less axillary spread. For breast surgery excluding the axilla, both techniques may be effective; however, for axillary dissection, the conventional Pecs II is likely to produce superior analgesia and additionally may help achieve complete coverage of the deeper pectoral nerve branches.


Assuntos
Nervos Intercostais/anatomia & histologia , Excisão de Linfonodo , Mastectomia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Músculos Peitorais/inervação , Nervos Torácicos/anatomia & histologia , Cadáver , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Mastectomia/efeitos adversos , Ultrassonografia de Intervenção
10.
Surgery ; 168(3): 486-496, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32620303

RESUMO

BACKGROUND: To compare outcomes of total mesorectal excision with or without lateral pelvic lymph node dissection for the treatment of rectal cancer. METHODS: The electronic data sources were explored to capture all studies comparing total mesorectal excision with and without lateral pelvic lymph node dissection in patients undergoing operation for rectal cancer. Random effects modelling was utilized for the analyses. The uncertainties associated with varying follow-up periods among the included studies were resolved by analysis of time-to-event outcomes. RESULTS: Eighteen comparative studies enrolling 6,133 patients were eligible. No difference was found between the 2 groups in terms of overall survival (hazard ratio: 0.92, 95% confidence interval 0.77-1.10, P = .36, I2 = 67%), overall survival at maximum follow-up (odds ratio: 1.02, 95% confidence interval 0.83-1.25, P = .86, I2 = 22%), 5-year overall survival (odds ratio: 1.01, 95% confidence interval 0.78-1.30, P = .94, I2 = 50%), disease-free survival (hazard ratio: 1.25, 95% confidence interval 0.87-1.82, P = .23, I2 = 74%), disease-free survival at maximum follow-up (odds ratio 1.07, 95% confidence interval 0.88-1.31, P = .50, I2 = 0%), 5-year disease-free survival (odds ratio: 1.07, 95% confidence interval 0.86-1.32, P = .54, I2 = 0%), local recurrence (odds ratio: 1.01, 95% confidence interval 0.72-1.42, P = .97, I2 = 34%), distant recurrence (odds ratio: 0.96, 95% confidence interval 0.62-1.46, P = .84, I2 = 18%), and total recurrence (odds ratio: 0.97, 95% confidence interval 0.72-1.29, P = .82, I2 = 0%). Total mesorectal excision with lateral pelvic lymph node dissection resulted in longer operative time (mean difference: 116.02, 95% confidence interval 89.20-142.83, P < .00001, I2 = 68%) and higher risks of postoperative complications (odds ratio: 1.59, 95% confidence interval 1.14-2.24, P = .007, I2 = 0%), urinary dysfunction (odds ratio: 6.66, 95% confidence interval 3.31-13.39, P < .00001, I2 = 23%), and sexual dysfunction (odds ratio: 9.67, 95% confidence interval 2.38-39.26, P = .002; I2 = 51%). The results remained consistent through separate analyses for randomized trials, observational studies, and patients with or without neoadjuvant chemoradiotherapy. CONCLUSION: The available evidence suggests that lateral pelvic lymph node dissection results in greater postoperative morbidity, urinary dysfunction, and sexual dysfunction without improving recurrence and survival. Further evidence is needed from randomized controlled trials to enable experts in the nerve-sparing surgical experiences and neoadjuvant therapy experience to advise on the best treatment strategies for the management of rectal cancer patients including those with possible positive nodes on pretreatment imaging.


Assuntos
Excisão de Linfonodo/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Protectomia/efeitos adversos , Neoplasias Retais/terapia , Quimiorradioterapia Adjuvante/efeitos adversos , Quimiorradioterapia Adjuvante/métodos , Intervalo Livre de Doença , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/prevenção & controle , Estudos Observacionais como Assunto , Pelve/cirurgia , Complicações Pós-Operatórias/etiologia , Protectomia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Retais/mortalidade , Neoplasias Retais/patologia
11.
J Urol ; 204(6): 1242-1248, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32717162

RESUMO

PURPOSE: Robotic assisted retroperitoneal lymph node dissection in patients with testicular cancer is controversial. Lately, unusual recurrence patterns with adverse outcomes after robotic assisted retroperitoneal lymph node dissection have been published. In this report we determine the feasibility, safety and early oncologic outcome of robotic assisted retroperitoneal lymph node dissection in patients with small volume metastatic testicular cancer. MATERIALS AND METHODS: We retrospectively evaluated 27 consecutive patients with small volume metastatic testicular cancer (October 2010 to November 2019) who underwent robotic assisted retroperitoneal lymph node dissection (unilateral modified template). Intraoperative and postoperative complications as well as early oncologic outcomes are reported. Surgery was performed in the primary metastatic setting in 22 (81%), post-chemotherapy in 4 (15%) and for late relapse in 1 patient (4%). Initial clinical stage was IIA for 14 (52%), IIB for 12 (43%) and III for 1 (4%) patient. RESULTS: Median operative time, blood loss and length of hospital stay were 175 minutes, 50 ml and 4 days, respectively. Expectedly, viable tumor was found in 21/27 patients (78%) and 6 patients (22%) showed fibrosis, necrosis or no tumor. Overall 3 (11%) patients experienced intraoperative (Satava II) and 1 (4%) postoperative (Clavien-Dindo IIIb) complications, respectively. Median followup was 16.5 months (3-69), and 3 (11%) patients experienced relapse outside of the surgical field after 12, 22 and 36 months. CONCLUSIONS: In highly selected patients with low volume metastatic testicular cancer robotic assisted retroperitoneal lymph node dissection may be indicated, and appears to be technically feasible and comparable with open surgery in terms of complications and early oncologic safety. Prospective data collection in larger series is necessary to clarify the role and specific indications of this approach.


Assuntos
Excisão de Linfonodo/efeitos adversos , Metástase Linfática/terapia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Seminoma/terapia , Neoplasias Testiculares/terapia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Quimioterapia Adjuvante , Estudos de Viabilidade , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Estadiamento de Neoplasias , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Espaço Retroperitoneal/patologia , Espaço Retroperitoneal/cirurgia , Estudos Retrospectivos , Seminoma/epidemiologia , Seminoma/secundário , Neoplasias Testiculares/epidemiologia , Neoplasias Testiculares/patologia , Resultado do Tratamento , Adulto Jovem
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 657-660, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683826

RESUMO

The standard treatment for advanced gastric cancer remains surgery-based comprehensive treatment. The D2 radical surgery has made outstanding contributions to the standarlization of gastric cancer surgery, which has improved patients' prognosis and quality of life. In recent years, neoadjuvant chemotherapy has achieved a certain effect on the treatment of advanced gastric cancer. With the continuous development of the concept of membrane anatomy in gastric cancer surgery, new surgical challenges have also been raised. For patients after neoadjuvant therapy, there is heated controversy in the possibility of completing radical gastrectomy with membrane anatomical concept for gastric cancer. We believe that if neoadjuvant therapy pushes mesenteric cancer cell back into the mesentery, theoretically membrane anatomy combined with neoadjuvant therapy is beneficial to the treatment efficacy of advanced gastric cancer. However, membrane anatomy has two important problems when combined with neoadjuvant therapy: (1) After neoadjuvant chemotherapy, there are varying degrees of edema around the stomach tissue, which will affect the visualization of anatomic planes. In addition, because the patients' coagulation function is damaged to a certain extent, it is difficult to avoid bleeding or minimize bleeding during the operation. Therefore, it is still controversial whether the patients with gastric cancer after neoadjuvant chemotherapy can undergo radical gastrectomy with membrane anatomy. (2) For patients with complete pathological remission, whether to obtain the maximum rate of pathological remission through intensive neoadjuvant therapy, or to obtain the survival benefit of patients with membrane anatomy surgery in clinic is still controversial. Faced with these confusions, multi-center clinical researches on the application of membrane anatomy surgery after neoadjuvant therapy is the only solution.


Assuntos
Gastrectomia/métodos , Mesentério/cirurgia , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Edema/etiologia , Gastrectomia/efeitos adversos , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Mesentério/patologia , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Prognóstico , Qualidade de Vida , Neoplasias Gástricas/patologia
13.
J Surg Oncol ; 122(2): 155-163, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32497273

RESUMO

OBJECTIVES: To identify the association between cording and breast cancer-related lymphedema (BCRL); describe time course, location, symptoms and functional impairments. METHODS: A total of 1181 patients were prospectively screened for BCRL after breast cancer (BC) surgery, including patient-reported outcome measures (4193) and perometric arm volume measurements (BCRL defined as relative or weight-adjusted volume change [RVC or WAC] ≥10% ≥3 months postoperatively). RESULTS: A total of 374/1181 patients (31.7%) reported cording first a median of 4.5 months postoperatively, and were more likely to: have body mass index less than 30 kg/m2 ; be less than 55 years of age; have had mastectomy, axillary lymph node dissection, regional lymph node radiation, neoadjuvant chemotherapy (all P < .001), or RVC/WAC ≥10% (P = .002). Patients who reported cording had 2.4 times the odds of developing BCRL compared to those who did not (odds ratio = 2.40; 95% confidence interval = 1.40-4.11; P = .002), and most frequently reported these symptoms: tenderness (61.2%), aching (60.7%), and firmness/tightness (59.8%). On multivariable analysis, cording was significantly correlated with functional difficulty for 17 actions. CONCLUSIONS: Patients frequently present with cording, potentially months after BC surgery. Risk factors for and symptoms of cording are identified, and treatment is recommended. Patients reporting cording are at higher risk of BCRL, therefore, cording should be incorporated into BCRL risk stratification.


Assuntos
Linfedema Relacionado a Câncer de Mama/epidemiologia , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/cirurgia , Axila/patologia , Linfedema Relacionado a Câncer de Mama/etiologia , Linfedema Relacionado a Câncer de Mama/patologia , Neoplasias da Mama/patologia , Estudos de Coortes , Detecção Precoce de Câncer , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Massachusetts/epidemiologia , Mastectomia/efeitos adversos , Mastectomia/estatística & dados numéricos , Pessoa de Meia-Idade , Síndromes Paraneoplásicas/epidemiologia , Síndromes Paraneoplásicas/etiologia , Síndromes Paraneoplásicas/patologia , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Estudos Prospectivos
14.
Int J Gynaecol Obstet ; 150(2): 163-168, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32433783

RESUMO

OBJECTIVE: To compare outcomes and prognosis among women with type I endometrial cancer undergoing hysterectomy and bilateral salpingo-oophorectomy (H-BSO) with or without systematic pelvic lymphadenectomy (PLD) or para-aortic lymphadenectomy (PALD). METHODS: Retrospective review of women postoperatively diagnosed with type I endometrial cancer who underwent H-BSO at a university hospital in Chengdu, China (January 2010 to June 2012). Women were divided into no lymphadenectomy (PLD-/PALD-), systematic pelvic lymphadenectomy (PLD+/PALD-), or combined pelvic and para-aortic lymphadenectomy (PLD+/PALD+) groups. Follow-up was by telephone. Postoperative outcomes and prognosis were compared and risk factors were analyzed. RESULTS: In total, 333 women met the inclusion criteria: 121 underwent PLD+/PALD-, 166 underwent PLD+/PALD+, and 46 underwent PLD-/PALD-. There were no differences in pre-operative characteristics among the groups (all P>0.05). The PLD+/PALD+ group had a higher laparotomy rate (P=0.001), the PLD-/PALD- group had shorter operation time (P=0.001) and lower blood loss (P<0.001). There were no differences between the PLD+/PALD- and PLD+/PALD+ groups. Overall, 291 women had sufficient follow-up data; there was no difference in overall survival, and PALD was not a predictor of survival. CONCLUSION: Postoperative outcomes were similar among all surgical groups; a survival benefit of PALD was not demonstrated.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/mortalidade , Adulto , Idoso , Estudos de Casos e Controles , China , Neoplasias do Endométrio/mortalidade , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Metástase Linfática , Pessoa de Meia-Idade , Pelve , Estudos Retrospectivos
15.
J Urol ; 204(5): 956-961, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32379565

RESUMO

PURPOSE: We assessed the multi-institutional safety of same day discharge for robot-assisted radical prostatectomy within a single health care system. MATERIALS AND METHODS: We included 358 patients undergoing planned same day discharge for robot-assisted radical prostatectomy at 6 French centers. Primary outcomes were same day discharge failure, and 30-day complication and readmission rates. Secondary outcomes included preoperative characteristics, perioperative parameters, Chung score and pain visual analogue scale at discharge, pathological features and followup. RESULTS: Mean patient age was 64.7 years. Mean operative time and blood loss were 147.5 minutes and 228 ml, respectively. Concomitant lymph node dissection and nerve sparing procedures were performed in 43% and 62% of cases, respectively. No patient required transfusion or conversion. The same day discharge failure, complication and readmission rates were 4.2%, 16.8% and 2.8%, respectively. The most frequent complications were low grade complications including urinary infection (6.4%) and ileus (2.8%). Blood loss, lymph node dissection and pain visual analogue scale were significantly correlated with same day discharge failure. Same day discharge failure was reported in 7.8% of patients with pelvic lymph node dissection compared with only 1.5% of patients who did not undergo lymph node dissection (p=0.003). ASA® score was the only factor significantly associated with postoperative complications (p=0.023). The only factor correlated with readmission was the pain visual analogue scale at discharge (p=0.017). CONCLUSIONS: This first multi-institutional evaluation confirms the safety of same day discharge robot-assisted radical prostatectomy in a single health care system and identifies for the first time factors associated with same day discharge failure and readmission. These findings may help physicians anticipate ideal same day discharge candidates and adapt postoperative followup.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Recuperação Pós-Cirúrgica Melhorada/normas , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Idoso , Procedimentos Cirúrgicos Ambulatórios/métodos , Procedimentos Cirúrgicos Ambulatórios/normas , Estudos de Viabilidade , França , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Excisão de Linfonodo/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Cuidados Pré-Operatórios/métodos , Cuidados Pré-Operatórios/normas , Próstata/cirurgia , Prostatectomia/métodos , Prostatectomia/normas , Prostatectomia/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/normas , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
16.
Chirurgia (Bucur) ; 115(2): 220-226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369726

RESUMO

Specific risk factors for gastroduodenal surgery in cirrhotic patients have been identified, which dictates for a more personalized management. The retrospective study was conducted between 2012-2019 on twelve patients (7 cases of duodenal ulcer, 2 cases of gastric ulcer and 3 patients with gastric cancer). We took into account a number of possible factors involved in the unfavorable evolution of patients, based on data published in the literature so far. In order to follow the involvement of each factor we compared two groups of patients, one with unfavorable evolutions, exitus and another with favorable evolutions. Emergency surgery, the presence of ascites at the time of intervention, a higher than 30 MELD score, alcoholic cirrhosis, liver encephalopathy and liver failure are common factors that are found in a high percentage (between 75% and 100%) in patients who have had an unfavorable evolution, exitus. The same risk factors are found in much lower percentages in patients who have evolved favorably postoperatively, most between 12.5% and 25%. We analyzed preoperative aspects, surgical approach, complications and risk factors for these patients, compared them with the results of our study and identified future therapeutic possibilities. For CHILD B or C patients, the indication for surgery should be discussed in advance with a multidisciplinary team. Endoscopic submucosal dissection or discontinuation of D2 dissection should be considered in these patients.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Úlcera Duodenal/cirurgia , Cirrose Hepática/complicações , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Dissecação/efeitos adversos , Dissecação/métodos , Úlcera Duodenal/complicações , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Estudos Retrospectivos , Fatores de Risco , Neoplasias Gástricas/complicações , Úlcera Gástrica/complicações
17.
Chirurgia (Bucur) ; 115(2): 227-235, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32369727

RESUMO

The emergency surgery for colorectal cancer is associated with high rates of morbidity and mortality due to factors related to the characteristics of the patients but also the therapeutic attitude. This study aims to identify the surgical interventions associated with the postoperative complications, with the main causes of morbidity, with the reinterventions and with the postoperative deaths. We included in this retrospective study 431 patients hospitalized and operated in an emergency for complicated colorectal malignant tumors in the Surgery II Clinic of the Clinical Emergency County Hospital "Sf. Ap. Andrei from Galati, in the period 2008-2017. The patients data were collected from observation sheets, operative protocols, pathological, imaging and laboratory bulletins, at the time of the emergency intervention, as well as from those of subsequent admissions in patients who benefited from serial interventions. The postoperative morbidity was 10.44%. The resections with anastomosis were associated with the presence of postoperative complications (p 0.01): pseudomembranous colitis, (p 0.01) and postoperative intestinal occlusion (p 0.01). The practice of lymph node dissection was associated with postoperative complications (p 0.01): pseudomembranous colitis (p 0.01) and intestinal occlusion (p 0.01). The reinterventions were associated with resections with anastomosis (p 0.01), lymph node dissection (p 0.01) or patients with open /semi-open abdomen (p 0.04). The postoperative mortality was 9.28%. It was associated with the practice of lymph node dissection (p 0.01), of the ileostomy (p 0.01), with the open /semi-open abdomen (p 0.04). Patients with colostomy had the lowest number of hospitalization days (p 0.01). The resections with anastomosis per primam and the lymph node dissection were associated with morbidity. The type of main surgery did not influence the postoperative mortality, this being associated with the concomitant surgery: the lymph node dissection, the ileostomy, and the abdomen closure type. The reinterventions were associated with resections with anastomosis per primam, with lymph node dissection and with the open /semi-open abdomen. The duration of hospitalization was significantly shorter in patients with a colostomy.


Assuntos
Colectomia/efeitos adversos , Neoplasias Colorretais/cirurgia , Enterostomia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Protectomia/efeitos adversos , Anastomose Cirúrgica/efeitos adversos , Emergências , Enterostomia/métodos , Humanos , Protectomia/métodos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Plast Reconstr Surg ; 145(6): 1528-1537, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459781

RESUMO

BACKGROUND: The subfascial compartment (deep to the deep fascia) in extremity lymphedema has not been evaluated. This study investigated the volumetric differences between the suprafascial and subfascial compartments of patients with unilateral lower extremity lymphedema. METHODS: Thirty-two female patients with unilateral lower extremity lymphedema were enrolled, with eight patients in each of Cheng lymphedema grades I to IV. The volumes of the suprafascial and subfascial compartments were calculated after manually drawing the region of interest on computed tomographic images. The volumetric differences and their ratios in the suprafascial and subfascial compartments between each patient's bilateral limbs were compared. RESULTS: The volume of the lymphedematous limbs (9647 ml) was significantly greater than the volume of unaffected limbs (6906 ml), with a median volumetric difference of 2097 ml (30.6 percent) (p < 0.01). The median suprafascial compartment volumetric difference was 1887 ml (56.6 percent) and the subfascial compartment volumetric difference was 208 ml (4.7 percent) (p < 0.01). The median volumetric difference ratio of the thigh and lower leg was 24.6 percent and 40.6 percent, respectively. The median volumetric differences in Cheng lymphedema grades I to IV were 1012, 1787, 2434, and 4107 ml, respectively, which were statistically significant among the four Cheng lymphedema grades using the Kruskal-Wallis test (p < 0.01). CONCLUSIONS: The volumetric differences in the lymphedematous limb were statistically significantly greater than in the unaffected limb, including both suprafascial and subfascial compartments. The volumetric differences are consistent with the Cheng lymphedema grading system as a reliable indicator of unilateral extremity lymphedema. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Fáscia/diagnóstico por imagem , Extremidade Inferior/diagnóstico por imagem , Linfedema/diagnóstico , Idoso , Tomografia Computadorizada de Feixe Cônico , Fáscia/patologia , Feminino , Neoplasias dos Genitais Femininos/patologia , Neoplasias dos Genitais Femininos/cirurgia , Humanos , Processamento de Imagem Assistida por Computador , Extremidade Inferior/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/epidemiologia , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Prevalência , Procedimentos Cirúrgicos Reconstrutivos , Índice de Gravidade de Doença
19.
BMC Surg ; 20(1): 65, 2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32252732

RESUMO

BACKGROUND: The aim of this study was to compare quilting suture with conventional suture on the formation of seroma at pectoral area after mastectomy (ME) with sentinel lymph nodes biopsy (SLN) or axillary lymph nodes dissection (ALND) for breast cancer. METHODS: Two hundred thirty-five consecutive breast cancer patients were retrospectively analyzed. The primary outcome was the incidence of Grade 2 or Grade 3 seroma at anterior pectoral area within 1 month postoperatively. We categorized seroma into early or late seroma according to the drainage removal time. Cox regression was used for analysis. RESULTS: The incidence of Grade 2 and 3 seroma was significantly higher in the conventional suture group compared with that in the quilting suture group (19.3% vs. 9.5%, p = 0.032), which was attributed to the late seroma in Grade 2 and 3. Quilting suture was associated with longer time for fixing flaps compared with that of conventional suture (504.7 s vs. 109.1 s, p < 0.001), but with less volume of drainage. Old age, high body mass index and conventional suture were independently risk factors for Grade 2 and 3 seroma. CONCLUSIONS: Quilting suture decreased the incidence of Grade 2 and 3 seroma at pectoral area within 1 month after mastectomy, especially the late seroma in Grade 2 and 3.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Complicações Pós-Operatórias/prevenção & controle , Seroma/etiologia , Adulto , Drenagem/efeitos adversos , Drenagem/métodos , Feminino , Humanos , Incidência , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos/efeitos adversos , Técnicas de Sutura/efeitos adversos , Suturas/efeitos adversos
20.
BJOG ; 127(7): 859-865, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32037645

RESUMO

OBJECTIVE: To evaluate the feasibility and effect of mesureteral preservation on urinary complications in the context of total mesometrial resection (TMMR), a surgical treatment for cervical cancer. DESIGN: Retrospective cohort study with historic control. SETTING: Single tertiary academic centre. POPULATION: Women older than 18 with primary cervical cancer staged FIGO IB1-IIB enrolled in the prospective Leipzig School MMR study and underwent total mesometrial resection (TMMR) without adjuvant radiation. METHOD: We retrospectively analysed 100 consecutive TMMR procedures which were performed for cancer of the uterine cervix and in which the mesureter was preserved (intervention group, 01/2014-06/2017). We compared this group with the previous 100 consecutive TMMRs, which were performed before the introduction of mesureteral preservation (control group, 09/2010-01/2014). MAIN OUTCOME MEASURES: The occurrence of urological and specifically ureteral complications. RESULTS: Mesureteral preservation was feasible and was associated with a significant decrease in ureteral complications (11% without mesureteral preservation versus 3% with mesureteral preservation, P = 0.049). Furthermore, we found a significant decrease in the number of postoperative percutaneous nephrostomies and re-operations (7% versus none, P = 0.014). There was also a trend towards a decrease in other urinary complications such as postoperative bladder atony and uretero-vaginal fistulas. CONCLUSION: The mesureter constitutes a convenient dissection plane enabling the preservation of lateral ureteral blood supply during TMMR. In our study, maintenance of mesureteral integrity was associated with a significant reduction in ureteral complications. Mesureteral preservation might also be useful in other types of pelvic surgeries that carry a high risk of ureteral damage. TWEETABLE ABSTRACT: Surgical preservation of the mesureter in cervical cancer patients was associated with a reduction in urinary complications.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Mesentério/cirurgia , Tratamentos com Preservação do Órgão/métodos , Exenteração Pélvica , Complicações Pós-Operatórias , Ureter/lesões , Obstrução Ureteral , Neoplasias do Colo do Útero , Feminino , Alemanha/epidemiologia , Humanos , Histerectomia/efeitos adversos , Histerectomia/métodos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Órgãos em Risco , Avaliação de Processos e Resultados em Cuidados de Saúde , Exenteração Pélvica/efeitos adversos , Exenteração Pélvica/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Obstrução Ureteral/diagnóstico , Obstrução Ureteral/etiologia , Obstrução Ureteral/prevenção & controle , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/cirurgia
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