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1.
Plast Reconstr Surg ; 145(2): 459-467, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985641

RESUMO

BACKGROUND: Injuries to the upper extremity lymphatic system from cancer may require measures to prevent secondary lymphedema. Guidelines were established relating to the use of tourniquet and elective hand and upper extremity surgery. However, reports in the setting of hand surgery have indicated that prior guidelines may not be protective to the patient. METHODS: The study systematically reviewed the current literature evaluating elective hand surgery in breast cancer patients. The authors evaluated the risk of complications, including new or worsening lymphedema and infection. RESULTS: One hundred ninety-eight abstracts were identified, and a bibliographic review was performed. Nine studies pertained to our subject, and four were included for final review. All studies included patients with prior breast cancer treatment involving breast surgery and axillary lymph node dissection. Pneumatic tourniquets were used during nearly all operations. Patients without presurgery ipsilateral lymphedema had a 2.7 percent incidence of developing new lymphedema and a 0.7 percent rate of postoperative infection. Patients with presurgery lymphedema had a 11.1 percent incidence of worsening lymphedema and a 16.7 percent rate of infection. However, all cases of new or exacerbated lymphedema resolved within 3 months. Tourniquet use was not found to increase rates of lymphedema. CONCLUSIONS: Based on the available evidence, there is no increased risk of complications for elective hand surgery in patients with prior breast cancer treatment. Breast cancer patients with preexisting ipsilateral lymphedema carry slightly increased risk of postoperative infection and worsening lymphedema. It is the authors' opinion and recommendation that elective hand surgery with a tourniquet is not a contradiction in patients who have received previous breast cancer treatments.


Assuntos
Neoplasias da Mama/cirurgia , Mãos/cirurgia , Linfedema/cirurgia , Neoplasias da Mama/complicações , Neoplasias da Mama/radioterapia , Síndrome do Túnel Carpal/etiologia , Síndrome do Túnel Carpal/cirurgia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfedema/complicações , Mastectomia/efeitos adversos , Mastectomia/métodos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia de Second-Look/estatística & dados numéricos , Biópsia de Linfonodo Sentinela/efeitos adversos , Biópsia de Linfonodo Sentinela/métodos , Infecção da Ferida Cirúrgica/etiologia , Torniquetes , Resultado do Tratamento
2.
J Surg Oncol ; 121(1): 100-108, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31240729

RESUMO

BACKGROUND AND OBJECTIVES: Previously, we have shown that 9-cis retinoic acid (9-cis RA) stimulates lymphangiogenesis and limits postsurgical lymphedema in animal models when administered via daily intraperitoneal injections. In this study, we investigate whether a single-use depot 9-cis RA drug delivery system (DDS) implanted at the site of lymphatic injury can mitigate the development of lymphedema in a clinically relevant mouse limb model. METHODS: Hind limb lymphedema was induced via surgical lymphadenectomy and irradiation. Animals were divided into two treatment groups: (1) 9-cis RA DDS, (2) placebo DDS. Outcomes measured included paw thickness, lymphatic clearance and density, epidermal thickness, and collagen deposition. RESULTS: Compared with control animals, 9-cis RA-treated animals had significantly less paw swelling from postoperative week 3 (P = .04) until the final timepoint at week 6 (P = .0007). Moreover, 9-cis RA-treated animals had significantly faster lymphatic clearance (P < .05), increased lymphatic density (P = .04), reduced lymphatic vessel size (P = .02), reduced epidermal hyperplasia (P = .04), and reduced collagen staining (P = .10). CONCLUSIONS: Animals receiving 9-cis RA sustained-release implants at the time of surgery had improved lymphatic function and structure, indicating reduced lymphedema progression. Thus, we demonstrate that 9-cis RA contained within a single-use depot DDS has favorable properties in limiting pathologic responses to lymphatic injury and may be an effective strategy against secondary lymphedema.


Assuntos
Alitretinoína/administração & dosagem , Excisão de Linfonodo/métodos , Linfedema/prevenção & controle , Animais , Colágeno/metabolismo , Preparações de Ação Retardada , Epiderme/efeitos dos fármacos , Epiderme/patologia , Feminino , Proteínas de Fluorescência Verde/biossíntese , Proteínas de Fluorescência Verde/genética , Membro Posterior , Hiperplasia , Excisão de Linfonodo/efeitos adversos , Sistema Linfático/efeitos dos fármacos , Sistema Linfático/metabolismo , Linfedema/metabolismo , Masculino , Camundongos , Camundongos Transgênicos , Complicações Pós-Operatórias/prevenção & controle
3.
Gynecol Oncol ; 156(1): 147-153, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31780238

RESUMO

OBJECTIVE: To compare the prevalence of patient-reported lower-extremity lymphedema (LEL) with sentinel lymph node (SLN) mapping versus comprehensive lymph node dissection (LND) for the surgical management of newly diagnosed endometrial carcinoma. METHODS: Patients who underwent primary surgery for endometrial cancer from 01/2006-12/2012 were mailed a survey that included a validated 13-item LEL screening questionnaire in 08/2016. Patients diagnosed with LEL prior to surgery and those who answered ≤6 survey items were excluded. RESULTS: Of 1275 potential participants, 623 (49%) responded to the survey and 599 were evaluable (180 SLN, 352 LND, 67 hysterectomy alone). Median BMI was similar among cohorts (P = 0.99). External-beam radiation therapy (EBRT) was used in 10/180 (5.5%) SLN and 35/352 (10%) LND patients (P = 0.1). Self-reported LEL prevalence was 27% (49/180) and 41% (144/352), respectively (OR, 1.85; 95% CI, 1.25-2.74; P = 0.002). LEL prevalence was 51% (23/45) in patients who received EBRT and 35% (170/487) in those who did not (OR, 1.95; 95% CI, 1.06-3.6; P = 0.03). High BMI was associated with increased prevalence of LEL (OR, 1.04; 95% CI, 1.02-1.06; P = 0.001). After controlling for EBRT and BMI, LND retained independent association with an increased prevalence of LEL over SLN (OR, 1.8; 95% CI, 1.22-2.69; P = 0.003). Patients with self-reported LEL had significantly worse QOL compared to those without self-reported LEL. CONCLUSIONS: This is the first study to assess patient-reported LEL after SLN mapping for endometrial cancer. SLN mapping was independently associated with a significantly lower prevalence of patient-reported LEL. High BMI and adjuvant EBRT were associated with an increased prevalence of patient-reported LEL.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/estatística & dados numéricos , Linfedema/epidemiologia , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Endométrio/epidemiologia , Feminino , Humanos , Perna (Membro)/patologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática , Linfedema/etiologia , Linfedema/patologia , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prevalência , Linfonodo Sentinela/patologia , Linfonodo Sentinela/cirurgia , Biópsia de Linfonodo Sentinela/efeitos adversos , Inquéritos e Questionários
4.
Zhonghua Zhong Liu Za Zhi ; 41(12): 900-903, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874546

RESUMO

With the continuous development of laparoscopic techniques and the concept of individualized treatment, laparoscopic surgery is also moving from "minimally invasive" to "minimally invasive plus precision" . Lymph node metastasis is one of the most important risk factors affecting the prognosis of gastric cancer (GC). Reasonable lymph node dissection has always been an important exploration direction in the field of GC surgery. In recent years, domestic and foreign studies have found that the new tracer, indocyanine green (ICG), can detect the lymphatic vasculature non-invasively, and more accurately display the perigastric lymph nodes, providing a new perspective in laparoscopic lymph node dissection for GC. Alternatively, since the application of ICG in laparoscopic gastrointestinal tumor surgery, especially in gastric cancer surgery is still in the early stage of exploration and experience accumulation, more high-level medical evidences are needed to evaluate its clinical value.


Assuntos
Gastrectomia/métodos , Verde de Indocianina/administração & dosagem , Laparoscopia , Excisão de Linfonodo/métodos , Neoplasias Gástricas , Humanos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Linfonodos , Metástase Linfática , Biópsia de Linfonodo Sentinela , Resultado do Tratamento
5.
J Hand Surg Asian Pac Vol ; 24(4): 452-455, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31690206

RESUMO

Background: The purpose of this study was to develop a reproducible upper limb swelling model and quantify the efficacy of changing elevation posture in swelling reduction using this model. Methods: A manual sphygmomanometer was applied to healthy volunteers' upper arms while in a dependent position for 25 minutes to create venous congestion and swelling. Seven different levels of pressure (250, 120, 100, 80, 50, 40 and 30 mmHg) were tested. Every 5 minutes, the level of swelling was measured using the volumetric method. Any complications were recorded. We then compared the swelling reduction potential among 3 limb postures (arm on head, elevation brace, and simple sling). The significance level was set at p < .05. Results: Thirty to forty milliliters of swelling was created for all pressure levels except the 250 and 30 mmHg. All complications including transient nerve palsy, pain and petechiae were severe at 250 and 120 mmHg, less severe at 100 mmHg, mild at 80 mmHg, and absent below 40 mmHg. Both the on head and elevated brace limb postures markedly and significantly decreased swelling greater than the simple sling posture. Conclusions: We found that 20 ml or greater swelling can be reliably created with a blood pressure cuff inflated to 40 mmHg on the upper limb. The on head and elevated brace postures demonstrated a greater degree of swelling reduction than the simple sling posture.


Assuntos
Linfedema/etiologia , Esfigmomanômetros , Extremidade Superior , Adulto , Axila , Neoplasias da Mama/secundário , Neoplasias da Mama/cirurgia , Feminino , Voluntários Saudáveis , Humanos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática , Projetos Piloto , Pressão
6.
Yonsei Med J ; 60(12): 1138-1145, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31769244

RESUMO

PURPOSE: This study provides a standardized operative strategical algorithm that can be applied to patients with T1/T2 gallbladder cancer (GBC). Our aim was to determine the oncologic outcome of radical cholecystectomy with para-aortic lymph node dissection without liver resection in T1/T2 GBC. MATERIALS AND METHODS: From January 2005 to December 2017, 164 patients with GBC underwent operations by a single surgeon at Severance Hospital. A retrospective review was performed for 113 of these patients, who were pathologically determined to be in stages T1 and T2 according to American Joint Committee on Cancer 7th guidelines. RESULTS: Of the 113 patients, 109 underwent curative resection for T1/T2 GBC; four patients who underwent palliative operations without radical cholecystectomies were excluded from further analyses. For all T1b and T2 lesions, radical cholecystectomy with para-aortic lymph node dissection was performed without liver resection. There were four GBC-related mortalities, and 5-year disease-specific survival was 97.0%. The median follow-up was 50 months (range: 5-145 months). In all T stages, the median was not reached for survival analysis. Five-year disease-specific survival for T1a, T1b, and T2 were 100%, 94.1%, and 97.1%, respectively. Five-year disease-free survival for T1a, T1b, and T2 were 100%, 87.0%, and 91.8%, respectively. CONCLUSION: Our results suggest that the current operative protocol can be applied to minimal invasive operations for GBC with similar oncologic outcomes as open approach. For T1/T2 GBC, radical cholecystectomy, including para-aortic lymph node dissection, can be performed safely with favorable oncologic outcomes.


Assuntos
Neoplasias da Vesícula Biliar/cirurgia , Hepatectomia , Fígado/cirurgia , Excisão de Linfonodo , Idoso , Intervalo Livre de Doença , Feminino , Neoplasias da Vesícula Biliar/patologia , Humanos , Fígado/patologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Masculino , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
7.
J Surg Oncol ; 120(8): 1397-1403, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31705561

RESUMO

BACKGROUND: We previously reported a prospective study showing axillary lymph node dissection (ALND) is associated with increased breast skin thickening during and 6 weeks post-radiation therapy (RT), and now report ALND's long-term impact at 1 year. METHODS: Among 66 women who received whole breast RT after lumpectomy, objective ultrasound measurements of epidermal thickness over four quadrants of the treated breast were measured at five time points: before RT, week 6 of RT, and 6 weeks, 6 months, and 1 year post-RT. Skin thickness ratio (STRA) was generated by normalizing for corresponding measurements of the contralateral breast. RESULTS: A total of 2,436 ultrasound images were obtained. Among 63 women with evaluable data at 1 year, mean STRA significantly increased at 6 months (absolute mean increase of 65%, SD 0.054), and remained elevated at 1 year post-RT (absolute mean increase of 44%, SD 0.048). In multivariable analysis, ALND compared to sentinel lymph node biopsy, longer interval between surgery and RT, increased baseline STRA, and Caucasian race predicted for more severe changes in STRA at 1 year compared to baseline (all P < .05). CONCLUSIONS: In the setting of whole breast RT, our findings suggest that ALND has long-term repercussions on breast skin thickening.


Assuntos
Axila/cirurgia , Neoplasias da Mama/radioterapia , Epiderme/diagnóstico por imagem , Excisão de Linfonodo/efeitos adversos , Radioterapia Adjuvante/efeitos adversos , Adulto , Idoso , Neoplasias da Mama/cirurgia , Grupo com Ancestrais do Continente Europeu , Feminino , Seguimentos , Humanos , Mastectomia Segmentar , Pessoa de Meia-Idade , Estudos Prospectivos , Tempo para o Tratamento , Ultrassonografia
8.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 955-960, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630493

RESUMO

Objective: To evaluate the incidence of intraoperative vascular injury (IVI) and associated anatomical features during laparoscopy - assisted distal gastrectomy (LADG) with D2 lymphadenectomy for gastric cancer. Methods: A descriptive cohort study was performed. Clinical data and operational videos of 278 consecutive gastric cancer patients who underwent LADG with D2 lymphadenectomy for gastric cancer at Department of General Surgery of Nanfang Hospital between January 2010 and December 2017 were retrospectively analyzed. IVI and vascular anatomy during lymphadenectomy were observed and recorded in the following four scenes: scene I: No. 4sb and No.4d of lower left (tail of pancreas) area; scene II: No.6 of lower right (subpyloric) area; scene III: No.5 and No.12a of upper right (suprapyloric) area; scene IV: No. 7, No. 8a, No. 9, No. 11p of central area posterior to the gastric body. IVI was defined as the injury of main perigastric vessel requiring additional procedure for hemostasis such as electrocauterization, gauze compression, clipping or suture. Results: Among 278 patients, 125 (45.0%) had IVI. Two cases of IVI required conversion to open operation and the injuried vascular was left gastric artery (LGA) and right gastric artery (RGA), respectively. Higher incidence of IVI was found in scene II (92/278, 33.1%) and scene IV(39/278, 14.0%). More common IVI was observed in right gastroepiploic vein (RGeV, 57/278, 20.5%) and left gastric vein (LGV, 33/278, 11.9%). The right gastroepiploic vessels were observed in all 278 patients, including 3 (1.1%) cases with 2 RGeVs, and 2 cases with 2 right gastroepiploic arteries (RGeA). RGA was observed clearly in 265 (95.3%) patients, whose ramification pattern was as follows: from proper hepatic artery (PHA, 223/265, 84.2%), from gastroduodenal artery (GDA, 16/265, 6.0%), from left hepatic artery (LHA, 12/265,4.5%), from the crossing of PHA and GDA (8/265, 3.0%), and 6 (2.3%) patients with 2 RGAs simultaneously from PHA and GDA, respectively. The most common injury of RGA (4/12) occurred in LHA. Excluding 2 cases of conversion to open surgery due to intraoperative hemorrhage, among 276 patients, LGV was observed in 270 patients (97.1%), whose drainage pattern was as follows: into the portal vein (PV, 148/270, 54.8%), into the spleen vein (SV, 56/270, 20.7%), into the junction of these two veins (52/270, 19.3%), into left portal vein (LPV, 8/270, 3.0%), meanwhile 6 patients had 2 LGVs simultaneously, including LGVs of 5 cases into PV and SV, and of 1 case into PV-SV junction and SV. The most common IVI was found in those patients with two LGVs (4/6). Conclusions: IVI during LADG with D2 lymphadenectomy is common. The highest risk of IVI is found in scene II and scene IV. Attentions should be paid to anatomic variation of vessels, especially the RGeV, LGV and RGA.


Assuntos
Gastrectomia/efeitos adversos , Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Lesões do Sistema Vascular/etiologia , Gastrectomia/métodos , Humanos , Complicações Intraoperatórias , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Estudos Retrospectivos , Lesões do Sistema Vascular/cirurgia , Gravação em Vídeo
9.
BMC Surg ; 19(1): 144, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615490

RESUMO

BACKGROUND: It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. METHODS: PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. RESULTS: A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(- 2.28, - 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(- 1.18, - 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = - 43.87; 95%CI(- 73.66, - 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. CONCLUSION: Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Perda Sanguínea Cirúrgica , Drenagem/efeitos adversos , Humanos , Tempo de Internação , Excisão de Linfonodo/efeitos adversos , Duração da Cirurgia , Pneumonectomia/métodos , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
BMC Surg ; 19(1): 143, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615499

RESUMO

BACKGROUND: The global increase in elderly populations is accompanied by an increasing number of candidates for esophagectomy. Here we aimed to determine the postoperative outcomes after subtotal esophagectomy in elderly patients with esophageal cancer. METHODS: Patients (n = 432) with who underwent curative-intent transthoracic subtotal esophagectomy with 2- or 3-field lymphadenectomies for thoracic esophageal cancer were classified as follows: non-elderly (age < 75 years, n = 373) and elderly (age ≥ 75 years, n = 59) and groups. To balance the essential variables including neoadjuvant treatment and stage of progression, we conducted propensity score analysis, and clinical characteristics, perioperative course and prognosis were compared. RESULTS: After two-to-one propensity score matching, 100 and 50 patients were classified in the non-elderly and elderly groups. The elderly group had more comorbidities and lower preoperative cholinesterase activities and prognostic nutrition indexes. Although incidences of postoperative pneumonia, arrhythmia and delirium were slightly increased in the elderly group, no significant differences were observed in overall incidence of postoperative complications, rates of repeat surgery and death caused by surgery, and length of postoperative hospital stay between the two groups. There were no significant differences in disease-free and disease-specific survival as well as overall survival between the two groups. CONCLUSION: Older age (≥75 years) had limited impact on morbidity, disease recurrence, and survival after subtotal esophagectomy. Therefore, age should not prevent older patients from benefitting from surgery.


Assuntos
Neoplasias Esofágicas/cirurgia , Esofagectomia/métodos , Excisão de Linfonodo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Esofagectomia/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Excisão de Linfonodo/efeitos adversos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Recidiva Local de Neoplasia , Complicações Pós-Operatórias/etiologia , Prognóstico , Pontuação de Propensão
12.
World J Gastroenterol ; 25(37): 5641-5654, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31602164

RESUMO

BACKGROUND: Robotic surgery has been considered to be significantly better than laparoscopic surgery for complicated procedures. AIM: To explore the short-term effect of robotic and laparoscopic spleen-preserving splenic hilar lymphadenectomy (SPSHL) for advanced gastric cancer (GC) by Huang's three-step maneuver. METHODS: A total of 643 patients who underwent SPSHL were recruited from April 2012 to July 2017, including 35 patients who underwent robotic SPSHL (RSPSHL) and 608 who underwent laparoscopic SPSHL (LSPSHL). One-to-four propensity score matching was used to analyze the differences in clinical data between patients who underwent robotic SPSHL and those who underwent laparoscopic SPSHL. RESULTS: In all, 175 patients were matched, including 35 patients who underwent RSPSHL and 140 who underwent LSPSHL. After matching, there were no significant differences detected in the baseline characteristics between the two groups. Significant differences in total operative time, estimated blood loss (EBL), splenic hilar blood loss (SHBL), splenic hilar dissection time (SHDT), and splenic trunk dissection time were evident between these groups (P < 0.05). Furthermore, no significant differences were observed between the two groups in the overall noncompliance rate of lymph node (LN) dissection (62.9% vs 60%, P = 0.757), number of retrieved No. 10 LNs (3.1 ± 1.4 vs 3.3 ± 2.5, P = 0.650), total number of examined LNs (37.8 ± 13.1 vs 40.6 ± 13.6, P = 0.274), and postoperative complications (14.3% vs 17.9%, P = 0.616). A stratified analysis that divided the patients receiving RSPSHL into an early group (EG) and a late group (LG) revealed that the LG experienced obvious improvements in SHDT and length of stay compared with the EG (P < 0.05). Logistic regression showed that robotic surgery was a significantly protective factor against both SHBL and SHDT (P < 0.05). CONCLUSION: RSPSHL is safe and feasible, especially after overcoming the early learning curve, as this procedure results in a radical curative effect equivalent to that of LSPSHL.


Assuntos
Laparoscopia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Metástase Linfática/terapia , Tratamentos com Preservação do Órgão/efeitos adversos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Baço/cirurgia , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Humanos , Laparoscopia/métodos , Curva de Aprendizado , Excisão de Linfonodo/métodos , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias Gástricas/patologia , Fatores de Tempo , Resultado do Tratamento
13.
Arch Esp Urol ; 72(8): 851-856, 2019 Oct.
Artigo em Espanhol | MEDLINE | ID: mdl-31579044

RESUMO

OBJECTIVES: To describe the available techniques to prevent and treat complications related with surgery involving lymphatic nodes and drainage: lymphorrea, lymphocele and lymphedema. METHODS: Bibliographic review and personal experience communication of different image-assisted techniques in the prevention and management of lymphatic related complications. RESULTS: We describe the conventional lymphography with ethiodized oil contrast (lipiodol) by lymphatic catheterization and intranodal percutaneous puncture used in diagnostics and interventional radiology; the gammagraphic lymphography with radioactive isotopes for diagnostic use; and the utilization of colorants/dyes (patent blue, V-blue, methylene blue, indocyanine green) for diagnostic and therapeutic procedures. CONCLUSIONS: Lipiodol lymphography offers well-defined radiologic images and it is useful in interventional radiology procedures. It has the inconvenience of lymphatics catheterization and is not available for surgical dynamic identification of lymphatics. Isotopic techniques are used for diagnostics and sentinel-node procedures. Colorants and dyes have several advantages: no need for catheterization, not expensive technology, price, availability, easy management. It allows the dynamic identification of lymphatics for surgical resolution of lymph-related complications.


Assuntos
Excisão de Linfonodo , Linfedema , Linfocele , Humanos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/métodos , Linfonodos , Linfedema/etiologia , Linfedema/prevenção & controle , Linfocele/etiologia , Linfocele/prevenção & controle , Linfografia , Biópsia de Linfonodo Sentinela
14.
Hinyokika Kiyo ; 65(7): 309-313, 2019 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-31501398

RESUMO

A 79-year-old man with vulvar apocrine adenocarcinoma and right inguinal lymph node metastasis underwent wide excision and free skin graft reconstruction of the primary lesion and right inguinal lymphadenectomy. However, left inguinal lymph node metastasis was noted after 11 months, and left inguinal lymphadenectomy was performed. Twelve days postoperatively, the patient developed left inguinal lymphocele. The lymphocele was drained percutaneously and compressed, but lymph secretion persisted and lymphocele skin necrosis was observed. Therefore, debridement and vacuum-assisted closure (VAC) therapy were performed in cooperation with the department of plastic surgery. Subsequently, lymph secretion declined and eventually stopped. The lymphocele scar was reconstructed with a free skin graft, and after further observation for 8 months, right lymph node swelling was noted. Nevertheless, on the left inguinal site, neither lymphocele recurrence nor inguinal lymph node metastasis was observed. In conclusion, VAC therapy might be beneficial in the treatment of postoperative inguinal lymphocele after lymphadenectomy.


Assuntos
Adenocarcinoma , Excisão de Linfonodo , Linfocele , Tratamento de Ferimentos com Pressão Negativa , Neoplasias Vulvares , Adenocarcinoma/cirurgia , Idoso , Feminino , Humanos , Canal Inguinal , Excisão de Linfonodo/efeitos adversos , Linfocele/etiologia , Linfocele/terapia , Recidiva Local de Neoplasia , Neoplasias Vulvares/cirurgia
15.
World J Gastroenterol ; 25(31): 4502-4511, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31496628

RESUMO

BACKGROUND: As one effective treatment for lateral pelvic lymph node (LPLN) metastasis (LPNM), laparoscopic LPLN dissection (LPND) is limited due to the complicated anatomy of the pelvic sidewall and various complications after surgery. With regard to improving the accuracy and completeness of LPND as well as safety, we tried an innovative method using indocyanine green (ICG) visualized with a near-infrared (NIR) camera system to guide the detection of LPLNs in patients with middle-low rectal cancer. AIM: To investigate whether ICG-enhanced NIR fluorescence-guided imaging is a better technique for LPND in patients with rectal cancer. METHODS: A total of 42 middle-low rectal cancer patients with clinical LPNM who underwent total mesorectal excision (TME) and LPND between October 2017 and March 2019 at our institution were assessed and divided into an ICG group and a non-ICG group. Clinical characteristics, operative outcomes, pathological outcomes, and postoperative complication information were compared and analysed between the two groups. RESULTS: Compared to the non-ICG group, the ICG group had significantly lower intraoperative blood loss (55.8 ± 37.5 mL vs 108.0 ± 52.7 mL, P = 0.003) and a significantly larger number of LPLNs harvested (11.5 ± 5.9 vs 7.1 ± 4.8, P = 0.017). The LPLNs of two patients in the non-IVG group were residual during LPND. In addition, no significant difference was found in terms of LPND, LPNM, operative time, conversion to laparotomy, preoperative complication, or hospital stay (P > 0.05). CONCLUSION: ICG-enhanced NIR fluorescence-guided imaging could be a feasible and convenient technique to guide LPND because it could bring specific advantages regarding the accuracy and completeness of surgery as well as safety.


Assuntos
Laparoscopia/métodos , Excisão de Linfonodo/métodos , Metástase Linfática/diagnóstico por imagem , Neoplasias Retais/cirurgia , Cirurgia Vídeoassistida/métodos , Idoso , Perda Sanguínea Cirúrgica/prevenção & controle , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Feminino , Corantes Fluorescentes/administração & dosagem , Humanos , Verde de Indocianina/administração & dosagem , Laparoscopia/efeitos adversos , Laparoscopia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfonodos/cirurgia , Metástase Linfática/patologia , Metástase Linfática/terapia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Duração da Cirurgia , Imagem Óptica/métodos , Pelve , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Estudos Retrospectivos , Resultado do Tratamento , Cirurgia Vídeoassistida/efeitos adversos , Cirurgia Vídeoassistida/estatística & dados numéricos
16.
Zhonghua Wai Ke Za Zhi ; 57(9): 713-716, 2019 Sep 01.
Artigo em Chinês | MEDLINE | ID: mdl-31474063

RESUMO

In the surgical treatment of breast cancer, "de-escalating" is becoming more popular, especially in the treatment of axilla. Axillary sentinel lymph node biopsy has become a routine treatment for axillary-negative breast cancer patients because it can effectively reduce the occurrence of upper limb lymphedema, so that some patients with sentinel lymph node negative can be exempted from axillary lymph node dissection. However, in recent years, several international clinical studies, such as AMAROS trial, explored the use of radiotherapy instead of dissection when 1 to 2 sentinel lymph nodes were positive. The results showed that radiotherapy can reduce the incidence of upper limb edema by nearly 50% compared with dissection. How to interpret the results of such non-inferiority studies, and how to treat the impact of axillary dissection and axillary radiotherapy on the occurrence of lymphedema? Based on the review of literature in recent 10 years, the incidence and hazard ratio of edema related to the two axillary treatments were compared. The conclusion is the hazard ratios are close to each other, around 3 for both arms. The results of clinical studies such as radiotherapy instead of axillary dissection need to be carefully interpreted. At the same time, axillary dissection is still suitable for some patients at current stage, and the corresponding prevention of upper limb lymphedema still needs attention.


Assuntos
Axila , Neoplasias da Mama/patologia , Excisão de Linfonodo/efeitos adversos , Linfedema/prevenção & controle , Radioterapia/efeitos adversos , Axila/patologia , Axila/efeitos da radiação , Axila/cirurgia , Humanos , Linfonodos/patologia , Linfonodos/efeitos da radiação , Linfonodos/cirurgia , Metástase Linfática/patologia , Linfedema/etiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Extremidade Superior/patologia , Extremidade Superior/efeitos da radiação , Extremidade Superior/cirurgia
17.
Surgery ; 166(4): 686-690, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31474490

RESUMO

BACKGROUND: Certain treatments increase lymphedema risk in breast cancer survivors. The purpose of this study was to determine whether quality of life improved with preoperative teaching by a lymphedema expert. METHODS: Preoperative breast cancer patients were prospectively randomized into intervention group 1 or control group 2. Group 1 had a discussion with the lymphedema expert and at 6 months, in addition to the preoperative surgical discussion and literature given to all. Arm measurements and quality of life evaluation with Functional Assessment of Cancer Therapy-Breast Cancer were completed preoperatively and at intervals for up to 3 years. Lymphedema was verified with a 10% increase in volume or circumference. Univariate and multivariate analysis were performed on data. RESULTS: There were 119 evaluable patients with no differences between groups 1 and 2. The rate of acute lymphedema was 51.5% (33 of 64) for group 1 and 47.2% (26 of 55) for group 2. Chronic lymphedema presented in 13 patients (9.3% group 1 and 12.7% group 2). Lymphedema was significantly associated with number of lymph nodes resected (P < .001). Significant findings in the Functional Assessment of Cancer Therapy-Breast Cancer were at 6 months for all and after diagnosis in lymphedema positive patients. CONCLUSION: Structured lymphedema teaching can help to improve quality of life in lymphedema patients.


Assuntos
Neoplasias da Mama/cirurgia , Sobreviventes de Câncer/psicologia , Excisão de Linfonodo/efeitos adversos , Linfedema/terapia , Mastectomia/efeitos adversos , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Neoplasias da Mama/patologia , Doença Crônica , Feminino , Seguimentos , Humanos , Excisão de Linfonodo/métodos , Linfedema/etiologia , Linfedema/fisiopatologia , Linfedema/psicologia , Mastectomia/métodos , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Resultado do Tratamento
18.
Int J Radiat Oncol Biol Phys ; 105(4): 852-860, 2019 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-31394167

RESUMO

PURPOSE: Postoperative radiation therapy (RT) delivered to lymphatics is associated with an increased risk of developing lymphedema. Reported effects of RT on lymphatic vessels have varied, however, possibly because of the use of different animal models with varying surgery and radiation schedules and the inability to directly and longitudinally image lymphatics in vivo. Here we report, using noninvasive imaging, changes in lymphatic remodeling and function in response to surgery and RT in a mouse model. METHODS AND MATERIALS: Popliteal lymphadenectomy in mice preceded single-dose gamma irradiation of the lower extremity at a single dose of 0, 20, or 40 Gy. The right hind limb of intact mice was also radiated with 4 fractions (4 × 5 Gy). Near-infrared fluorescence lymphatic imaging with indocyanine green was performed over 6 months to monitor lymphatic vessel remodeling. RESULTS: Postoperative mice treated with 20 Gy showed transient changes in lymphatic drainage, exacerbated vessel remodeling including qualitative vessel dilation and abnormal indocyanine green pooling from week 1 to 2, and initiation of restoration of lymphatic vessels, although dermal backflow was occasionally observed. Mice treated with 40 Gy showed steadily increasing lymphatic impairment until week 3 and extravasation of dye and dermal backflow in weeks 4 to 25. The ankles of mice treated with 40 Gy were significantly swollen from weeks 2 to 4 as compared with mice treated with 0 Gy or 20 Gy. Mice that received fractionated RT exhibited lymphatic vessel remodeling similar to remodeling that occurred when a single 20 Gy dose was given; however, dermal backflow did not resolve as it did in the case of a single 20 Gy dose. CONCLUSIONS: The degree of nonreversing lymphatic damage seen in our mouse model was dependent on RT dose. Our results suggest that near-infrared fluorescence lymphatic imaging detection of early lymphatic changes can be used to predict development of lymphedema in patients with cancer.


Assuntos
Excisão de Linfonodo/efeitos adversos , Irradiação Linfática/efeitos adversos , Vasos Linfáticos/efeitos da radiação , Linfedema/etiologia , Animais , Tornozelo/diagnóstico por imagem , Corantes/administração & dosagem , Relação Dose-Resposta à Radiação , Feminino , Raios gama , Verde de Indocianina/administração & dosagem , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/efeitos da radiação , Extremidade Inferior/cirurgia , Linfa/fisiologia , Excisão de Linfonodo/métodos , Vasos Linfáticos/diagnóstico por imagem , Vasos Linfáticos/patologia , Vasos Linfáticos/fisiopatologia , Linfografia/métodos , Masculino , Camundongos , Modelos Animais , Imagem Óptica/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Doses de Radiação , Fatores de Tempo
19.
World J Surg Oncol ; 17(1): 141, 2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31409355

RESUMO

BACKGROUND: To evaluate the clinical significance of low-frequency electrical stimulation in preventing urinary retention after radical hysterectomy. METHODS: A total of 91 women with stage IA2-IB2 cervical cancer, who were treated with radical hysterectomy and lymphadenectomy from January 2009 to December 2012, were enrolled into this study and were randomly divided into two groups: trail group (48 cases) and control group (43 cases). Traditional bladder function training and low-frequency electrical stimulation were conducted in the trail group, while patients in the control group were only treated by traditional bladder training. The general condition, rate of urinary retention, and muscle strength grades of pelvic floor muscle in the perioperative period were compared between these two groups. RESULTS: The incidence of postoperative urinary retention in the electrical stimulation group was 10.41%, significantly lower than that in the control group (44.18%), and the difference was statistically significant (P < 0.01). The duration of postoperative fever and use of antibiotics were almost the same between these two groups. Eleven days after surgery, the difference in grades of the pelvic floor muscle between these two groups was not statistically significant. However, 14 days after the operation, grades of the pelvic floor muscle were significantly higher in the trail group than in the control group, and the difference was statistically significant (P < 0.01). In addition, although there was no significant difference between the two groups with different parameters (P = 0.782), the incidence of urinary retention was lower in the endorphins analgesia program group than in the neuromuscular repair program group (9.09% < 11.54%). CONCLUSION: Low-frequency electrical stimulation is more effective than conventional intervention in preventing urinary retention after radical hysterectomy. It also intensifies the recovery of pelvic muscle strength.


Assuntos
Estimulação Elétrica/métodos , Histerectomia/efeitos adversos , Excisão de Linfonodo/efeitos adversos , Complicações Pós-Operatórias/terapia , Retenção Urinária/terapia , Neoplasias do Colo do Útero/cirurgia , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Retenção Urinária/etiologia , Neoplasias do Colo do Útero/patologia , Adulto Jovem
20.
Trials ; 20(1): 528, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443731

RESUMO

BACKGROUND: The prognostic benefits and safety of extended lymphadenectomy for hilar cholangiocarcinoma remain uncertain. The available evidence is still insufficient concerning its retrospective aspect. The aim of this study is to explore the clinical effect and safety of extended lymphadenectomy compared to regional lymphadenectomy in patients with hilar cholangiocarcinoma. METHODS: The Relay-HC trial is a prospective, multicenter, and randomized controlled trial. Seven hundred and thirty-four eligible patients with resectable perihilar cholangiocarcinoma across 15 tertiary hospitals in China will be randomly assigned (1:1) to receive either regional lymphadenectomy or extended lymphadenectomy. The primary objective is to determine the overall survival after the two approaches. Secondary objectives of the study include the evaluation of perioperative mortality, postoperative complication, and disease-free survival. This study has been approved by the ethics committee of each participating hospital. DISCUSSION: The Relay-HC trial is designed to investigate the prognostic benefits and safety of expanded lymphadenectomy for hilar cholangiocarcinoma. Currently, it has never been investigated in a prospective randomized controlled clinical trial. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR), ChiCTR1800015688 . Registered on 15 April 2018.


Assuntos
Neoplasias dos Ductos Biliares/cirurgia , Tumor de Klatskin/cirurgia , Excisão de Linfonodo/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/patologia , China , Intervalo Livre de Doença , Feminino , Humanos , Tumor de Klatskin/mortalidade , Tumor de Klatskin/secundário , Excisão de Linfonodo/efeitos adversos , Excisão de Linfonodo/mortalidade , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Adulto Jovem
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