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1.
Pan Afr Med J ; 33: 245, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692779

RESUMO

Mohs micrographic surgery (MMS) is a technique allowing for intraoperative histologic assessment of surgical margin of malignant tumors. This study aims to highlight the role of MMS in the achievement of radical healing of basal cell carcinoma (BCC) in our patients. We conducted a study of 29 patients with basal cell carcinoma of the face over a period of 5 years. The median age of patients was 45.8 years (12-80). The sex-ratio M/F was 1.23. One-stage surgical procedure was sufficient to obtain complete resection in 51% of cases. Three-stage surgical procedure was needed in 14% of the cases. The mean duration of one-stage surgical procedure was 1 hour. No complications were reported in the postoperative period and sequelae were simple. The aesthetic and functional result was satisfactory. No recurrence was noted. BCC accounts for approximately 80% of all skin cancers. The decision to use MMS to treat BCC is based on three variables: the seat and the size of the tumor, its histological appearance with the identification of resection margin and its recurrent nature. MMS is currently the most effective method in the treatment of BCC and allows maximum healthy tissue preservation. It is a safe and repeatable surgical procedure based on team work and adapted to the treatment of patients with BCC who are at high risk of recidivism. The aesthetic and functional results are satisfactory. Recurrence rate at 5 years is 10 times lower than with the other methods.


Assuntos
Carcinoma Basocelular/cirurgia , Neoplasias Faciais/cirurgia , Cirurgia de Mohs/métodos , Neoplasias Cutâneas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma Basocelular/patologia , Criança , Neoplasias Faciais/patologia , Feminino , Hospitais Universitários , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Marrocos , Estudos Prospectivos , Neoplasias Cutâneas/patologia , Resultado do Tratamento , Adulto Jovem
2.
Arch Esp Urol ; 72(9): 926-932, 2019 Nov.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31697253

RESUMO

OBJECTIVES: We aim to present and analyze the long term results of descending transperitoneal laparoscopic nephrectomy (TLN) technique (Tunc technique). METHODS: A total of 308 patients that underwent descending TLN were included to the study between January 2011 and March 2018. Mean operation time, mean estimated blood loss, duration of hospital stay, complications, mean tumor size, and pathologic margin status were analyzed. RESULTS: A total of 308 patients underwent the descending TLN technique. Mean tumor size was 6.5±1.83 (range 3.5-12 cm). Mean intraoperative estimated blood loss was 38±6.91mL. Mean operation time was 24.97±6.8 minutes. Duration of hospital stay was1.85±0.69 days. Only one patient received postoperative blood transfusion for chronic anemia. Two of the patients had endoGIA stapler malfunction. None of the patients required conversion to open surgery intraoperative. There was no positive margin status. CONCLUSIONS: We could prove the safety and effectiveness of descending TLN technique. The main advantages of descending TLN over traditional ascending nephrectomy technique are shorter operation time and hospital stay.


Assuntos
Neoplasias Renais , Laparoscopia , Nefrectomia , Humanos , Neoplasias Renais/cirurgia , Laparoscopia/métodos , Tempo de Internação , Margens de Excisão , Nefrectomia/métodos
3.
Pan Afr Med J ; 33: 282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692859

RESUMO

Paratesticular liposarcomas (PLS) is a very uncommon pathology type of paratesticular sarcomas, with less 200 similar cases reported to date in the English literature. There are a few cases regarding giant paratesticular liposarcoma measuring over 10 cm. We present an unusual case with a giant well differentiated PLS of the left testis extended to the pelvic cavity. We report the case of a 55-year-old man who presented with large left groin mass. The patient underwent left orchiectomy following a cure of a scrotal hernia. Histological and immunohistochemical findings were suggestive of a well-differentiated liposarcoma of spermatic cord. The surgical margins were positive. Metastatic work-up, which included CT of the thorax, abdomen and pelvis, did not reveal any distant metastasis in thorax but there is a left pathological external iliac lymph nodes and a left lateroplevic lipomatous mass extended to the iliac fossa and left parietocolic gutter up to the umbilicus measuring 15x7x17 cm. Our patient refused treatment. A review of the literature revealed that there are fewer cases of giant well differentiated paratesticular liposarcoma extended to the pelvic cavity were reported. This study focuses on the clinical characteristics and treatment of this rare type of tumours.


Assuntos
Neoplasias dos Genitais Masculinos/diagnóstico , Lipossarcoma/diagnóstico , Cordão Espermático/patologia , Neoplasias Testiculares/diagnóstico , Neoplasias dos Genitais Masculinos/patologia , Neoplasias dos Genitais Masculinos/cirurgia , Humanos , Lipossarcoma/patologia , Lipossarcoma/cirurgia , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Orquiectomia , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia
4.
Anticancer Res ; 39(11): 6325-6332, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704863

RESUMO

BACKGROUND/AIM: We aimed to assess surgical outcome and long-term survival after elective hepatic resection for hepatocellular carcinoma (HCC) and colorectal liver metastasis (CRLM) in patients aged 80 years or older. PATIENTS AND METHODS: This study included 100 patients aged 70 years or older, who underwent hepatic resection for HCC or CRLM between January 2000 and December 2012. Outcomes and clinicopathological data were compared between the elderly (aged 70-79 years; n=84) and extremely elderly groups (aged 80 years or older; n=16). RESULTS: Incidence of postoperative complications, in-hospital mortality, and postoperative OS in the extremely elderly group were comparable with those of the elderly group. In patients with HCC, the extremely elderly group was associated with shorter DFS (p=0.030) in univariate analysis, while multivariate analysis showed significant and independent factors of cancer recurrence. CONCLUSION: Hepatic resection for HCC and CRLM in patients aged 80 years and older may be safe and acceptable with appropriate selection. For HCC in patients aged 80 years and older, hepatic resection may be effective when negative surgical margins can be achieved.


Assuntos
Carcinoma Hepatocelular/cirurgia , Neoplasias Colorretais/patologia , Hepatectomia , Neoplasias Hepáticas/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Comorbidade , Intervalo Livre de Doença , Feminino , Hepatectomia/mortalidade , Hepatectomia/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Neoplasias Hepáticas/secundário , Masculino , Margens de Excisão , Complicações Pós-Operatórias , Análise de Sobrevida , Resultado do Tratamento
5.
Anticancer Res ; 39(11): 6365-6372, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704869

RESUMO

BACKGROUND/AIM: Although few studies have shown the effectiveness of adjuvant therapy with acridine orange (AO) for soft tissue sarcoma (STS) patients, no study has investigated this among cases with marginal resection. The aim of the study was to evaluate the effectiveness of AO therapy directly by comparing it to marginal resection cases that did not receive AO. PATIENTS AND METHODS: This retrospective study included 19 and 33 patients with STS who received AO therapy (AO group) and marginal resection without AO therapy (non-AO group), respectively. The patients' clinical information was collected, and the clinical courses were compared. RESULTS: The local recurrence rate in the AO group was significantly lower than that in the non-AO group (p<0.05). The local recurrence-free survival curves significantly differed between the two groups (p<0.05). High grade malignancy and no treatment with AO were identified as risk factors for local recurrence (p<0.05). CONCLUSION: AO therapy strongly suppressed local recurrence after marginal resection of STS.


Assuntos
Laranja Acridina/uso terapêutico , Corantes Fluorescentes/uso terapêutico , Margens de Excisão , Recidiva Local de Neoplasia , Sarcoma/tratamento farmacológico , Sarcoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos , Estudos de Casos e Controles , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Estudos Retrospectivos , Sarcoma/patologia
6.
Pan Afr Med J ; 33: 207, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692722

RESUMO

Introduction: Soft tissue sarcomas (STS) consist of over 70 histologic subtypes and constitute only 1% of adult malignancies. The fulcrum of management is surgical resection with neoadjuvant or adjuvant treatment-chemoradiation. Methods: The study is a retrospective review of consecutive STS patients who had surgery at the University College Hospital, Ibadan, between October 2007-2017. Data extraction was from the admission and operative registers, theatre records and histology reports. Statistical analysis was done using the Statistical Package for Social Sciences (SPSS) version 20 (Chicago IL USA). Results were summarized as charts and graphs. Results: Five hundred and ninety six cases of STS were seen over the ten-year period. Of these, 383 (64.3%) patients had surgery and the case files of 326 (85.1%) of these patients was available for review. The duration of soft tissue swelling, ranged from 1-96 months. A third of the tumors were superficial while 68% were deep-seated. Oncoplastic reconstruction was done in 42(13%) patients. The resection margin was negative in 88%. A total of 202 patients were followed up regularly for between 24-36 months only. Conclusion: Patients who benefitted from definitive surgical treatment for STS were found to be the young and middle age group. These patients had extended duration of symptoms with lesions > 5cm in size. Truncal and visceral STS had the worst prognosis. A Multi-Disciplinary Tumor (MDT) board for STS and a robust follow up would enhance the management of STS in a low resource setting.


Assuntos
Sarcoma/cirurgia , Adolescente , Adulto , África ao Sul do Saara , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Estudos Retrospectivos , Sarcoma/patologia , Fatores de Tempo , Adulto Jovem
7.
Medicine (Baltimore) ; 98(40): e17435, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31577762

RESUMO

To compare the efficacies of 3-dimensional laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy for complex renal tumors. The complex renal tumors was defined as Preoperative Aspects and Dimensions Used for an anatomical (PADAU) ≥10, including some cT1b tumors.This was a retrospective analysis of patients with local complex renal tumors who presented to our hospital from January 2014 to January 2018. All patients were managed with laparoscopic partial nephrectomy (LPN) or 3-dimensional partial nephrectomy (3DLPN).There were 48 patients in the LPN group and 60 in the 3DLPN group. In the matched groups, demographic and tumor characteristics including Charlson Comorbidity Index, PADUA, based on the preoperative images, were similar. By contrast, 3DLPN achieved better results in terms of warm ischemia time (19 vs 27 minutes), operation time (105 vs 128 minutes), postoperative complications (14.9% vs 23.4%), and marginal width (0.6 cm vs 0.4 cm). We found statistically significant differences in terms of length of stay, estimated blood loss (EBL), positive surgical margin (PSM), and conversion to open or radical nephrectomy (RN). Median follow-up time was 17 and 18.5 months for the LPN and 3DLPN groups, respectively. The recovery of renal function (% change eGFR, 0 vs -8.7) was significantly different between the 3DLPN and LPN groups, whereas 12-month recurrence-free survival did not differ.Both 3-dimensional laparoscopic nephron-sparing nephrectomy and conventional laparoscopic partial nephrectomy are safe, effective, and acceptable approaches to treating complex renal tumors, while the former may facilitate tumor resection and renorrhaphy for challenging cases, offering a minimally invasive surgical option for patients who may otherwise require open surgery.


Assuntos
Imagem Tridimensional , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia , Idoso , Feminino , Humanos , Neoplasias Renais/patologia , Tempo de Internação , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Duração da Cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento , Isquemia Quente
8.
Medicine (Baltimore) ; 98(43): e17633, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31651879

RESUMO

PURPOSE: To investigate potential preoperative predictors of urethral or apical positive surgical margin (PSM) and the value of apical prostate biopsy in predicting urethral/apical margin status after radical prostatectomy (RP). METHODS: A total of 531 patients who underwent RP during 2010 to 2017 at West China Hospital were enrolled in this retrospective study. Preoperative and postoperative factors including age, BMI, PSA, clinical T stage and biopsy Gleason score were analyzed. Univariate analysis and logistic regression were used to find out the potential predictive factors for PSM. Two logistic regression models were built to evaluate the role of apical prostate biopsy in predicting urethral/apical margin status. RESULTS: The overall PSM rate was about 30.1% (160/531) and 97 of them were reported urethral/apical PSM. The incidence of urethral or apical PSM in patients with positive cores in the apical prostate was higher than those without (23.0% vs 9.9%, P < .001). We further found that the multivariable model with positive apical prostate biopsy could significantly increase the predictive value of urethral or apical PSM status (AUC: 0.744 vs 0.783, P = .016). Our analysis also showed that neo-adjuvant hormone therapy was an independent protective factor for urethral or apical PSM in patients with positive apical prostate biopsy, but not all patients. CONCLUSION: This study revealed the necessity of apical prostate biopsy to predict the risk of apical or urethral PSM. In clinical practice, neo-adjuvant hormone therapy should be given when patients with positive apical prostate biopsy to reduce the presence of PSM, especially patients with high/very high risk prostate cancer.


Assuntos
Biópsia/métodos , Margens de Excisão , Prostatectomia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/cirurgia , Uretra/patologia , Idoso , China , Humanos , Masculino , Gradação de Tumores , Invasividade Neoplásica , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos
9.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 920-925, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630487

RESUMO

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.


Assuntos
Mesentério/patologia , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Colectomia/métodos , Colectomia/normas , Fáscia/patologia , Humanos , Margens de Excisão , Mesocolo/patologia , Mesocolo/cirurgia , Invasividade Neoplásica , Metástase Neoplásica , Protectomia/normas , Reto/anatomia & histologia , Reto/patologia
10.
Am Surg ; 85(9): 965-972, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638508

RESUMO

Serum carbohydrate antigen (CA19-9) is known to correlate with stage, resectability, and prognosis of pancreatic cancer. The goal of pancreaticoduodenectomy is to achieve an R0 resection because worse outcomes are reported in the presence of positive margins. The purpose of this study was to evaluate the predictive utility of CA19-9 for pancreaticoduodenectomy margin status. A retrospective review of patients with pancreatic adenocarcinoma undergoing pancreaticoduodenectomy between October 2007 and November 2018 at our institution was performed. Patient demographics, preoperative CA19-9, and tumor characteristics were analyzed. Univariate and multivariate logistic regression was performed to determine factors associated with positive margins. A total of 184 patients were included. The mean age was 65 years; most patients were male and white. Majority had a positive preoperative CA19-9 (69%). There were nearly twice as many patients with negative as positive margins. Groups had similar demographics and preoperative CA19-9. A greater proportion of patients with negative margins had smaller tumors and early disease. On univariate and multivariate analysis, larger and higher stage tumors had greater odds of positive margins (P < 0.05). There was no significant association between margin status and preoperative CA19-9. Preoperative CA19-9 is not predictive of margin status. These results suggest that although preoperative CA19-9 values are associated with both resectability and prognosis, positive margins may not be a contributing mechanism.


Assuntos
Adenocarcinoma/sangue , Adenocarcinoma/cirurgia , Antígeno CA-19-9/sangue , Margens de Excisão , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estadiamento de Neoplasias , Neoplasias Pancreáticas/patologia , Estudos Retrospectivos , Análise de Sobrevida
11.
An Bras Dermatol ; 94(4): 442-445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644617

RESUMO

BACKGROUND: Basal cell carcinoma is the most common type of skin cancer. Although the literature provides a great deal of information on the recurrences of basal cell carcinoma, studies about these indices addressing only the cases in which flaps and/or grafts have been performed for surgical reconstruction of the excision of this tumor are still lacking. OBJECTIVES: To evaluate rates of recurrence of basal cell carcinoma submitted to conventional surgery with pre-established margins and reconstruction by flaps or grafts. METHODS: A retrospective and observational study was performed through the analysis of 109 patients, who met inclusion criteria with 116 basal cell carcinomas submitted to conventional surgery and pre-established safety margins, requiring reconstruction through a graft or cutaneous flap. This work was performed the small surgeries sector of Dermatology of the Specialty Outpatient Clinic of the University Hospital of the State University of Londrina, between January 1, 2011 and December 31, 2015. The following data were collected and inserted in an Excel worksheet: name, registration number of the hospital patient, sex, age, tumor location, histopathological type of BCC, procedure performed (type of flap and/or graft), follow-up time, recurrence. RESULTS: Of the 116 procedures, there were recurrences in 3 cases (2.6%) that were located in the nasal region and related to sclerodermiform or micronodular histological types. STUDY LIMITATIONS: Retrospective nature of the study. CONCLUSION: The present study of the dermatology department of this university hospital showed a low rate of recurrence of basal cell carcinoma in cases where flaps and/or grafts were used in the surgical reconstruction.


Assuntos
Carcinoma Basocelular/etiologia , Recidiva Local de Neoplasia/etiologia , Neoplasias Cutâneas/etiologia , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos/efeitos adversos , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Estudos Retrospectivos , Distribuição por Sexo , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/cirurgia
12.
Br J Radiol ; 92(1104): 20190466, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31600090

RESUMO

OBJECTIVE: One approach to reduce treatment-related morbidity for human papilloma virus (HPV)-associated tonsil cancer is omitting radiotherapy to the contralateral neck. Pathologic risk factors for early contralateral neck disease, however, are poorly understood. We report on the risk contralateral neck failures from the time of pre-operative diagnostic imaging to time of planning for adjuvant radiation in a single institution series of HPV-associated tonsillar cancer patients undergoing surgery followed by radiotherapy (RT). METHODS: Retrospective analysis of 123 patients with T1-T3 HPV-positive tonsillar squamous cell carcinoma treated between 2010 and 2016 with transoral robotic surgery and selective ipsilateral neck dissection followed by adjuvant RT. Contralateral neck recurrence was classified as the detection of a pathologic node in the contralateral neck prior to initiation of adjuvant RT. RESULTS: Seven patients (5.7%) developed contralateral neck disease/failure between the time of pre-operative diagnostic neck imaging and time of planning of adjuvant radiation. Increased ratio of positive/resected nodes [odds ratio (OR) 1.073, p = 0.005] was significantly associated with increased risk of contralateral neck recurrence, with a trend found for close/positive margins (OR 5.355, p = 0.06), tumor size (OR 2.046, p = 0.09), and total number of nodes positive (OR 1.179, p = 0.062). CONCLUSIONS: Patients who develop very early contralateral neck disease, between completion of ipsilateral neck dissection and the initiation of radiotherapy, have a higher ratio of positive nodes to total nodes resected in the ipsilateral neck. These findings suggest that proper selection of patients for omission of treatment of the contralateral, node-negative neck should be made with this in mind, with future studies needed to document the impact on toxicity and disease outcomes from such an approach. ADVANCES IN KNOWLEDGE: Pathologic risk factors in the dissected, ipsilateral neck in patients with tonsil cancer may inform the risk of contralateral neck failure. Patient selection for future, prospective efforts to examine sparing of the contralateral neck need to be based with these risk factors in mind.


Assuntos
Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Segunda Neoplasia Primária/etiologia , Infecções por Papillomavirus/complicações , Neoplasias Tonsilares/radioterapia , Neoplasias Tonsilares/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/virologia , Feminino , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Razão de Chances , Papillomaviridae , Período Pós-Operatório , Radioterapia Adjuvante/métodos , Radioterapia de Intensidade Modulada , Análise de Regressão , Estudos Retrospectivos , Risco , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/virologia , Carga Tumoral
14.
Zhonghua Wai Ke Za Zhi ; 57(10): 38-43, 2019 Oct 01.
Artigo em Chinês | MEDLINE | ID: mdl-31510731

RESUMO

Objective: To evaluate the accuracy of endoscopic titanium clip localization combined with CT three-dimensional reconstruction for the control of incision margin in early gastric cancer under laparoscopy. Methods: A prospective analysis was made for gastric cancer whose lesions were located in the middle of the stomach and T stage was 1 to 2 from October 2017 to January 2019 at Department of Gastrointestinal and Pancreatic Surgery, Zhejiang Provincial People's Hospital. Totally 25 patients were eventually enrolled in the study. There were 17 males and 8 females aging of (63.6± 7.2) years (range: 48 to 77 years). All cases were treated with titanium clip localization under endoscope combined with CT three-dimensional (3D) reconstruction to construct a virtual panorama of gastric cavity and lesions, and to design surgical margins. Laparoscopic surgical resection was performed according to the surgical margins designed before operation. The distance from the gastric angle to the origin of the minor curvature of the incisional margin, the distance from the gastric angle to the the center of lesion and the distance of the upper incision margin were measured under three-dimensional CT reconstruction and under actual specimen. Paired t test was used to compare the three distances measured by two methods. Results: The measured distances from the gastric angle to the center of the lesion and the proximal incisional margin under 3D reconstruction CT were according to the measured values of actual specimens ((2.67±1.38) cm vs. (2.83±1.56) cm, t=1.51, P=0.14; (5.23±0.60) cm vs. 5 cm, t=1.93, P=0.07); the measured distances from the gastric angle to the origin of the minor curvature of the incisional margin under CT 3D reconstruction were different with the measured values of solid specimens ((5.94±0.94) cm vs. (6.37±0.90) cm, t=3.52, P=0.00). Conclusion: The method of titanium clip localization combined with CT 3D reconstruction can provide a feasible laparoscopic localization method and incision edge solution for T1 to 2 gastric central cancer.


Assuntos
Margens de Excisão , Neoplasias Gástricas/diagnóstico por imagem , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Gastrectomia , Gastroscopia , Humanos , Imagem Tridimensional , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios X
15.
Dis Colon Rectum ; 62(10): 1177-1185, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31490826

RESUMO

BACKGROUND: Recent studies suggest better oncological results after open versus laparoscopic rectal resection for cancer. The external validity of these results has not been tested on a nationwide basis. OBJECTIVE: This study aimed to identify risk factors for positive circumferential resection margin in patients undergoing surgery for rectal cancer with special emphasis on surgical approach. DESIGN: This database study was based on the Danish nationwide colorectal cancer database. To identify risk factors for positive circumferential resection margin, we performed uni- and multivariate logistic regression analyses. To assess the role of surgical approach, a propensity score-matched analysis was performed. SETTINGS: This study was conducted at public hospitals across Denmark. PATIENTS: Patients undergoing elective rectal resection from October 2009 through December 2013 were included. MAIN OUTCOME MEASURES: The primary outcome measured was the risk of a positive circumferential resection margin. RESULTS: Included in the final analyses were 2721 cases (745 operated on by an open approach; 1976 by laparoscopy). On direct comparison, positive circumferential resection margin occurred more often after open resection (6.3% vs 4.7%; p = 0.047). After multivariate analyses, tumors located low in the rectum, neoadjuvant chemoradiation therapy, increasing T and N stage, tumor fixated in the pelvis, and dissection in the muscularis plane increased the risk of a positive circumferential resection margin. In the propensity score-matched sample (541 exact matched pairs), the laparoscopic approach did not influence the risk of a positive circumferential resection margin (OR, 0.9; 95% CI, 0.6-1.5; p = 0.77). LIMITATIONS: This was a retrospective review of prospectively collected data, and thereby contained possible selection bias. CONCLUSIONS: Based on this nationwide database study, and after multivariate and propensity score-matched analyses, there was no increased risk of positive circumferential resection margin after laparoscopic vs open rectal resection. See Video Abstract at http://links.lww.com/DCR/A996. MARGEN DE RESECCIÓN CIRCUNFERENCIAL DESPUÉS DE LA RESECCIÓN RECTAL LAPAROSCÓPICA Y ABIERTA: UN ESTUDIO DE COHORTE DE PUNTUACIÓN DE PROPENSIÓN A NIVEL NACIONAL: Estudios recientes sugieren mejores resultados oncológicos después de la resección rectal abierta versus laparoscópica. La validez de estos resultados no se ha probado a nivel nacional. OBJETIVO: Identificar los factores de riesgo del margen de resección circunferencial positivo en pacientes sometidos a cirugía por cáncer de recto con especial énfasis en el abordaje quirúrgico. DISEÑO:: Estudio de la base de datos nacional de Dinamarca de cáncer colorrectal. Para identificar los factores de riesgo del margen de resección circunferencial positivo, realizamos análisis de regresión logística uni y multivariable. Para evaluar el papel del abordaje quirúrgico, se realizó un análisis emparejado de puntuación de propensión. AJUSTES: Hospitales públicos en toda Dinamarca. PACIENTES: Pacientes sometidos a resección rectal electiva en el período comprendido entre octubre de 2009 y diciembre de 2013. PRINCIPALES MEDIDAS DE RESULTADOS: Riesgo del margen de resección circunferencial positivo. RESULTADOS: 2721 casos (745 operados por abordaje abierto; 1976 por laparoscopia) se incluyeron en el análisis final. En la comparación directa, el margen de resección circunferencial positivo ocurrió más a frecuentemente, después de la resección abierta (6.3 vs 4.7%; p = 0.047). Posterior a los análisis multivariados, tumores localizados en el recto bajo, quimioterapia con radioterapia neoadyuvante, incremento de etapas T y la N, tumor fijo en pelvis y la disección en el plano muscular, aumentaron el riesgo del margen de resección circunferencial positivo. En la muestra emparejada del puntaje de propensión (541 pares coincidentes exactos), el abordaje laparoscópico no influyó en el riesgo del margen de resección circunferencial positivo (razón de probabilidades (IC 95%) 0.9 (0.6-1.5); p = 0.77). LIMITACIONES: Revisión retrospectiva de los datos recopilados prospectivamente y por lo tanto, posible sesgo de selección. CONCLUSIONES: El estudio de la base de datos a nivel nacional y después de los análisis emparejados multivariados y de puntuación de propensión, no hubo un mayor riesgo del margen de resección circunferencial positivo después de la resección laparoscópica versus resección abierta. Vea el Resumen del video en http://links.lww.com/DCR/A996.


Assuntos
Colectomia/métodos , Neoplasias Colorretais/cirurgia , Laparoscopia/métodos , Margens de Excisão , Estadiamento de Neoplasias/métodos , Pontuação de Propensão , Reto/cirurgia , Idoso , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reto/diagnóstico por imagem , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento
18.
Curr Urol Rep ; 20(10): 63, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31478109

RESUMO

PURPOSE OF REVIEW: Although still considered experimental, focal irreversible electroporation (IRE) as a primary treatment for prostate cancer (PCa) is considered one of the most promising ablative technologies for focal therapy. This review provides a description of the principle of IRE for the treatment of PCa, combined with an overview of the recent research. RECENT FINDINGS: It has been almost a decade since the first human studies of focal IRE for PCa were trying to demonstrate its feasibility and safety, and recently new data are emerging regarding the functional and oncological outcomes. It was shown that the expected ablation efficacy of IRE is dependent on increased safety margins of > 9 mm and an uninterrupted IRE procedure, but these findings need further investigation in larger cohorts and randomized control trials (RCT). Recent data from larger cohorts with a longer follow-up of up to 12 months prove that focal IRE as primary treatment for localized PCa is indeed safe, has effective short-term oncological control in selected patients, and it has good functional outcomes by retaining urinary function and causing only mild erectile dysfunction.


Assuntos
Técnicas de Ablação/métodos , Eletroporação/métodos , Neoplasias da Próstata/terapia , Disfunção Erétil/etiologia , Humanos , Masculino , Margens de Excisão , Neoplasias da Próstata/patologia , Recuperação de Função Fisiológica
19.
Artigo em Chinês | MEDLINE | ID: mdl-31550768

RESUMO

Surgical margin principle is one of the central surgical principles for head and neck cancers. Negative surgical margin is the primary purpose of surgery for head and neck cancers. This paper is based on the current clinical application of surgical margins of head and neck cancers, and it is proposed that surgical margins of head and neck cancers may be classified into three types: surface margin, deep margin, and tissue interface margin in consideration of surgical exposure of tumors. The classification of surgical margins can make the clinical application and the research of surgical margins of head and neck cancers more systematic and clear.


Assuntos
Neoplasias de Cabeça e Pescoço , Margens de Excisão , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos
20.
Cancer Sci ; 110(10): 3315-3327, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31385407

RESUMO

Despite advances and refinements in surgery and perioperative chemotherapy, there are still unmet medical needs with respect to radical cystectomy for muscle-invasive bladder cancer (MIBC). We investigated the potential benefit of supplementary granulocyte macrophage colony-stimulating factor (GM-CSF) to chemoimmunotherapy with programmed cell death protein-1 (PD-1)/programmed death-ligand 1 (PD-L1) axis blockade and standard neoadjuvant chemotherapy in bladder cancer. We inoculated 2 × 105 MBT2 cells s.c. in C3H mice to create a syngeneic animal model of local recurrence (LR). When the tumor diameter reached 12 mm, the mice were allocated randomly as follows: (i) non-treated control (vehicle only); (ii) anti-mPD-L1 monotherapy; (iii) mGM-CSF monotherapy; (iv) anti-mPD-L1 plus mGM-CSF; (v) gemcitabine and cisplatin (GC); (vi) GC plus anti-mPD-L1; (vii) GC plus mGM-CSF; and (viii) GC plus anti-mPD-L1 plus mGM-CSF. After completing 2-week neoadjuvant therapy, tumors were resected for resection margin evaluation and immunohistochemical staining and blood was collected for flow cytometry and ELISA. Operative wounds were sutured, and the operative site was monitored to detect LR. Addition of anti-mPD-L1 and mGM-CSF to neoadjuvant GC chemotherapy enhanced the antitumor effect and reduced positive resection margins (50% vs 12.5%). Combination of GC, anti-mPD-L1, and mGM-CSF resulted in longer LR-free survival and cancer-specific survival compared to those in other groups. These effects involved an immunotherapy-related decrease in oncological properties such as tumor invasion capacity and epithelial-mesenchymal transition. mGM-CSF significantly decreased the accumulation of myeloid-derived suppressor cells in both the blood and tumor microenvironment and blood interleukin-6 levels. Supplementary GM-CSF to neoadjuvant GC plus PD-L1 blockade could decrease LR after radical surgery by immune modulation in the blood and tumor microenvironment.


Assuntos
Antineoplásicos Imunológicos/administração & dosagem , Antígeno B7-H1/antagonistas & inibidores , Cisplatino/administração & dosagem , Desoxicitidina/análogos & derivados , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Recidiva Local de Neoplasia/terapia , Neoplasias da Bexiga Urinária/terapia , Animais , Antineoplásicos Imunológicos/farmacologia , Linhagem Celular Tumoral , Cisplatino/farmacologia , Terapia Combinada , Cistectomia , Desoxicitidina/administração & dosagem , Desoxicitidina/farmacologia , Transição Epitelial-Mesenquimal/efeitos dos fármacos , Fator Estimulador de Colônias de Granulócitos e Macrófagos/farmacologia , Humanos , Margens de Excisão , Camundongos , Terapia Neoadjuvante , Recidiva Local de Neoplasia/imunologia , Distribuição Aleatória , Análise de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/imunologia , Neoplasias da Bexiga Urinária/patologia , Ensaios Antitumorais Modelo de Xenoenxerto
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