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1.
Arch Esp Urol ; 75(3): 282-286, 2022 Apr.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-35435171

RESUMO

OBJECTIVE: Classical transverse, verticalabdominal or thoracoabdominal incisions inpediatric patients are frequently used to removelarge abdominal tumors such as hepatoblastomaand neuroblastoma. We present our initial experienceson our patients who was operated by modifiedMakuuchi incision.MATERIALS AND METHODS: We used this incisionin 6 cases with large abdominal tumors (1 hepatoblastomaand 5 neuroblastoma and/or ganglioneuroma)between January 2019 and August 2020.RESULTS: These patients had previously receivedchemotherapy according to appropiate protocol. Theexposure of surgical field was perfect with this incisionand dissection of the tumors was easily performed.Complete removal of large abdominal tumors was successfullyachieved in the patients although the masseshave close proximity and adhesions with importantstructures and organs. There was serous collection in2 patients and it resolved spontaneously. No wound infection, hernia or wound dehiscence was observedduring a mean follow-up of 9.6 months (ranged from3 to18 months).CONCLUSION: According to our preliminary experiences,the Modified Makuuchi incision provides a niceexposure for removal of large abdominal tumors to thesurgeons and is well tolerated by children.


OBJETIVO: Las incisiones clásicastransversa, abdominal vertical o toracoabdominal enpacientes pediátricos son utilizadas frecuentementeen la escisión de tumores abdominales de gran tamañocomo el hepatoblastoma y el neuroblastoma.Presentamos nuestra experiencia inicial en pacientesoperados usando la incision de Makuuchi modificada.MATERIALES Y MÉTODOS: Usamos esta incision en6 casos con tumores abdominales de gran tamaño (1hepatoblastoma y 5 neuroblastomas y/o ganglioneuroma)entre Enero 2019 y Agosto 2020. RESULTADOS: Los pacientes recibieron quimioterapianeoadyuvante según protocolo. La exposicióndel campo quirúrgico, así como la disección del tumor,fue perfecta con esta incisión. Se logró remover la totalidadde los tumores con éxito a pesar de su proximidady adherencias a órganos vecinos. Dos pacientespresentaron colecciónes serosas que se resolvieronespontáneamente. No se observaron infecciones de herida, hernias o dehiscencia de heridas durante elperíodo de seguimiento con una media de 9.6 meses(rango de 3-18 meses). CONCLUSIONES: Según nuestra experiencia preliminar,la incisión de Makuuchi modificada ofrece alcirujano una buena exposición del campo quirúrgicopara la extirpación de tumores abdominales de grantamaño, además de ser bien tolerada por los niños.


Assuntos
Neoplasias Abdominais , Neuroblastoma , Neoplasias Abdominais/cirurgia , Criança , Humanos , Neuroblastoma/cirurgia , Complicações Pós-Operatórias
2.
J Coll Physicians Surg Pak ; 32(4): 514-518, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35330527

RESUMO

OBJECTIVE: To evaluate the clinicopathological differences between splenectomy during gastric cancer surgery and splenectomy during extra-gastric abdominal cancer surgery. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Erzurum Regional Education and Research Hospital, Erzurum, Turkey between January 2015 and January 2020. METHODOLOGY: Patients who were operated due to intra-abdominal malignancies were searched retrospectively. Among those patients, concomitant splenectomy cases were filtered for the study. The patients' general clinicopathological characteristics were retrieved from their medical records. Patients were divided into two groups, according to the objectives. The clinicopathological differences between the groups were evaluated with appropriate statistical tests, assuming significant p value of less than 0.05. RESULTS: The study included 45 patients. The mean age of the patients was 62.84 ± 12.59 (30-86 years), and male to female ratio was 19:26. Splenectomy was performed during gastric cancer surgery in 30 patients (66.7%) and 43 patients (95.6%) were operated in elective conditions. There was a need for more erythrocyte suspension in patients, who underwent splenectomy during gastric cancer surgery (p=0.040). However, length of hospital stay and overall morbidity were higher at splenectomy with extra-gastric cancer group, (p = 0.036 and p = 0.011, respectively). CONCLUSION: Splenectomy during gastric cancer surgery is more demanding; and requires more erythrocyte suspension. However, these patients had less morbidity tendencies. Length of stay was longer with splenectomy during extra-gastric abdominal cancer group. KEY WORDS: Splenectomy, Gastric cancer, Length of stay, Morbidity.


Assuntos
Neoplasias Abdominais , Neoplasias Gástricas , Neoplasias Abdominais/cirurgia , Idoso , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Esplenectomia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia
3.
Eur J Surg Oncol ; 48(1): 283-291, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34489122

RESUMO

INTRODUCTION: Surgery plays a key role in the management of Neuroblastic tumours (NB), where the standard approach is open surgery, while minimally invasive surgery (MIS) may be considered an option in selected cases. The indication(s) and morbidity of MIS remain undetermined due to small number of reported studies. The aim of this study was to critically address the contemporary indications, morbidity and overall survival (OS) and propose guidelines exploring the utility of MIS for NB. MATERIALS & METHODS: A SIOPEN study where data of patients with NB who underwent MIS between 2005 and 2018, including demographics, tumour features, imaging, complications, follow up and survival, were extracted and then analysed. RESULTS: A total of 222 patients from 16 centres were identified. The majority were adrenal gland origin (54%) compared to abdominal non-adrenal and pelvic (16%) and thoracic (30%). Complete and near complete macroscopic resection (>95%) was achieved in 95%, with 10% of cases having conversion to open surgery. Complications were reported in 10% within 30 days of surgery. The presence of IDRF (30%) and/or tumour volume >75 ml were risk factors for conversion and complications in multivariate analysis. Overall mortality was 8.5%. CONCLUSIONS: MIS for NB showed that it is a secure approach allowing more than 95% resection. The presence of IDRFs was not an absolute contraindication for MIS. Conversion to open surgery and overall complication rates were low, however they become significant if tumour volume >75 mL. Based on these data, we propose new MIS guidelines for neuroblastic tumours.


Assuntos
Neoplasias Abdominais/cirurgia , Neoplasias das Glândulas Suprarrenais/cirurgia , Ganglioneuroblastoma/cirurgia , Ganglioneuroma/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroblastoma/cirurgia , Neoplasias Pélvicas/cirurgia , Neoplasias Torácicas/cirurgia , Neoplasias Abdominais/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Criança , Pré-Escolar , Conversão para Cirurgia Aberta , Feminino , Ganglioneuroblastoma/patologia , Ganglioneuroma/patologia , Humanos , Lactente , Masculino , Neuroblastoma/patologia , Neoplasias Pélvicas/patologia , Guias de Prática Clínica como Assunto , Neoplasias Torácicas/patologia , Carga Tumoral
4.
Br J Surg ; 109(2): 220-226, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34931236

RESUMO

BACKGROUND: Assessment of exercise capacity is an important component of risk assessment before major surgery. Cardiopulmonary exercise testing (CPET) provides comprehensive assessment but is resource-intensive, limiting widespread adoption. Measurement of a patient's peak power output (PPO) using a simplified test on a cycle ergometer has the potential to identify patients likely to have abnormal CPET findings and to be at increased perioperative risk. The aim of this study was to investigate the potential for PPO to identify those with abnormal CPET and to determine whether PPO predicted the risk of adverse postoperative outcomes. METHODS: In a retrospective analysis of a single-centre cohort, the ability of PPO to predict a high-risk CPET result in patients undergoing major cancer surgery was analysed. The assessment was validated in patients undergoing major abdominal surgery from a UK national multicentre cohort. The association between PPO and adverse postoperative outcomes to traditional CPET-derived variables were compared. RESULTS: In 2262 patients from a single centre, PPO was an excellent discriminator of high-risk CPET, with an area under the receiver operating characteristic curve (AUROC) of 0.901 (95 per cent c.i. 0.888 to 0.913). In the national cohort of 2742 patients, there was excellent discrimination, with an AUROC of 0.856 (0.842 to 0.871). A PPO cut-off of 1.5 W/kg may be appropriate for use in screening, with a sensitivity of 90 per cent in both cohorts. PPO and traditional CPET-derived predictors demonstrated similar discrimination of major postoperative complications and death. The association between PPO and major postoperative complications persisted on multivariable analysis. CONCLUSION: These results suggest a role for the PPO test in preoperative screening and risk stratification for major surgery. Prospective evaluation is recommended.


Assuntos
Teste de Esforço/métodos , Tolerância ao Exercício , Período Pré-Operatório , Neoplasias Abdominais/cirurgia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Medição de Risco/métodos , Reino Unido
5.
Br J Surg ; 108(12): 1448-1464, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34871379

RESUMO

BACKGROUND: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. METHODS: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. RESULTS: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). CONCLUSION: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.


This study compared death rates in patients who developed pulmonary complications of surgery before and during the pandemic in two large, international studies. Patients who underwent surgery during the pandemic tended to be younger and fitter. Overall, 4.3 per cent were diagnosed with SARS-CoV-2 infection after surgery in the pandemic cohort. Deaths within 30 days after surgery tripled during the first wave of the pandemic (from 0.7 to 2.0 per cent), whereas the rate of pulmonary complications remained the similar (7.1 to 6.3 per cent). Over half of these excess deaths (54.8 per cent) were estimated to be related to SARS-CoV-2 infection.


Assuntos
COVID-19/mortalidade , Procedimentos Cirúrgicos Eletivos , Complicações Pós-Operatórias/mortalidade , Respiração Artificial/estatística & dados numéricos , Síndrome do Desconforto Respiratório/mortalidade , Neoplasias Abdominais/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias
6.
Gan To Kagaku Ryoho ; 48(12): 1491-1495, 2021 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-34911917

RESUMO

It has been reported that preoperative rehabilitation reduces the risk of postoperative complications. We examined the factors impacting the efficacy of preoperative rehabilitation. Forty-three cancer patients who underwent abdominal surgery after preoperative rehabilitation at our hospital were assessed". Walkable"was defined as having the ability to walk to the toilet(distance>30 meters)without requiring support. Following the clinical path, if patients became"walkable"by the second day after surgery, they belonged to the smooth group, while the remaining patients belonged to the delayed group. We examined the factors influencing walking ability. The smooth group consisted of 34 patients(79%), and the delayed group consisted of 9 patients(21%). The significant factors related to delays in acquiring walking ability were old age and weakened lower limb function. Improving lower limb function through preoperative rehabilitation may lead to patients acquiring walking ability earlier after surgery, especially in older patients.


Assuntos
Neoplasias Abdominais , Caminhada , Neoplasias Abdominais/cirurgia , Idoso , Humanos , Complicações Pós-Operatórias
7.
Pan Afr Med J ; 39: 211, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34630823

RESUMO

Giant desmoid tumor has been rarely reported in the literature but it is a therapeutic challenge. We here report a case of tumor manifesting as painful abdominal mass causing a major esthetic problem. Radiological assessment allowed to determine its depth extension and limits of resection. Desmoid tumor of the abdominal wall was evoked and surgically resected, with simple outcome. This study highlights challenges in the management of this entity,due to its large size.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Parede Abdominal/diagnóstico por imagem , Fibromatose Agressiva/diagnóstico por imagem , Neoplasias Abdominais/patologia , Neoplasias Abdominais/cirurgia , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Feminino , Fibromatose Agressiva/patologia , Fibromatose Agressiva/cirurgia , Humanos , Pessoa de Meia-Idade
10.
Ann Clin Lab Sci ; 51(4): 573-579, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34452899

RESUMO

OBJECTIVE: Composite neuroblastoma is a tumor composed of multiple tumoral clones within the neuroblastoma family. To date, establishing this unique histopathologic diagnosis has required the evaluation of the primary tumor mass. We report a case of composite neuroblastoma diagnosed by evaluation of a metastatic lymph node. METHODS: One abdominal lymph node involved by tumor was evaluated in a 6-year-old boy. The primary abdominal mass was not examined. Following histopathologic examination, clonality studies using comparative genomic hybridization (CGH) and fluorescence in situ hybridization (FISH) were also performed. RESULTS: Two distinct tumor components were identified by histopathologic evaluation and classified as differentiating neuroblastoma (component A) and poorly differentiated neuroblastoma (component B). Based on the patient's age, each clone was further classified as Unfavorable Histology. The presence of these two different tumoral clones was confirmed by CGH and FISH. CONCLUSION: This case affirms the histopathologic approach to evaluating composite tumors, as established by the International Neuroblastoma Pathology Classification (INPC) model for ganglioneuroblastoma, nodular tumors. Also, when both components are metastatic, this case demonstrates that composite tumors can be diagnosed by the evaluation of metastatic lesions alone. Finally, it supports the addition of composite neuroblastoma to a future version of the INPC.


Assuntos
Neoplasias Abdominais/patologia , Ganglioneuroblastoma/secundário , Linfonodos/patologia , Neoplasias Abdominais/cirurgia , Criança , Ganglioneuroblastoma/cirurgia , Humanos , Linfonodos/cirurgia , Masculino , Prognóstico
11.
Ann R Coll Surg Engl ; 103(10): 738-744, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34436951

RESUMO

INTRODUCTION: Management of malignant small bowel obstruction (mSBO) is challenging. The decision to perform an operation evaluates the perceived chance of success against a patient's fitness for operation. The aim of this study was to characterise the mSBO patient population in a tertiary UK centre and assess the patient's treatment pathway including use and effects of palliative surgery, total parenteral nutrition (TPN), Gastrografin and dexamethasone as well as preoperative stratification. METHODS: Patients were included if they had mSBO confirmed on computed tomography imaging due to a primary or metastatic neoplasm. Data were collected on pathway and management, and Cox proportional hazard methods were utilised to observe effects on survival. RESULTS: Ninety-four patients were included, with 104 inpatient episodes. Mean age was 67.4 (SD 13.7), with 57 (60.6%) females. Most (89.4%) had only one admission for mSBO. Eighty-four (89.4%) patients died over the ten-year period, 18 (17.3%) within 30 days of admission. Fifty patients (53.1%) underwent operative management: 70% bypass, 24% stoma formation and 6% open-close laparotomies. Log rank testing of survival probability analysis was significant (p = 0.00018), with 50% survival probability at 107.32 days for operative management and 47.87 days for non-operative. DISCUSSION AND CONCLUSION: Operative management forms part of the treatment pathway for a significant proportion of patients with mSBO, offering a survival benefit, though quality of survival is not known. Case selection is good, with few open-close laparotomies. Trials of non-operative interventions such as Gastrografin and dexamethasone are not utilised fully.


Assuntos
Neoplasias Abdominais/cirurgia , Obstrução Intestinal/cirurgia , Neoplasias Abdominais/complicações , Neoplasias Abdominais/mortalidade , Neoplasias Abdominais/terapia , Idoso , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Obstrução Intestinal/terapia , Masculino , Nutrição Parenteral Total , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Análise de Sobrevida
12.
J Surg Oncol ; 124(7): 1173-1181, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34320228

RESUMO

BACKGROUND: This study assessed whether electromagnetic navigation can be of added value during resection of recurrent or post-therapy intra-abdominal/pelvic soft tissue sarcomas (STS) in challenging locations. MATERIALS AND METHODS: Patients were included in a prospective navigation study. A pre-operatively 3D roadmap was made and tracked using electromagnetic reference markers. During the operation, an electromagnetic pointer was used for the localization of the tumor/critical anatomical structures. The primary endpoint was feasibility, secondary outcomes were safety and usability. RESULTS: Nine patients with a total of 12 tumors were included, 7 patients with locally recurrent sarcoma. Three patients received neoadjuvant radiotherapy and three other patients received neoadjuvant systemic treatment. The median tumor size was 4.6 cm (2.4-10.4). The majority of distances from tumor to critical anatomical structures was <0.5 cm. The tumors were localized using the navigation system without technical or safety issues. Despite the challenging nature of these resections, 89% were R0 resections, with a median blood loss of 100 ml (20-1050) and one incident of vascular damage. Based on the survey, surgeons stated navigation resulted in shorter surgery time and made the resections easier. CONCLUSION: Electromagnetic navigation facilitates resections of challenging lower intra-abdominal/pelvic STS and might be of added value.


Assuntos
Neoplasias Abdominais/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Pélvicas/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Cirurgia Assistida por Computador , Neoplasias Abdominais/diagnóstico por imagem , Idoso , Perda Sanguínea Cirúrgica , Meios de Contraste , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico por imagem , Duração da Cirurgia , Neoplasias Pélvicas/diagnóstico por imagem , Estudos Prospectivos , Sarcoma/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
Eur J Surg Oncol ; 47(11): 2952-2958, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34092455

RESUMO

INTRODUCTION: The impact of prehabilitation remains controversial due to a short presurgical waiting period and the diminished capacity of the patient population. A strategy to augment and optimize the effectiveness of prehabilitations for abdominal cancer patients may be found in the unlikely field of sport science. We investigated the use of blood flow restriction training and sport nutrition supplementation to augment functional capacity and increase muscle strength in twenty-four abdominal cancer patients awaiting surgery. MATERIALS AND METHODS: The sport science-based program was comprised of blood flow restriction exercise 5 to 6 times per week and a daily sports nutrition supplement containing l-citrulline, creatine monohydrate, and whey protein. RESULTS: After 4 weeks of prehabilitation, 6-min walk test, timed up and go, short physical performance battery, 5-chair stand test and physical component score of quality of life were significantly improved (all p < 0.05). Total body and appendicular lean mass as assessed by dual energy X-ray absorptiometry increased by 0.73 ± 1.04 kg (p = 0.004) and 0.42 ± 0.64 kg (p = 0.006), respectively. Total body fat mass and trunk fat mass decreased (p = 0.004 and p = 0.021). There were no significant changes in hand grip strength, fear of falling, the mental component summary of quality of life, or fasting serum concentrations of myostatin, follistatin, and growth hormone. CONCLUSION: A multimodal prehabilitation program, which encompasses blood flow restriction training and sports nutrition supplements, is both feasible and effective in improving lean mass and physical function in abdominal cancer patients prior to surgery.


Assuntos
Neoplasias Abdominais/cirurgia , Suplementos Nutricionais , Força Muscular/fisiologia , Exercício Pré-Operatório , Medicina Esportiva , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
J Surg Oncol ; 124(4): 679-686, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34120344

RESUMO

BACKGROUND: The aim of the study is to evaluate functional and oncological outcomes of patients undergoing abdominal wall soft tissue tumors (AWSTT) surgery. METHODS: All consecutive patients that underwent surgery for malignant and intermediate AWSTT from 1999 to 2019 were retrospectively analyzed. RESULTS: Ninety-two patients were identified, 20 (22%) operated on for a desmoid tumor and 72 (78%) for a soft tissue sarcoma (STS). Fifty-two patients (57%) had in toto resection of the abdominal wall (from the skin to the peritoneum) and 9 (10%) required simultaneous visceral resection. The closure was direct in 28 patients (30%) and requiring a mesh, a flap or a combination of the two in respectively 42, 16, and 6 patients (47%, 17%, 6%). The postoperative complications rate was 26%. Thirteen patients (14%) developed an incisional hernia after a median delay of 27 months. After a median follow-up of 40 months, out of the 72 patients operated on for STS, 7 (10%) developed local recurrence and 11 (15%) distant recurrence. The median recurrence-free and overall survivals were 61 and 116, months respectively. CONCLUSIONS: Management of AWSTT requires extensive surgery but allows good local control with an acceptable rate of incisional hernia.


Assuntos
Neoplasias Abdominais/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Recidiva Local de Neoplasia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Sarcoma/cirurgia , Neoplasias Abdominais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Taxa de Sobrevida , Adulto Jovem
15.
Pediatr Surg Int ; 37(10): 1349-1354, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34148111

RESUMO

PURPOSE: Tumor biopsy is often essential for diagnosis and management of intraabdominal neoplasms found in children. Open surgical biopsy is the traditional approach used to obtain an adequate tissue sample to guide further therapy, but image-guided percutaneous core-needle biopsy is being used more often due to concerns about the morbidity of open biopsy. We used a national database to evaluate the morbidity associated with open intraabdominal tumor biopsy. METHODS: We identified all patients undergoing laparotomy with tumor biopsy in the National Surgical Quality Improvement Project-Pediatric (NSQIP-P) database from 2012 to 2018 and measured the frequency of complications in the 30 days postoperatively. We tested associations between patient characteristics and outcomes to identify risk factors for complications. RESULTS: We identified 454 patients undergoing laparotomy for biopsy of an intraabdominal neoplasm. Median postoperative hospital stay was 7 days (IQR 4-12) and operative time was 117 min (IQR 84-172). The overall complication rate was 12.1%, with post-operative infection (6%) and bleeding (4.2%) being the most common complications. Several patient characteristics were associated with bleeding, but the only significant association on multivariable analysis was underlying hematologic disorder. CONCLUSION: Open abdominal surgery for pediatric intraabdominal tumor biopsy is accompanied by significant morbidity. Postoperative infection was the most common complication, which can delay initiation of further therapy, especially chemotherapy. These findings support the need to prospectively compare percutaneous image-guided core-needle biopsy to open biopsy as a way to minimize risk and optimize outcomes for this vulnerable population.


Assuntos
Neoplasias Abdominais , Neoplasias Abdominais/epidemiologia , Neoplasias Abdominais/cirurgia , Criança , Humanos , Biópsia Guiada por Imagem , Laparotomia , Tempo de Internação , Morbidade , Estudos Retrospectivos
16.
Ann Ital Chir ; 92: 172-179, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34031290

RESUMO

OBJECTIVE: Intraabdominal schwannomas are rare benign tumors. In this study, we aimed to present our clinical experience in patients with intrabdominally located Schwannoma. MATERIAL-METHOD: Patients who received the diagnosis of intrabdominal schwannoma between 2011-2019 were retrospectively examined. Demographic and clinical characteristics, treatment methods, short- and long-term results and immunohistochemical characteristics of the patients were analyzed. RESULTS: A total of 7 patients were included in the study. Four patients were female and three were male. The mean age was 51.5 (31-63) years. The most common clinical presentation was abdominal pain (57.1%). Tumor location was stomach (n=2), pelvic region (n=2), rectum (n=1), retropancreas (n=1), and left juxtadrenal space (n=1). Postoperative wound infection developed in one patient and pancreatic fistula complication was seen in one patient. Re-admissions to the hospital were due to anemia and pleural effusion in two patients. The mean tumor diameter was 6 cm (0.3-13 cm). All patients were S 100 strongly positive Mitoses / 50 HPFs (high power field), <2 Ki67 <3%. The mean follow- up period was 60 months. Currently, 5 patients are being followed without disease, 1 patient survives despite recurrence and 1 patient has died due to non-cancer reasons. CONCLUSION: Intrabdominal schwannomas are rare tumors which most commonly exhibit gastrointestinal involvement. Since these tumors are mostly benign, the long-term prognosis of patients is good. Schwannoma should be kept in mind in the differential diagnosis of intrabdominal masses. Radical resections with high morbidity and mortality should be avoided if preoperative diagnosis is made. KEY WORDS: Abdominal tumor, Mesenchymal tumor, Nerve sheath tumor, Schwannoma.


Assuntos
Neoplasias Abdominais , Neurilemoma , Neoplasias Pélvicas , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Pélvicas/diagnóstico , Neoplasias Pélvicas/cirurgia , Estudos Retrospectivos , Turquia
17.
Rozhl Chir ; 100(1): 10-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33691417

RESUMO

A complex review of surgery treatment of unusually giant intra-abdominal and retroperitoneal tumors regardless of their origin and histological findings. The therapy of such neoplasms requires a multidisciplinary approach which is necessary to make a reasonable and responsible decision concerning not only the indication of surgery, but also its extent. The authors describe 5 case reports, highlighting specific aspects and pitfalls of the diagnosis and treatment of these rare cases.


Assuntos
Neoplasias Abdominais , Neoplasias Retroperitoneais , Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/cirurgia , Humanos , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia
18.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 43(1): 37-41, 2021 Feb 28.
Artigo em Chinês | MEDLINE | ID: mdl-33663660

RESUMO

Objective To explore the outcomes in patients who receive the endovascular abdominal aortic aneurysm repair(EVAR)and have concomitant intra-abdominal malignancy.Methods Between January 2014 and December 2019,all the patients who underwent surgery for malignancy and/or EVAR were retrospectively reviewed.Results Twenty-eight abdominal aortic aneurysm(AAA)patients with concomitant intra-abdominal malignancy were included.The patients were treated by two-stage operation and the priority was given for EVAR in 21 patients.There was no perioperative death or major complications.In the follow-up,one patient developed graft thrombosis and one had type Ⅱ endoleak.There was no AAA-associated death.Conclusions It is preferred that EVAR should come first followed by operation for malignancy.Details of treatment strategy still need further investigation.


Assuntos
Neoplasias Abdominais , Aneurisma da Aorta Abdominal , Implante de Prótese Vascular , Procedimentos Endovasculares , Neoplasias Abdominais/complicações , Neoplasias Abdominais/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/cirurgia , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
19.
Eur J Surg Oncol ; 47(7): 1771-1777, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33549374

RESUMO

AIM: This observational study aimed to evaluate the impact of intensity of radiological surveillance on survival following resection of retroperitoneal sarcoma. METHOD: Retrospective cohort study of patients undergoing primary resection of soft tissue sarcoma arising in the retroperitoneum, abdomen or pelvis at a single, high-volume sarcoma centre. Intensity of follow-up regimes up to 5 postoperative years were categorized as 'European Society for Medical Oncology (ESMO) compliant' (intense), or 'non-ESMO compliant' (less-intense). The primary outcome measure was overall survival (OS). The secondary outcome measures were disease-free survival (DFS) and reoperation rate. Analyses were stratified by high (grade 2 or 3) or low (grade 1) tumour grade. RESULTS: Of 168 patients, 67.1% had high-grade and 32.9% had low-grade disease. Overall, 40.0% of patients had ESMO-compliant radiological follow-up (high-grade:25.7%, low-grade:66.7%). 41.7% of patients died and 48.2% suffered local or distant recurrence by cessation of follow up. Upon univariable analysis for high-grade tumours, ESMO compliance reduced DFS (p = 0.066) but had no impact on OS. There was no significant difference in the reoperation rate in patients with ESMO-compliant and non-compliant follow-up (p = 0.097). In low-grade tumours, ESMO compliance significantly reduced DFS (p < 0.001), but without effecting OS. In risk-adjusted models for high-grade tumours, ESMO compliant follow-up was associated with reduced OS (HR:3.47, 1.40-8.61, p = 0.007) and no difference in DFS. In low-grade tumours, there was no association between overall ESMO compliance and OS or DFS. CONCLUSION: This study did not find a benefit for high-intensity radiological surveillance and overall survival in patients undergoing primary resection for high or low-grade retroperitoneal sarcoma.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/cirurgia , Pelve/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Sarcoma/diagnóstico por imagem , Sarcoma/cirurgia , Neoplasias Abdominais/mortalidade , Neoplasias Abdominais/patologia , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Recidiva Local de Neoplasia , Pelve/patologia , Pelve/cirurgia , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Sarcoma/mortalidade , Sarcoma/patologia , Taxa de Sobrevida
20.
BMC Surg ; 21(1): 90, 2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33602207

RESUMO

BACKGROUND: Primitive neuroectodermal tumours are clinically rare. Here, we report a case of a large peripheral primitive neuroectodermal tumour of the abdominal wall. The defect was reconstructed with the longest lateral circumflex femoral artery musculocutaneous flap reported to date. CASE PRESENTATION: A 15-year-old male suffered rupture and bleeding of an abdominal wall mass with a volume of approximately 23*18*10 cm3, involving the whole layer of the abdominal wall. Pathological examination revealed a peripheral primitive neuroectodermal tumour. The tumour was removed via oncologic resection, and the abdominal wall was reconstructed with a bilateral 44*8 cm2 lateral circumflex femoral artery musculocutaneous flap combined with a titanium polypropylene patch. The patient had smooth recovery postoperative, and the functions of the donor and recipient areas of the flap were not significantly affected. CONCLUSION: In this case report, we describe a rare primitive neuroectodermal tumour of the abdominal wall, which invaded almost the entire abdominal wall due to delay of treatment. After thoroughly removing the tumour, we immediately reconstructed the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap and achieved better appearance and function after the operation. This case suggests that we should adopt an integrated scheme of surgery combined with radiotherapy and chemotherapy in the treatment of peripheral primitive neuroectodermal tumours. Under the premise of determining the blood supply, the lateral circumflex femoral artery musculocutaneous flap can be cut to a sufficient length.


Assuntos
Neoplasias Abdominais , Tumores Neuroectodérmicos Primitivos , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Abdominais/cirurgia , Parede Abdominal/cirurgia , Adolescente , Artéria Femoral/cirurgia , Humanos , Masculino , Retalho Miocutâneo , Tumores Neuroectodérmicos Primitivos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos
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