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2.
Dermatol Clin ; 41(1): 163-174, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410976

RESUMO

The nail unit and genitalia represent rare locations where malignant tumors may arise. Human papillomavirus has emerged as a causative agent of the development of the most common malignancies in these sites. Tissue preservation with surgery is of utmost importance, and tissue-sparing approaches are increasingly emphasized in the dermatology, urology, and gynecology literature. In addition to its tissue-sparing nature, Mohs micrographic surgery allows the complete evaluation of histologic margins to ensure tumor extirpation and may be the ideal treatment modality. The authors herein present approaches for the evaluation and treatment of malignant tumors of the nail unit and genitalia.


Assuntos
Genitália , Neoplasias , Humanos , Neoplasias/cirurgia , Margens de Excisão , Cirurgia de Mohs
3.
Adv Anesth ; 40(1): 33-44, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36333050

RESUMO

Ambulatory surgery centers (ASC) serve an important role for hospital systems of increasing operating capacity and offloading patient volume. When seeking to perform more complex cancer surgeries at an ASC, a systematic approach with care pathways can yield success by facilitating quick recovery for patients and reducing complication rates. End-to-end patient engagement is a key component of patient-centered care at the Josie Robertson Surgery Center and begins the moment the decision to have surgery is made and extends to the postdischarge period to track recovery. Engagement includes comprehensive education, standardization of processes, and setting clear expectations for recovery and discharge.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Neoplasias , Humanos , Alta do Paciente , Participação do Paciente , Assistência ao Convalescente , Neoplasias/cirurgia , Neoplasias/etiologia
4.
J Craniofac Surg ; 33(8): 2450-2454, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36409869

RESUMO

ABSTRACT: Scalp defects of various etiologies require distinct reconstruction strategies. Therefore, the authors divided scalp defects into the following categories: scar alopecia, open scalp wound, benign or low-grade malignant tumor, and high-grade malignancy. The authors reviewed the experience with scalp reconstruction of a single center to determine the factors that affect the reconstructive choices.Patients who underwent scalp reconstruction between 2008 and 2020 were retrospectively reviewed. Reconstruction methods were classified according to the etiology of the defect and were compared for each etiology. Accordingly, a reconstruction algorithm for scalp defects was proposed.A total of 180 patients were included in this study, and the reconstruction methods demonstrated significant differences according to etiology (P < 0.05). For scar alopecia and open scalp wounds, reconstruction methods such as direct repair, local flap transfer, and tissue expander placement were used depending on the defect size. Patients with benign or low-grade malignancies mainly underwent reconstruction with local flaps or skin grafts and tissue expanders for covering the defects. Patients with high-grade malignancies underwent reconstruction with free flaps if they were scheduled for preoperative or postoperative radiation therapy.Various factors, suchas the etiology, size, location, and depthofthe defect, should be considered in scalp reconstruction. The defect etiology is an important factor that determines the reconstructive goal. Our algorithm is based on the etiology of defects and is intended to aid physicians in choosing the appropriate treatment for various scalp defects.


Assuntos
Retalhos de Tecido Biológico , Neoplasias , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Couro Cabeludo/lesões , Estudos Retrospectivos , Cicatriz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos de Tecido Biológico/cirurgia , Neoplasias/patologia , Neoplasias/cirurgia , Alopecia/etiologia , Alopecia/cirurgia
5.
J Cancer Res Ther ; 18(6): 1629-1634, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36412422

RESUMO

Aim: The pandemic by novel coronavirus disease 2019 (COVID-19) is the biggest threat to global health care. Routine care of cancer patients is affected the most. Our institute, situated in Mumbai, declared as the hotspot of COVID-19 in India, continued to cater to the needs of cancer patients. We did an observational study to review the experience of managing uro-oncology patients and who underwent either open, endoscopic, or robot-assisted surgery for urological malignancy. Materials and Methods: During the peak of COVID-19 pandemic from March 21, 2020, to June 21, 2020, all the uro-oncology cases managed in our tertiary care hospital were analyzed. Teleconsultation was started for follow-up patients. All patients requiring surgery underwent reverse transcription-polymerase chain reaction for COVID-19. Institutional protocol was formulated based on existing international guidelines for patient management. Adequate personal protection and hydroxychloroquine prophylaxis were provided to health-care professionals. Results: During the study period, 417 outpatient consultations were made. Forty-nine patients underwent surgery for different urological malignancies. Majority of the surgeries were robot-assisted surgeries (59.2%, 29 patients), followed by endoscopic procedures (28.5%, 14 patients) and few open procedures (10.2%, five patients). Most of our patients were elderly males (mean, 62.5 years). With a median follow-up of 55 days (interquartile range, 32-77), there was no report of COVID-19 infection in any patient or health-care provider. Conclusions: We can continue treating needy cancer patients with minimal risk by taking all precautions. Our initial experience of managing uro-oncology cases during this pandemic is encouraging. Robotic surgeries can be safely performed.


Assuntos
COVID-19 , Neoplasias , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Idoso , Procedimentos Cirúrgicos Robóticos/efeitos adversos , COVID-19/epidemiologia , Pandemias , Índia/epidemiologia , Neoplasias/cirurgia
8.
J Natl Compr Canc Netw ; 20(11): 1223-1232.e8, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36351336

RESUMO

BACKGROUND: Although frailty is known to impact short-term postoperative outcomes, its long-term impact is unknown. This study examined the association between frailty and remaining alive and at home after cancer surgery among older adults. METHODS: Adults aged ≥70 years undergoing cancer resection were included in this population-based retrospective cohort study using linked administrative datasets in Ontario, Canada. The probability of remaining alive and at home in the 5 years after cancer resection was evaluated using Kaplan-Meier methods. Extended Cox regression with time-varying effects examined the association between frailty and remaining alive and at home. RESULTS: Of 82,037 patients, 6,443 (7.9%) had preoperative frailty. With median follow-up of 47 months (interquartile range, 23-81 months), patients with frailty had a significantly lower probability of remaining alive and at home 5 years after cancer surgery compared with those without frailty (39.1% [95% CI, 37.8%-40.4%] vs 62.5% [95% CI, 62.1%-63.9%]). After adjusting for age, sex, rural living, material deprivation, immigration status, cancer type, surgical procedure intensity, year of surgery, and receipt of perioperative therapy, frailty remained associated with increased hazards of not remaining alive and at home. This increase was highest 31 to 90 days after surgery (hazard ratio [HR], 2.00 [95% CI, 1.78-2.24]) and remained significantly elevated beyond 1 year after surgery (HR, 1.56 [95% CI, 1.48-1.64]). This pattern was observed across cancer sites, including those requiring low-intensity surgery (breast and melanoma). CONCLUSIONS: Preoperative frailty was independently associated with a decreased probability of remaining alive and at home after cancer surgery among older adults. This relationship persisted over time for all cancer types beyond short-term mortality and the initial postoperative period. Frailty assessment may be useful for all candidates for cancer surgery, and these data can be used when counseling, selecting, and preparing patients for surgery.


Assuntos
Fragilidade , Neoplasias , Idoso , Humanos , Fragilidade/epidemiologia , Fragilidade/etiologia , Idoso Fragilizado , Avaliação Geriátrica , Estudos Retrospectivos , Fatores de Risco , Neoplasias/epidemiologia , Neoplasias/cirurgia , Ontário/epidemiologia
9.
Can J Surg ; 65(6): E782-E791, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36384689

RESUMO

BACKGROUND: Cancer surgery cancellation can have negative consequences for the patient, the surgeon and the health care system. There is a paucity of literature on cancer surgery cancellation and its association with wait times, perioperative outcomes, survival and costs of care. Therefore, the objective of this study was to determine the incidence of same-day cancer surgery cancellation in a universal health care context and its association with short and long-term outcomes. METHODS: This was a population-based retrospective cancer cohort study in Ontario, Canada (2010-2016). There were 199 599 patients in the control cohort and 3539 patients in the cohort that experienced a cancellation. We assessed the cohorts for differences in survival, perioperative complications and costs of care. RESULTS: The overall cancellation rate was 1.74% and was predicted by cancer type (genitourinary), lower income quintile, and more central region of residence. Wait times in the cancelled cohort were longer than in the control cohort; however, this difference was not associated with worse survival outcomes. Patients in the cancelled cohort had higher complication rates while in hospital (7.3 %) than those in the control cohort (4.9%; p < 0.01). After adjusting for important confounders, the cancelled cohort was more costly ($1100). CONCLUSION: Same-day cancer surgery cancellation rates were low. They were associated with longer wait times, higher complication rates and increased costs of care. Survival was not worse in the cancelled cohort, suggesting that appropriate cancer urgency prioritization occurs. Preventable causes of cancellation should be targeted to improve outcomes in patients with cancer.


Assuntos
Neoplasias , Assistência de Saúde Universal , Humanos , Incidência , Estudos Retrospectivos , Estudos de Coortes , Neoplasias/epidemiologia , Neoplasias/cirurgia , Ontário/epidemiologia
10.
Neurosurg Focus ; 53(5): E3, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36321284

RESUMO

OBJECTIVE: Trigeminal neuralgia (TN) secondary to tumor represents a rare and diverse entity, and treatment for secondary TN remains controversial. This report reviews a single institution's experience in treating secondary TN with stereotactic radiosurgery (SRS) and focuses on the durability of pain relief with respect to various treatment targets, i.e., the trigeminal nerve, offending tumor, or both. METHODS: Between the years 2009 and 2021, 21 patients with TN secondary to benign (n = 13) or malignant (n = 8) tumors underwent SRS. Barrow Neurological Institute (BNI) pain intensity scale scores were collected from patient electronic medical records at baseline, initial follow-up, and 1 and 3 years post-SRS. The interval change in BNI scale score (ΔBNI) at the various follow-up time points was also calculated to assess the durability of pain relief following SRS. RESULTS: The median follow-up period was 24 (range 0.5-155) months. Five patients (24%) received treatment to the trigeminal nerve only, 10 (48%) received treatment to the tumor only, and 6 (29%) had treatment to both the nerve and tumor. The overall radiation dosage ranged from 14 to 60 Gy delivered in 1-5 fractions, with a median overall dose of 26 Gy. The median dose to the tumor was 22.5 (range 14-35) Gy, delivered in 1-5 fractions. Of the treatments targeting the tumor, 25% were delivered in a single fraction with doses ranging from 14 to 20 Gy, 60% were delivered in 3 fractions with doses ranging from 18 to 27 Gy, and 15% were delivered in 5 fractions with doses ranging from 25 to 35 Gy. The most common dose regimen for tumor treatment was 24 Gy in 3 fractions. The median biologically effective dose (with an assumed alpha/beta ratio of 10 [BED10]) for tumor treatments was 43.1 (range 13.3-60.0) Gy. There was a significant difference in the proportion of patients with recurrent pain (ΔBNI score ≥ 0) at the time of last follow-up across the differing SRS treatment targets: trigeminal nerve only, tumor only, or both (p = 0.04). At the time of last follow-up, the median ΔBNI score after SRS to the nerve only was -1, 0 after SRS to tumor only, and -2 after SRS to both targets. CONCLUSIONS: SRS offers clinical symptomatic benefit to patients with TN secondary to tumor. For optimal pain relief and response durability, treatment targeting both the tumor and the trigeminal nerve appears to be most advantageous.


Assuntos
Neoplasias , Radiocirurgia , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Dor/cirurgia , Neoplasias/cirurgia
11.
Medicina (Kaunas) ; 58(10)2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-36295541

RESUMO

The incidence and societal burden of cancer is increasing globally. Surgery is indicated in the majority of solid tumours, and recent research in the emerging field of onco-anaesthesiology suggests that anaesthetic-analgesic interventions in the perioperative period could potentially influence long-term oncologic outcomes. While prospective, randomised controlled clinical trials are the only research method that can conclusively prove a causal relationship between anaesthetic technique and cancer recurrence, live animal (in vivo) experimental models may more realistically test the biological plausibility of these hypotheses and the mechanisms underpinning them, than limited in vitro modelling. This review outlines the advantages and limitations of available animal models of cancer and how they might be used in perioperative cancer metastasis modelling, including spontaneous or induced tumours, allograft, xenograft, and transgenic tumour models.


Assuntos
Anestesiologia , Anestésicos , Neoplasias , Animais , Humanos , Estudos Prospectivos , Neoplasias/cirurgia , Analgésicos , Modelos Teóricos
12.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 39(5): 958-965, 2022 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-36310484

RESUMO

To solve the problems of small one-time ablation range and easy charring of the tissue around the electrode associated with the tumor radiofrequency ablation needle, based on the multiphysical field coupling analysis software COMSOL, the effects of needle material, the number of sub needles and the bending angle of sub needles on the ablation effect of radiofrequency ablation electrode needle were studied. The results show that compared with titanium alloy and stainless steel, nickel titanium alloy has better radiofrequency energy transmission efficiency and it is the best material for electrode needle. The number of sub needles has a great influence on the average necrosis depth and the maximum necrosis diameter. Under the same conditions, the more the number of sub needles, the larger the volume of coagulation necrosis area. The bending angle of the needle has a great effect on the maximum diameter of the coagulated necrotic area, but has little effect on the average necrotic depth. Under the same other conditions, the coagulation necrosis area formed by ablation increased with the increase of the bending angle of the sub needle. For the three needles with bending angles of 60 °, 90 ° and 120 ° analyzed in this paper, the one with bending angle of 120 ° can obtain the largest coagulation necrosis area. In general, the design of nickel titanium alloy with 120 ° bending 8-pin is the optimal. The average depth of radiofrequency ablation necrosis area is 32.40 mm, and the maximum necrosis diameter is 52.65 mm. The above optimized design parameters can provide guidance for the structure and material design of tumor radiofrequency ablation needle.


Assuntos
Ablação por Cateter , Neoplasias , Humanos , Agulhas , Temperatura , Ablação por Cateter/métodos , Necrose , Neoplasias/cirurgia , Ligas
13.
Diagn Interv Imaging ; 103(11): 499-509, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36266192

RESUMO

Thermal tumor ablation techniques including radiofrequency, microwave, LASER, high-intensity focused ultrasound and cryoablation are routinely used to treated liver, kidney, bone, or lung tumors. However, all these techniques are thermal and can therefore be affected by heat sink effect, which can lead to incomplete ablation, and thermal injuries of non-targeted tissues are possible. Under certain conditions, high voltage pulsed electric field can induce formation of pores in the cell membrane. This phenomenon, called electropermeabilization, is also known as "electroporation". Under certain conditions, electroporation can be irreversible, leading to cell death. Irreversible electroporation has demonstrated efficacy for the treatment of liver and prostate cancers, whereas data are scarce regarding pancreatic and renal cancers. During reversible electroporation, transient cell permeability can be used to introduce cytotoxic drugs into tumor cells (commonly bleomycin or cisplatin). Reversible electroporation used in conjunction with cytotoxic drugs shows promise in terms of oncological response, particularly for solid cutaneous and subcutaneous tumors such as melanoma. Irreversible and reversible electroporation are both not thermal ablation techniques and therefore open a new promising horizon for tumor ablation.


Assuntos
Antineoplásicos , Eletroquimioterapia , Neoplasias , Humanos , Eletroquimioterapia/métodos , Oncologia , Eletroporação/métodos , Neoplasias/cirurgia
15.
Br J Radiol ; 95(1140): 20220282, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36314726

RESUMO

This surgical perspective paper highlights the importance and rationale of performing a needle biopsy of a gallbladder mass though the future anticipated surgical incision site. It is a simple, and cost-effective technique, requiring close collaboration between the surgeon and the radiologist.


Assuntos
Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar , Neoplasias , Humanos , Colecistectomia , Biópsia por Agulha , Neoplasias/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia
18.
Medicina (Kaunas) ; 58(9)2022 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-36143832

RESUMO

Most patients suffering from neoplastic diseases will at some point during their illness be approached surgically. Surgery itself may be unfortunately responsible for tumor proliferation and metastatic spread. With the perioperative period increasingly becoming a focus of research in anesthesia, anesthesiologists have looked at the chance to influence cancer progression based on their choice of anesthesia regimen and strategy. Many anesthetic agents have been investigated for their potential impact on the course of cancer disease. There is an abundance of retrospective studies and very few prospective ones that tackled this issue. The aim of this article is to review the current state of the evidence on general anesthesia involving volatile and intravenous agents as substrates, focusing on halogenated inhalational agents and propofol, to guide clinical decision making in assessments of the best practice for perioperative management of cancer surgery.


Assuntos
Anestésicos Gerais , Neoplasias , Propofol , Anestesia por Inalação , Anestesia Intravenosa , Anestesiologistas , Anestésicos Intravenosos , Humanos , Neoplasias/cirurgia , Propofol/uso terapêutico , Estudos Prospectivos , Estudos Retrospectivos , Sono
19.
Cancer Imaging ; 22(1): 48, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068619

RESUMO

Molecular imaging technologies are increasingly used to diagnose, monitor, and guide treatment of i.e., cancer. In this review, the current status and future prospects of the use of molecular imaging as an instrument to help realize precision surgery is addressed with focus on the main components that form the conceptual basis of intraoperative molecular imaging. Paramount for successful interventions is the relevance and accessibility of surgical targets. In addition, selection of the correct combination of imaging agents and modalities is critical to visualize both microscopic and bulk disease sites with high affinity and specificity. In this context developments within engineering/imaging physics continue to drive the growth of image-guided surgery. Particularly important herein is enhancement of sensitivity through improved contrast and spatial resolution, features that are critical if sites of cancer involvement are not to be overlooked during surgery. By facilitating the connection between surgical planning and surgical execution, digital surgery technologies such as computer-aided visualization nicely complement these technologies. The complexity of image guidance, combined with the plurality of technologies that are becoming available, also drives the need for evaluation mechanisms that can objectively score the impact that technologies exert on the performance of healthcare professionals and outcome improvement for patients.


Assuntos
Neoplasias , Cirurgia Assistida por Computador , Humanos , Imagem Molecular , Neoplasias/diagnóstico por imagem , Neoplasias/cirurgia , Cirurgia Assistida por Computador/métodos
20.
World J Surg Oncol ; 20(1): 302, 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127678

RESUMO

BACKGROUND: India encountered two waves of COVID-19 pandemic with variability in its characteristics and severity. Concerns were raised over the safety of treatment, and higher morbidity was predicted for oncological surgery. The present study was conducted to evaluate and compare the rate of morbidity and mortality in patients undergoing curative surgery for cancer before and during the COVID-19 pandemic. METHOD: The prospectively obtained clinical data of 1576 patients treated between April 2019 and May 2021 was reviewed; of these, 959 patients were operated before COVID-19 and 617 during the pandemic. The data on complications, deaths, confirmed or suspected COVID-19 cases, and COVID-19 infection among health workers (HCW) was extracted. RESULTS: A 35% fall in number of surgeries was seen during the COVID period; significant fall was seen in genital and esophageal cancer. There was no difference in postoperative complication; however, the postoperative mortality was significantly higher. A total of 71 patients had COVID-19, of which 62 were preoperative and 9 postoperative, while 30/38 healthcare workers contracted COVID-19, of which 7 had the infection twice and 3 were infected after two doses of vaccination; there was no mortality in healthcare workers. CONCLUSION: The present study demonstrates higher mortality rates after surgery in cancer patients, with no significant change in morbidity rates. A substantial proportion of HCWs were also infected though there was no mortality among this group. The results suggest higher mortality in cancer patients despite following the guidelines and protocols.


Assuntos
COVID-19 , Influenza Humana , Neoplasias , COVID-19/epidemiologia , Pessoal de Saúde , Humanos , Influenza Humana/epidemiologia , Neoplasias/epidemiologia , Neoplasias/cirurgia , Pandemias , Estudos Retrospectivos
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