Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.109
Filtrar
1.
Surg Oncol ; 34: 182-185, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32891326

RESUMO

In the midst of the coronavirus disease 2019 (COVID-19) pandemic, governmental agencies, state medical boards, and healthcare organizations have called for restricting "elective" operations to mitigate the risk of transmission of the virus amongst patients and healthcare providers and to preserve essential resources for potential regional surges of COVID patients. While the fear of delaying surgical care for many of our patients is deeply challenging for us as cancer care providers, we must balance our personal commitment to providing timely and appropriate oncologic care to our cancer patients with our societal responsibility to protect our patients (including those on whom we are operating), co-workers, trainees, families, and community, from undue risks of contracting and propagating COVID-19. Herein, we present guidelines for surgical decision-making and case prioritization developed among all adult disease specialties in the MD Anderson Cancer Center Departments of Surgical Oncology and Breast Surgical Oncology in Houston, Texas.


Assuntos
Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Neoplasias/cirurgia , Seleção de Pacientes , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Betacoronavirus , Neoplasias da Mama/cirurgia , Neoplasias do Sistema Digestório/cirurgia , Neoplasias das Glândulas Endócrinas/cirurgia , Humanos , Melanoma/cirurgia , Tumores Neuroendócrinos/cirurgia , Pandemias , Equipe de Assistência ao Paciente , Neoplasias Peritoneais/cirurgia , Sarcoma/cirurgia , Oncologia Cirúrgica
2.
Rev Col Bras Cir ; 47: e20202528, 2020 Sep 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32901706

RESUMO

OBJECTIVE: to evaluate the impact of probable sarcopenia (PS) on the survival of oncological patients submitted to major surgeries. METHOD: prospective cohort bicentrical study enrolling adult oncological patients submitted to major surgeries at Cancer Hospital and Santa Casa de Misericordia in Cuiabá-MT. The main endpoint was the verification of postoperative death. Demographic and clinical data was collected. PS was defined as the presence of 1) sarcopenia risk assessed by SARC-F questionnaire and 2) low muscle strength measured by dynamometry. The cumulative mortality rate was calculated for patients with either PS or non PS using Kaplan Meier curve. The univariate and multivariate Cox regression model was used to evaluate the association of mortality with various investigated confounding variables. RESULTS: a total of 220 patients with a mean (SD) age of 58.7±14.0 years old, 60.5% males participated of the study. Patients with PS had higher risk to postoperative death (RR=5.35 95%CI 1.95-14.66; p=0,001) and for infectious complications (RR=2.45 95%CI 1.12-5.33; p=0.036). The 60 days mean survival was shorter for patients with PS: 44 (IQR=32-37) vs 58 (IQR=56-59) days (log rank <0,001). The Cox multivariate regression showed that PS was an independent risk factor (HR=5.8 95%CI 1.49-22.58; p=0.011) for mortality. CONCLUSION: patients bearing PS submitted to major oncological surgery have less probability of short term survival and preoperative PS is an independent risk for postoperative mortality.


Assuntos
Neoplasias/cirurgia , Sarcopenia/complicações , Adulto , Idoso , Algoritmos , Brasil/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/mortalidade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Fatores de Risco , Sarcopenia/mortalidade , Inquéritos e Questionários , Taxa de Sobrevida
3.
Am Surg ; 86(9): 1129-1134, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32955355

RESUMO

INTRODUCTION: Using the National Cancer Database (NCDB), we seek to analyze the relationship of patient distance to hospital of treatment on mortality trends after surgery, since patients often travel large distances to referral centers. METHODS: A retrospective cohort study of the NCDB from 2004 to 2013 was performed, and patients with gastrointestinal, melanoma, and head and neck primary site tumors who underwent surgery were included. We excluded cases with no recorded mortality status or distance from the hospital. A multivariable logistic regression was conducted with adjustments for population density, treating facility location, age, race, gender, education, income, insurance, comorbidities (Charlson-Deyo score), days from diagnosis to treatment, positive margin, tumor stage and grade, and lymph or vascular invasion. RESULTS: A total of 1 424 482 patients were included. Overall median distance to hospital was 9.7 miles (range 4.2-23.7 miles); 696 647 (48.91%) of the sample traveled a distance greater than 10 miles to the institution where the procedure was performed. The multivariable regression analysis demonstrated overall lower mortality for those patients travelling a longer distance to care for multiple tumor types, including: liver (OR .87, .77-.99, P = .032), pancreas (OR .82, .76-.89, P < .001), colon (OR .92, .89-.95, P < .001), rectum (OR .90, .83-.96, P = .003), melanoma (OR .83, .79-.88, P < .001), and tumors of the larynx (OR .80, .69-.94, P = .005). DISCUSSION: Increased distance traveled for surgical treatment has a significant correlation with decreased odds of mortality for multiple cancers, highlighting the importance of centralized referral patterns for oncology care.


Assuntos
Neoplasias/mortalidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros , Procedimentos Cirúrgicos Operatórios/métodos , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
4.
Anticancer Res ; 40(10): 5701-5706, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32988895

RESUMO

BACKGROUND/AIM: The simultaneous increase of antioxidant CAT (catalase) enzyme and plasma MDA (malonidialdehyde) concentrations versus the numeric rating scale (NRS) pain score following surgery is unknown. Patients and Methods: The study included 114 patients with gallstone disease and 29 patients in the cancer group. RESULTS: Following surgery, the plasma CAT concentrations increased and plasma MDA concentrations decreased in all patients and especially in cancer patients. The linear mixed model time-effect was statistically significant in CAT and MDA (p<0.001 and p=0.02, respectively). In addition, a significant correlation between NRS pain score values and plasma MDA median concentrations in cancer patients was identified (r=0.430, p<0.001). CONCLUSION: The plasma MDA concentrations decreased and CAT concentrations increased significantly in all patients and especially in cancer patients following surgery. The simultaneous increase of antioxidant CAT enzyme with the decrease of plasma MDA may be an important ROS inhibiting mechanism to help patients return to normal antioxidant-oxidant status.


Assuntos
Catalase/sangue , Cálculos Biliares/sangue , Malondialdeído/sangue , Neoplasias/sangue , Dor/sangue , Antioxidantes/metabolismo , Feminino , Cálculos Biliares/patologia , Cálculos Biliares/cirurgia , Glutationa Peroxidase/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Neoplasias/cirurgia , Estresse Oxidativo/genética , Dor/patologia , Dor/cirurgia , Medição da Dor , Espécies Reativas de Oxigênio/metabolismo , Superóxido Dismutase/sangue
5.
Medicine (Baltimore) ; 99(36): e22057, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899070

RESUMO

INTRODUCTION: Based on existing literature, the juxtaglomerular cell tumor (JGCT) is a rare renal tumor, typically present with hypertension and hypokalemia. Nonfunctioning JGCT, without hypertension or hypokalemia, is extremely rare. PATIENT CONCERNS: Herein, we report a case of nonfunctioning JGCT mimicking renal cell carcinoma. The 29-year-old woman with an unremarkable past medical history presented with a left renal tumor without hypertension or hypokalemia. DIAGNOSIS: Both CT and 18F-FDG-PET/CT suggested a malignancy, possibly renal cell carcinoma. INTERVENTIONS: The tumor was then removed completely via robotic assistant laparoscopic partial nephrectomy; and pathology result was JGCT. Since the patient had no hypertension or hypokalemia, a nonfunctional JGCT was diagnosed. OUTCOMES: The patient recovered uneventfully, and was in good health in 6-months' follow-up period. CONCLUSION: Preoperative identification of JGCT is very difficult due to the lack of specific clinical manifestations. This case teaches us that for young patients with renal tumors whose CT enhancement is not obvious at the early phase, JGCT should be considered as a differential diagnosis. Radical nephrectomy should be avoided for JGCT in consideration of its relatively good prognosis.


Assuntos
Carcinoma de Células Renais/diagnóstico , Sistema Justaglomerular/patologia , Neoplasias Renais/patologia , Neoplasias/cirurgia , Adulto , Assistência ao Convalescente , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18/administração & dosagem , Humanos , Neoplasias Renais/diagnóstico por imagem , Laparoscopia/instrumentação , Nefrectomia/métodos , Nefrectomia/tendências , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Resultado do Tratamento
6.
Cancer Radiother ; 24(6-7): 602-611, 2020 Oct.
Artigo em Francês | MEDLINE | ID: mdl-32855027

RESUMO

Mechanisms of late radio-induced lesions are the result of multiple and complex phenomena, with many entangled cellular and tissue factors. The biological continuum between acute and late radio-induced effects will be described, with firstly a break in homeostasis that leads to cellular redistributions. New insights into late toxicity will finally be addressed. Individual radiosensitivity is a primary factor for the development of late toxicity, and clinicians urgently need predictive tests to offer truly personalized radiation therapy. An update will be made on the various functional and genetic tests currently being validated. The management of radio-induced side effects remains a frequent issue for radiation oncologists, and an update will be made for certain specific clinical situations. Finally, an innovative management for patients with significant side effects after pelvic radiotherapy will be developed, involved mesenchymal stem cell transplantation, with the presentation of the "PRISME" protocol currently open to patients recruitment.


Assuntos
Neoplasias/radioterapia , Lesões por Radiação/terapia , Terapia Combinada , Humanos , Neoplasias/cirurgia , Lesões por Radiação/etiologia , Tolerância a Radiação , Radioterapia/efeitos adversos , Transplante de Células-Tronco , Fatores de Tempo
7.
JCO Glob Oncol ; 6: 1306-1311, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32795195

RESUMO

PURPOSE: The rapid dissemination of information through social media renders a profound lens to evaluate perceptions of emerging topics, especially in the context of a global pandemic. The primary objective of this cross-sectional study was to elucidate trends on social media in the setting of surgical cancer care affected by the COVID-19 pandemic across the globe. METHODS: A public search of Twitter from April 1 to 30, 2020, was conducted, which yielded 996 posts related to COVID-19 and cancer. Two authors (E.J.K. and H.S.) individually reviewed all posts and recorded the post category, engagement, author category, and geographic location. Data were then analyzed through descriptive analyses. Only English-language posts were included, and any noncancer- or non-COVID-related posts were excluded from the analysis. RESULTS: A total of 734 unique authors from 26 different countries wrote 996 relevant posts that averaged 12.0 likes, 4.7 retweets, and 0.5 hashtags per post. Only 2.3% (23 of 996) of posts included a video. Authors of the included tweets most frequently were friends and families of patients (183; 18.4%), academic institutions or organizations (182; 18.3%), and physicians (138; 13.9%). Topics of importance were cancellations of surgeries (299; 40.1%), COVID-19 education (211; 121.2%), and research studies (93; 9.3%). The United Kingdom and the United States made up 81.5% of the cohort, followed by Canada (6.6%) and India (2.4%). Of posts where a specific type of surgery was identified (196), the most common type mentioned was breast cancer (50; 25.5%), followed by lung cancer (37; 18.9%) and urologic cancer (22; 11.2%). CONCLUSION: This analysis provides insight into the resulting impacts of COVID-19 on the global discussion of surgical cancer care.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Neoplasias/cirurgia , Pandemias , Pneumonia Viral , Mídias Sociais , Academias e Institutos/estatística & dados numéricos , Estudos Transversais , Família , Humanos , Percepção , Mídias Sociais/estatística & dados numéricos
8.
World J Surg ; 44(10): 3207-3211, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32766957

RESUMO

BACKGROUND: The COVID-19 pandemic has resulted in a significant decrease in the number of elective cancer operations performed. Cancer patients are felt to be a high-risk group for COVID-19, and therefore, concerns have been raised regarding the safety of operating during this time; however, the potential risk of cancer progression if untreated must also be considered. The aim of this study was therefore to identify the incidence of COVID-19 post-operatively in patients undergoing elective cancer surgery of all types. METHODS: Data were collected on all patients who had an elective therapeutic cancer operation in a single large district general hospital, where standard COVID-19 precautions were in place, between 01/02/2020 and 27/4/2020, Follow-up was for a minimum of 2 weeks post-discharge. The primary outcome was the incidence of COVID-19 during the follow-up period. RESULTS: A total of 621 elective cancer surgeries, from a range of specialities, were performed during the study period, with 55% (n = 341) being done as day cases. None of the patients were positive for COVID-19 post-operatively using reverse transcriptase polymerase chain reaction testing. CONCLUSIONS: The risk of COVID-19 following elective cancer surgery in this group of high-risk patients appears to be minimal in this study. With further precautions being introduced to reduce the risk of transmission of COVID-19, an increase in the rate of elective cancer surgery should be a current priority for all hospitals where possible.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Neoplasias/cirurgia , Segurança do Paciente , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/etiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Fatores de Risco , Reino Unido
12.
Eur Rev Med Pharmacol Sci ; 24(13): 7519-7523, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32706094

RESUMO

OBJECTIVE: Experience of Department of Oncologic and Degenerative Spine Surgery of Rizzoli Orthopaedic Institute during SARS-CoV-2 pandemic lockdown. PATIENTS AND METHODS: Retrospective observational study of surgically treated patients from 09th March 2020 to 04th May 2020. DATA COLLECTED: age, sex, type of disease, neurological status, days of hospitalization, complications and type of discharge. A comparison analysis with same period of the last year was performed in order to evaluate the impact of COVID-19 spreading on daily surgical activity. RESULTS: A total of 107 surgical procedures in 102 patients were performed from 09th March 2020 to 04th May 2020. Analysis showed a statistically significant difference in age, sex, ASIA class and type of treated disease compared to the same period of the last year (p=0.042, 0.006, 0.022 and 0.007, respectively). No statistically significant differences were observed in type of discharge, length of hospitalization and complications (p= 0.447, 0.261 and 0.127, respectively). 3 COVID-19 infections have been identified in hospitalized patients. 1 COVID-19 patient wad admitted from Emergency Department and was managed according to a dedicated path. CONCLUSIONS: Surgical activity was paradoxically increased during SARS-CoV-2 pandemic lockdown through the management of urgent and non-deferrable spinal disease with a low rate (3,9%) of COVID-19 infections.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/cirurgia , Infecções por Coronavirus/virologia , Neoplasias/cirurgia , Neoplasias/virologia , Pneumonia Viral/cirurgia , Pneumonia Viral/virologia , Coluna Vertebral/cirurgia , Coluna Vertebral/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Adulto Jovem
14.
Ann Surg ; 272(2): e112-e117, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32675512

RESUMO

OBJECTIVE: To analyze the impact of COVID-19 emergency on elective oncological surgical activity in Italy. SUMMARY OF BACKGROUND DATA: COVID-19 emergency shocked national health systems, subtracting resources from treatment of other diseases. Its impact on surgical oncology is still to elucidate. METHODS: A 56-question survey regarding the oncological surgical activity in Italy during the COVID-19 emergency was sent to referral centers for hepato-bilio-pancreatic, colorectal, esophago-gastric, and sarcoma/soft-tissue tumors. The survey portrays the situation 5 weeks after the first case of secondary transmission in Italy. RESULTS: In total, 54 surgical Units in 36 Hospitals completed the survey (95%). After COVID-19 emergency, 70% of Units had reduction of hospital beds (median -50%) and 76% of surgical activity (median -50%). The number of surgical procedures decreased: 3.8 (interquartile range 2.7-5.4) per week before the emergency versus 2.6 (22-4.4) after (P = 0.036). In Lombardy, the most involved district, the number decreased from 3.9 to 2 procedures per week. The time interval between multidisciplinary discussion and surgery more than doubled: 7 (6-10) versus 3 (3-4) weeks (P < 0.001). Two-third (n = 34) of departments had repeated multidisciplinary discussion of patients. The commonest criteria to prioritize surgery were tumor biology (80%), time interval from neoadjuvant therapy (61%), risk of becoming unresectable (57%), and tumor-related symptoms (52%). Oncological hub-and-spoke program was planned in 29 departments, but was active only in 10 (19%). CONCLUSIONS: This survey showed how surgical oncology suffered remarkable reduction of the activity resulting in doubled waiting-list. The oncological hub-and-spoke program did not work adequately. The reassessment of healthcare systems to better protect the oncological path seems a priority.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Oncologia/organização & administração , Neoplasias/cirurgia , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Itália/epidemiologia , Pandemias , Seleção de Pacientes , Estudos Prospectivos
17.
Rev Col Bras Cir ; 47: e20202601, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32638914

RESUMO

OBJECTIVE: to suggest a script for surgical oncology assistance in COVID-19 pandemic in Brazil. METHOD: a narrative review and a "brainstorming" consensus were carried out after discussion with more than 350 Brazilian specialists and renowned surgeons from Portugal, France, Italy and United States of America. RESULTS: consensus on testing for COVID-19: 1- All patients to be operated should be tested between 24 and 48 before the procedure; 2- The team that has contact with sick or symptomatic patients should be tested; 3 - Chest tomography was suggested to investigate pulmonary changes. Consensus on protection of care teams: 1 - Use of surgical masks inside the hospitals. Use of N95 masks for all professionals in the operating room; 2 - Selection of cases for minimally invasive surgery and maximum pneumoperitoneal aspiration before removal of the surgical specimen; 2 - Optimization of the number of people in teams, with a minimum number of professionals, reducing their occupational exposure, the consumption of protective equipment and the circulation of people in the hospital environment; 3 - Isolation of contaminated patients. Priority consensus: 1- Construction of service priorities; 2 - Interdisciplinary discussion on minimally invasive or conventional pathways. CONCLUSION: the Brazilian Society of Surgical Oncology (BSSO) suggests a script for coping with oncological treatment, remembering that the impoundment in the assistance of these cases, can configure a new wave of overload in health systems.


Assuntos
Betacoronavirus , Consenso , Infecções por Coronavirus/epidemiologia , Neoplasias/cirurgia , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , Infecções por Coronavirus/diagnóstico , Pessoal de Saúde , Humanos , Cooperação Internacional , Itália , Pulmão/diagnóstico por imagem , Máscaras , Procedimentos Cirúrgicos Minimamente Invasivos , Neoplasias/complicações , Exposição Ocupacional/prevenção & controle , Pandemias , Paris , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Portugal , Cuidados Pré-Operatórios , Manejo de Espécimes , Washington
19.
J Cancer Res Ther ; 16(2): 350-355, 2020.
Artigo em Inglês | MEDLINE | ID: covidwho-455553

RESUMO

The coronavirus disease 2019 (COVID-19) has become a global pandemic since its outbreak in December 2019, which posed a threat to the safety and well-being of people on a global scale. Cancer patients are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and their critical morbidity and case fatality rates are high. The ablation expert committee of the Chinese Society of Clinical Oncology compiled corresponding expert recommendations. These recommendations summarize the preventive measures and management of tumor ablation treatment in medical institutions, including outpatient clinics, oncology wards, ablation operation room, and postablation follow-ups in accordance with the guidelines and protocols imposed by the National Health Commission of the People's Republic of China and the experience in management and prevention according to various hospitals. This consensus aims to reduce and prevent the spread of SARS-CoV-2 and its cross-infection between cancer patients in hospitals and provide regulatory advice and guidelines for medical personnel.


Assuntos
Betacoronavirus , Ablação por Cateter/efeitos adversos , Infecções Relacionadas a Cateter/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças , Neoplasias/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto/normas , Infecções Relacionadas a Cateter/virologia , China/epidemiologia , Congressos como Assunto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Humanos , Neoplasias/patologia , Neoplasias/virologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA