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In orthopaedic oncology, surgical planning and intraoperative execution errors may result in positive tumor resection margins that increase the risk of local recurrence and adversely affect patients' survival. Computer navigation and 3D-printed resection guides have been reported to address surgical inaccuracy by replicating the surgical plans in complex cases. However, limitations include surgeons' attention shift from the operative field to view the navigation monitor and expensive navigation facilities in computer navigation surgery. Practical concerns are lacking real-time visual feedback of preoperative images and the lead-time in manufacturing 3D-printed objects. Mixed Reality (MR) is a technology of merging real and virtual worlds to produce new environments with enhanced visualizations, where physical and digital objects coexist and allow users to interact with both in real-time. The unique MR features of enhanced medical images visualization and interaction with holograms allow surgeons real-time and on-demand medical information and remote assistance in their immediate working environment. Early application of MR technology has been reported in surgical procedures. Its role is unclear in orthopaedic oncology. This review aims to provide orthopaedic tumor surgeons with up-to-date knowledge of the emerging MR technology. The paper presents its essential features and clinical workflow, reviews the current literature and potential clinical applications, and discusses the limitations and future development in orthopaedic oncology. The emerging MR technology adds a new dimension to digital assistive tools with a more accessible and less costly alternative in orthopaedic oncology. The MR head-mounted display and hand-free control may achieve clinical point-of-care inside or outside the operating room and improve service efficiency and patient safety. However, lacking an accurate hologram-to-patient matching, an MR platform dedicated to orthopaedic oncology, and clinical results may hinder its wide adoption. Industry-academic partnerships are essential to advance the technology with its clinical role determined through future clinical studies.
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OBJECTIVES: The objective was to submit our first experience in endoscopic inguinal lymphadenectomy (EIL), evaluate the feasibility of the procedure and carry out a review of the literature. MATERIAL AND METHODS: A 41-year-old patient was diagnosed with penile cancer with squamous cell carcinoma pT2G1 pathology, with no palpable inguinal lymph nodes. A bilateral inguinal lymphadenectomy was performed with preservation of the saphenous vein, conventional left and endoscopic right procedures. The perioperative data is presented and that obtained is discussed in the literature. RESULTS: The total time was 270 minutes, 180 for endoscopic and 90 for conventional procedures. Blood loss was minimal in both cases. Fifteen lymph nodes were dissected on the endoscopic side, and 17 in the conventional side, the latter with more pain and devitalised skin flap. CONCLUSIONS: EIL for penile cancer is feasible and there is less morbidity with an early recovery. The literature is not conclusive on the indication of EIL.
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OBJECTIVES: Determine the 5-year survival rate, prognostic factors, postoperative morbidity and mortality rates and the accuracy of the Maruyama computer program.MATERIAL and METHODS: This prospective study evaluated 32 patients with advanced gastric adenocarcinoma underwent radical gastrectomy with D2 (n= 13) or D3-D4 (n= 19) extended lymphadenectomy, at Belen Hospital, Trujillo, Peru, from 1990 to 1998.RESULTS: Gastric cancer patients (20 F: 12 M) had a median age of 55.4 + 14.5 years (range, 20 to 76 years). In D3-D4 patients there was a significant increased in the number of cases with lesions type Borrmann III-IV (p= 0.03), N3 (p= 0.04), M1 (p= 0.04) and undifferentiated type in histology (p= 0.04) compared with D2 cases. The 5-year survival in curative and palliative surgery was of 48.9% and 10.7%, respectively (p<0.001). The 5-year survival in D2 surgery was of 42.7% and in D3-D4 was of 27.6% (p= NS). The 5-year survival rate in the total series was of 30.9%. Location (p< 0.05) and size of the tumor (p< 0.01), distant metastases (p< 0.05), clinical stage (p< 0.05), Borrmann's type (p< 0.05) and curability (p< 0.05) were factors that influenced long-term survival. The morbidity rate with D2 and D3-D4 disection was of 30.7% and 57.8%, respectively (p= NS), and in the total series was of 46.8%. The mortality rate in this series was of 3.1%. The prediction of the lymphs node metastases with the computer program was highly exact (13-16: 100%, 7-12: 75%, 1-6: 66%).CONCLUSIONS: Extended lymphadenectomy had a low surgical mortality but high morbidity and permitted that one third of advanced gastric cancer patients underwent surgery obtains 5-year survival.
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The present retrospective study evaluated 180 patients with resectable (Group I ) and 128 patients with unresectable (Group II) gastric carcinoma at Belen Hospital, Trujillo, Peru, from 1966 to 1998, with the aim to identify the clinical and pathological features, actuarial survival rate and surgical morbidity and mortality rates of both groups. The mean age of the total series was of 58.3 + 14.8 years (range, 18 to 85 years). The most frequent symptoms in both groups were abdominal pain (89.4% and 94.5% respectively) and the most common sign was pallor (62.8% and 54.5% respectively). The unresectable cases presented a higher frequency of palpable mass (p<0.001), upper two thirds neoplasms (p=0.0032), T4 lesions (p<0.001), distant metastasis (p<0.001), stage IV (p<0.001), hepatic metastasis (p<0.001) and peritoneal metastasis (p<0.001), compared with resectable gastric cancer patients. The total surgical mortality rate was of 19.5% (Group I: 12.1%, Group II: 28.9%). The most frequent complications were pneumonia (Group I: 8.9%, Group II: 7.8%) and surgical wound infection (Group I: 10.6%, Group II: 3.9%). In Group II, the exploratory laparotomy was carried out in 82 cases, whilst 46 cases underwent gastroenterostomy (n=34), gastrostomy (n=6), gastrectomy by exclusion (n=5) and ileotransversoanastomosis (n=1). The 5-year survival rate in resectable patients was of 18.5% and in unresectable cases the survival rate at 12 and 36 months was of 9% and 0% respectively. The early diagnosis of this neoplasm, mainly in high risk patients, would offer better possibilities of an opportune treatment.