Clinical Surgical Oncology最新文献

Background

Two-stage revision remains the gold standard to eradicate deep infection of endoprosthetic replacements following bone tumour removal. We aim to (1) report the infection eradication and limb-salvage rate with two-stage revision surgery and to (2) report the common causative microorganisms.

Patients and methods

A retrospective review of 44 consecutive patients who underwent two-stage revision surgery to treat periprosthetic joint infection was conducted between 1999 and 2018 ​at a tertiary orthopaedic oncology centre from prospectively collated oncology database. Patients’ mean age was 36.1 years (range 12–78 years). The sites of prosthesis were distal femur in 22 patients (50%), proximal femur in five patients (11%), proximal tibia in 16 patients (36%) and total femur with proximal tibia replacement in one patient (2%). The mean duration of follow-up was 96 months (6–251 months).

Results

Infection was eradicated in 26 patients (59%). The infection-free survival was 93% (CI 85–100%) at two years, 78% (66–92%) at five years and 61% (46–80%) at 10 years. 11 patients (25%) had amputation following failure of limb-salvage surgery. The amputation-free survival was at 100% at two years, 89% (79–100%) at five years and 73% (58–92%) at 10 years. Polymicrobial infection was reported in 8 patients (18%) and multi-drug resistance in 14 patients (32%). Coagulase-negative staphylococcus was the commonest microorganism isolated in 21 patients (48%).

Conclusion

Two-stage revision is a reliable approach to achieve limb-salvage. Infected tumour endoprostheses have a high rate of multi-drug resistance and polymicrobial infections. PJI recurrence still has a high rate of amputation.

Background

Cytoreductive surgery (CRS) has been advocated as an additional treatment with survival benefits for advanced gastrointestinal stromal tumor (GIST), especially in patients with responsive disease or focal progression after treatment with imatinib. Ripretinib is a fourth-line therapy for advanced GIST. This single-center pilot study investigated the short-term safety and efficacy of CRS after treatment with ripretinib in selected patients with recurrent or metastatic GIST.

Methods

Medical records of patients with recurrent or metastatic GIST who underwent CRS after ripretinib in the First Affiliated Hospital of Sun Yat-sen University between June 1^st, 2020 and June 1^st, 2022 were retrospectively reviewed. Patients’ clinicopathological characteristics, preoperative treatment and general condition, surgical information, and postoperative management were recorded.

Results

This study included 7 patients who underwent CRS after ripretinib. Radiographic response to ripretinib included partial response (n ​= ​1), stable disease (n ​= ​5), and progressive disease (n ​= ​1). The cumulative size of targeted lesions shrank by 4.8%–45.3% in 5 patients. R0/R1 resection was achieved in 6 (85.7%) patients. Postoperative complications (IId) were reported in 2 (28.6%) patients. There were no delayed post-operative complications. Median follow-up was 11.8 months. Median time-to-progression and median post-operative progression-free survival were not reached. Four patients who did not progress before surgery had no evidence of disease.

Conclusion

Ripretinib combined with CRS is safe and effective in select patients with advanced GIST despite extensive prior therapy.

Purpose

The purpose of our study is to correlate grade of Muscle invasive urothelial carcinoma with prognosis of patients in terms of disease recurrence, metastasis and death.

Materals and methods

We retrieved 48 cases of invasive urothelial carcinomas which on initial presentation had invaded muscularis propria (pT2) or beyond muscularis propria (pT3 or pT4), diagnosed and treated in Shaukat Khanum Memorial hospital Lahore and whose 8–20 years follow up data was available in hospital archives received either as Transurethral resection or cystectomy specimens from 2002 to 2015. Cases diagnosed as primary adenocarcinomas, Neuroendocrine carcinomas or other bladder malignancy other than urothelial carcinoma were excluded.

Results

All 48 pT2 and higher stage patients were high grade. 34/48(70.8%) patients had disease recurrence, 11/48(22.9%) had no recurrence of disease and 3 patients lost to follow up. 43/48(89.5%) patients developed disease metastasis while 5/48(10.4%) did not develop metastatic disease. 39/48(81.2%) died of disease, 3 patients lost to follow up while 6/48(12.5%) patients survived. 5 out of 6 patients who survived had underwent cystectomy while 6 more underwent cystectomy but still died of disease.

Conclusion

Muscle invasion is itself an independent prognostic factor in predicting prognosis of patients and grade of such tumors is not much helpful as either majority of tumors are high grade or even if they are low grade, the prognosis is not good.

Implant breast reconstruction is the most common form of breast reconstruction worldwide. Nipple sparing mastectomy (NSM) has been shown to be oncologically safe in appropriately selected patients and provide superior aesthetic outcomes. Patients with larger ptotic breasts traditionally have not been candidates for nipple sparing mastectomies due to higher rates of nipple and skin flap necrosis, leading to reconstructive failure, and difficulty positioning the nipple areolar complex (NAC) on the breast mound. Patient factors, breast factors and adjuvant oncological therapies should all be taken into account to determine the safest treatment for the patient. Surgical options can be grouped into single staged procedures with skin reducing incisions and direct to implant reconstruction versus staged procedures. This review article aims to highlight risk factors associated with surgical complications and examine the surgical options available to manage this complex problem with their associated outcomes.

Background

Diagnosis of a bone or soft tissue sarcomas is uncommon, and the odds of being present during pregnancy are rare. Hence, the management of sarcoma during pregnancy is more complicated, and to date, no single guideline suits all.

Method

Patients diagnosed with either bone or soft-tissue sarcomas or metastatic sarcoma progression during pregnancy were identified retrospectively between 1983 and 2021 from our orthopaedic oncology database. Demographic and relevant information regarding their management was collected, including maternal and neonatal outcomes, metastatic progression, and survival rates.

Results

A sum of 30 patients diagnosed with sarcoma during pregnancy were included; 16 (53.33%) with bone sarcoma and nine (30%) with soft-tissue sarcoma. Five (16.67%) had metastatic progression of their bone or soft-tissue sarcoma during pregnancy. The median age at diagnosis is 31 years old, youngest at 18 and eldest at 38 years old. Detailed discussions between the sarcoma multidisciplinary team (MDT) and obstetric teams took place throughout each patient's pregnancy follow-up. Seven underwent termination of pregnancy, and six underwent surgical treatment during pregnancy with no maternal or neonatal complications reported. Eight were induced early and four underwent early caesarean section to allow for staging and definitive management without any neonatal complications. Maternal one-year and five-year survival rates for bone sarcomas were 100% and 73.68%, respectively, and 100% and 70%, respectively, for soft-tissue sarcomas. One survived more than five years in the metastatic progression group but succumbed at 7th year due to cerebral metastasis.

Conclusion

The management of bone and soft-tissue sarcomas during pregnancy by sarcoma MDT with collective knowledge and expertise led to good neonatal or maternal outcomes comparable to maternal survival rates of the non-pregnant population. The treatment plan should be based on individual expectations from the patient depending on the gestational period of the pregnancy, the type of pathology, and the location of the sarcoma.

Oligometastasis-directed therapies have shown promise in improving patient outcomes. In this review, we summarized the current understanding of oligometastatic nasopharyngeal carcinoma (NPC) and the role of surgery in its management. Since the majority of clinical evidence supporting the benefit of surgical treatment on oligometastatic NPC is derived from non-controlled, single-arm, observational studies, therefore, findings reported before should be interpreted with caution and it is crucial to identify the right patients for oligometastasectomy to ensure the safety and effectiveness for patients. Future studies investigating the oligometastatic state should employ more robust study designs, such as randomized controlled trials, to guide clinical decision-making. Additionally, a comprehensive understanding of the tumor biology associated with oligometastatic NPC is necessary for developing effective treatment strategies for patients.

Background

Improvements in imaging methods and adjuvant chemotherapy have increased survival rates in children with bone sarcomas up to 80%, therefore long-lasting limb salvage procedures are needed.

Purpose

To describe a case series of pediatric patients who have undergone physeal distraction prior to tumor resection for treatment of metaphyseal malignant bone tumors.

Methods

Between January 2007 to December 2020, 8 patients (5 boys and 3 girls) with a mean age of 7.2 years (2–13), underwent physeal distraction as the first stage of a tumor resection protocol. Six patients had Ewing's sarcoma and two had osteosarcoma. Tumor locations were: proximal tibia (4 cases), distal femur, proximal humerus, distal radius, and distal fibula (1 case each). The affected bones were replaced with cadaver allograft in 6 patients; there was also one fibula autograft and one vascularized fibula graft. Chemotherapy was administered pre- and post-surgery; one patient received adjuvant radiotherapy. Average follow-up was 62.6 months (8–152).

Results

Physeal distraction lasted an average of 10.6 days (3–15); delay to definitive resection was 17 days (range 13–22). Mean length of resection was 10.7 ​cm (range 5–14) and all had negative margins. There were no local recurrences. Three patients suffered disease progression with metastasis and died. Surgical complications included: pin infection (1 patient), surgical site infection (2 patients), allograft fracture (1 patient), and nonunion of the diaphyseal junction (3 patients). Final lower limb length discrepancy was 1.5 ​cm (range 1–2 ​cm). Normal joint function was achieved in 6 patients. The mean MSTS score was 75% (53%–97%).

Conclusions

Physeal distraction technique is an oncologically safe limb salvage procedure with good functional results, and it should be considered in the treatment of metaphyseal pediatric malignant tumors.

Treatment options for metastatic pancreatic ductal adenocarcinoma (mPDAC) patients remain limited, meaning that death within weeks of diagnosis unfortunately remains a common occurrence. Whilst metastases from other malignancy sites, such as colorectal and breast, are amenable to resection in selected patients, consensus remains largely against resection of mPDAC. Without surgical resection, chemotherapy remains the main treatment option and despite advances in regimens, a large proportion of mPDAC patients do not respond to these treatments. Understandably, investigation into whether different genetic subtypes of PDAC can explain the changes in response to chemotherapy have been carried out but as yet has not demonstrated any marked differences between those that do and do not respond to chemotherapy treatment.

This review outlines the emerging role that both the gut and tumour microbiome play in modulating the progression of PDAC, ranging from chemosensitivity to immune infiltration of the tumour This puts the gut microbiome in a promising position as a potential future therapeutic route for mPDAC patients. Possible methods to modulate the gut and tumour microbiome include antibiotics, probiotics and faecal microbiota transplantation (FMT). The next steps should therefore be to focus upon how we can effectively and safely introduce these beneficial bacteria into the gut and tumour microbiome of mPDAC patients through clinical trials.

Introduction

& Aims: Hindquarter amputation (HQA) has a high incidence of post-operative wound complications. We aim to use the HQA procedure as a model to investigate the potential advantages of negative pressure wound therapy (NPWT) on wound healing complications in high-risk pelvic oncology wounds.

Methods

We conducted a retrospective analysis of all patients undergoing HQA between January 2009 and November 2020 ​at a single tertiary centre. 106 patients underwent HQA for sarcoma. 43.4% (46 patients) had NPWT therapy following HQA. We compared the incidence of wound complications necessitating a return to the operating theatre, total incidence of wound infection (according to CDC Surgical site infection guidelines) and local recurrence between patients with and without NPWT.

Results

In the absence of neo-adjuvant radiotherapy, there was no difference in the incidence of wound complications requiring re-operation between the NPWT group and the conventional dressing group (odds ratio [OR], 1.01; p ​= ​0.983, 95% confidence interval [CI], 0.365–2.8). However, the use of NPWT decreased the incidence of reoperation after neo-adjuvant radiotherapy versus conventional dressings [OR], 0.087; p ​= ​0.033, 95% CI, 0.009–0.818). The incidence of wound infection has declined with the increasing use of NPWT between 2009 and 2020. There was no difference in the incidence of local recurrence after two years between patient groups with and without NPWT.

Conclusion

The application of NPWT reduces the incidence of wound complications in high-risk pelvic oncology wounds after neo-adjuvant radiotherapy. We demonstrated a reduction in the incidence of reoperation due to wound complications in patients who received NPWT following HQA.

The liver is the main target organ for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments, to prevent the occurrence of liver metastases, increase the local damage rate of liver metastases, prolong long-term survival, and improve quality of life. The revised Guideline version 2023 includes the diagnosis and followup, prevention, multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, with stateoftheart experience and findings, detailed content, and strong operability.