Clinical Surgical Oncology最新文献

With a logistical advantage, new wire-free procedures have simplified implantation and retrieval of non-palpable breast cancers with enhanced clinical outcomes. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non-radiation localisation techniques, such as Magseed, Radiofrequency identification TAG and Savi-scout reflector from published literature over a 3 year period. The study, following PRISMA guidelines, identified 26 studies from 2020 to 2022 involving 6275 innovative agents, analyzing three groups. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10–15%) and a re-excision rate of 11.29% (95%CI, 9–14%) for all three wireless group combined whereas studies that compare them with wire showed higher positive margin rate of 14.87% (95% CI, 12–18%) and re-excision rate of 16.23% (95% CI, 14–18%) for wire-guided localisation. Compared with odd's ratio, there was no statistical significance for margin involvement between WGL and novel agents OR 0.870 95% CI (0.707–1.071); z=-1.310 p=0.190; however, there was a statistical significance with fewer re-excision for wireless group OR 0.791; 95% CI (0.648–0.965); z=-2.309 p=0.021. In sub group analysis with kruskal-wallis test, there was no statistical significance between each group for both margin-positivity (p=0.797; Chi² 0.605) and re-excision rates (p=0.464; chi²1.535). Consolidated insertion and retrieval success for wireless group were 98.13% and 99.13% respectively whereas WGL had a similar retrieval success rate of 99.63%. To establish the best localisation approach, future prospective randomised trials will be required to assess quantitative cost-effective analyses.

Purpose

Methods

Results

Conclusions

Purpose

Management of obstructive colorectal cancer (OCRC) can be achieved through either emergent resection of the primary tumor (single operation), or the creation of temporary decompression stoma or self-expandable metallic stents (SEMS) insertion followed by tumor resection (staged procedure). The aim of the study was to compare the short-term outcomes of single and staged surgery in acute non-metastatic elderly OCRC patients.

Methods

Twenty-two elderly patients (aged over 75) scheduled to receive either single surgery (n ​= ​14) or staged surgery (n ​= ​8) for the management of acute OCRC were enrolled from 2012 to 2017. The stoma rate, postoperative complications were compared.

Results

The stoma rate was 42.9% in single surgery group and 25% in SEMS group. No difference was found in the rate of total complications (50% vs 25%, P ​= ​0.25). In the single surgery group, four patients (28.6%) experienced SSIs, and pneumonia occurred in three patients (21.4%), whereas none of the patient in staged surgery had infection related complication. Overall, the rate of infection related complication in single surgery group (50%) was significantly higher than that in staged surgery group (P ​= ​0.015).

Conclusions

Either single or stage surgery is feasible for acute elderly OCRC patients. However, single surgery is associated with significant increase in infection related complication.

Background

Hyperbilirubinemia is known to increase morbidity and mortality in patients undergoing liver resection for cholangiocarcinoma (CCA). Preoperative biliary drainage (PBD) in patients who have no acute cholangitis or require portal vein embolization is still debatable. The goal of this study is to investigate how PBD affects the surgical results after liver resection.

Methods

Between October 2013 and December 2020, CCA patients presenting with obstructive jaundice who underwent liver resection were retrospectively reviewed. The pre-operative, peri-operative and post-operative characteristics were extracted. To compare the outcomes of the PBD and direct surgery groups, propensity score matching analysis (PSM) and multivariable risk regression analysis were used to analyze.

Results

A total of 355 patients were enrolled, with 99 of them undergoing PBD. At diagnosis, those with PBD showed significantly greater bilirubin levels than those without (20.7 vs 9.6 ​mg/dL, p ​< ​0.001). However, after drainage, the bilirubin level in the PBD group was lower than the direct surgery group (5.5 vs 9.6 ​mg/dL, p ​< ​0.001). Overall postoperative morbidity and mortality were unaffected by PBD in full patient cohort. However, after PSM, PBD was associated with decreased major post-hepatectomy liver failure (PHLF) and 90-day mortality rate, (20.3% vs 39.24%, p ​= ​0.014 and 3.8% vs 22.8%, p ​= ​0.001, respectively). At multivariable analysis of PSM patient cohort, PBD was associated with decreased major post-operative complication (RR 0.64, 95%CI 0.419–0.986), PHLF (RR 0.40, 95%CI 0.227–0.705) and 90-day mortality (RR 0.21, 95%CI 0.086–0.629).

Conclusion

PBD was associated with decreased post-hepatectomy liver failure and postoperative mortality after liver resection in jaundiced CCA patients.

Introduction

For patients affected by extremity or trunk soft-tissue sarcomas (STS) large resections might be needed to achieve negative margins. This is a common scenario especially in locally advanced or recurrent tumors often within a pre-irradiated field. The objective of this study was to evaluate the results of free-flap reconstructions (FFR) after sarcoma surgery.

Objective

The endpoints were surgical results, quality of surgical margins and oncological outcome.

Methods

Retrospective analysis of patients with extremity and trunk STS with free-flap reconstruction between 2008 and 2022. Demographic and tumor data, perioperative treatment, margin status, morbidity and evolution were evaluated.

Results

Of 467 patients, 25 (5.35%) required 26 free-flap reconstructions. Surgery was performed on an irradiated field in 8 (32%) patients. Reconstructions were mostly needed for distal lower extremity resections and the most common type of flap used was antero-lateral tight (ALT) flap. No R2 resections were performed. R0 and R1 resections were achieved in 22 (84.6%) and 4 (15.4%), respectively. All R1 resections were preplanned positive along a preserved critical structure. Surgical morbidity rate was 26% (7/26) and the re-operation rate was 15% (4/26) with 7.7% flap losses (2/26). At a median follow-up of 38 months, 7 (28%) patients presented local recurrences.

Conclusion

In a referral sarcoma center, having a multidisciplinary surgical team capable of complex resections and reconstructions is of utmost importance for a correct and integral surgical planning. This allows optimal oncologic resections with acceptable morbidity.

Background

Liposarcoma is the most common soft tissue sarcoma, which comprises around 20% of soft tissue sarcoma. While diverse therapeutic approaches exist for liposarcoma, the primary goal remains the achievement of effective local disease control. Wide resection of liposarcoma is the cornerstone of treatment. Radiotherapy is often employed as an adjuvant measure to enhance the local disease control. At Hospital Kuala Lumpur, the treatment protocol includes R0 resection and followed by adjuvant radiotherapy. This study aims to review the demographic characteristic of liposarcoma patients and evaluate the efficacy of their treatment based on the treatment protocol.

Method and material

This is a retrospective cohort study. A total of 72 patients (male/female ​= ​43/29) were included in this study. Recorded parameters included the histologic subtype, tumor location, treatment modality, resection margin, radiotherapy status, and occurrences of local recurrence and metastasis.

Result

Histopathological examination revealed a varied spectrum of liposarcoma subtypes, with the predominant subtype being atypical lipomatous tumor (n ​= ​35), followed by myxoid liposarcoma (n ​= ​32), two cases of dedifferentiated liposarcoma, and three cases of pleomorphic liposarcoma. Of these patients, 69 underwent resection, while three necessitated amputations. Total 62 achieving negative and 10 cases had R1 margins. Adjuvant radiotherapy was administered in 58 cases. Overall, the local recurrence was observed in only six cases.

Conclusion

This study emphasizes that achieving R0 resection is the fundamental approach in the treatment of liposarcoma and is able to minimize the risk of local recurrence.

Introduction

The diagnosis and treatment of breast cancer have tremendously changed in the last decades improving the survival and quality of life of the patients. Adherence to clinical practice guidelines in oncology significantly improves patients’ recurrence-free and overall survival. Nowadays, no national registry/database for breast cancer patients is available. This study aims to perform a nationwide analysis of the breast cancer guidelines adherence in Bulgaria, in particular regarding the diagnostic methods for histological confirmation and the types of radical surgery performed using an artificial intelligence (AI) powered software.

Materials and methods

We analyzed data from January 2019 to August 2023 nationwide using the platform with access to anonymized medical information from Bulgaria's leading territorial oncology hospitals. A total of 13,790 patients met the inclusion criteria.

Results

The gold standard diagnostic tool, CNB, was done in 5427 patients (39.35%), an intraoperative frozen section was performed as a method for confirmation of breast cancer in 6257 patients (45.37%) and the standard technique for lymph node evaluation, sentinel lymph node biopsy, was done in 357 patients (2.99%).

Conclusion

In Bulgaria, there are still difficulties in achieving comparable rates of core-needle biopsy for the diagnosis of breast cancer and we have demonstrated unacceptably high rates of frozen section use for intraoperative diagnosis of breast cancer. Breast-conserving surgery is widely accepted and available, but still, the rates are lower than usual for developed countries. The rates of sentinel lymph node biopsy, however, are unreasonably low.