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Treatment Outcome of Carcinoma Vulva Ten-Year Experience from a Tertiary Cancer Centre in South India. 南印度一家三级癌症中心的外阴癌十年治疗结果
IF 1.5 Q4 ONCOLOGY Pub Date : 2017-01-01 Epub Date: 2017-12-14 DOI: 10.1155/2017/7161437
Sakthiushadevi Jeevarajan, Amudhan Duraipandian, Rajkumar Kottayasamy Seenivasagam, Subbiah Shanmugam, Rajaraman Ramamurthy

Background: Carcinoma vulva is a rare disease accounting for 1.3% of all gynaecological malignancies. The present study is a 10-year retrospective review of our experience of the surgical options, morbidity, failure pattern, and survival for invasive carcinoma vulva.

Materials and methods: Retrospective analysis of case records of 39 patients who underwent surgery for invasive vulval cancer between 2004 and 2013 in the Department of Surgical Oncology at the Government Royapettah Hospital, Chennai.

Results: The median age was 55 years. Radical vulvectomy was the preferred surgery. 31 patients underwent lymphadenectomy. Seroma formation and groin skin necrosis were the most common postoperative complications. With a median follow-up of 32 months, 8 patients (20.5%) developed recurrence (systemic = 1, regional = 4, and local = 3). The estimated 5-year disease-free survival (DFS) was 65.4% and the overall survival (OS) was 85.1%. On univariate analysis, stage and lymph node involvement significantly affected OS. Nodal involvement with extracapsular spread (ECS) significantly affected both DFS and OS.

Conclusion: The treatment of carcinoma vulva should be individualized with multidisciplinary cooperation. The paucity of data, especially from India, necessitates the need for more studies, preferably multicentric, keeping in mind the low prevalence.

背景:外阴癌是一种罕见疾病,占所有妇科恶性肿瘤的 1.3%:外阴癌是一种罕见疾病,占所有妇科恶性肿瘤的 1.3%。本研究是一项为期 10 年的回顾性研究,回顾了我们在外阴浸润癌的手术方案、发病率、失败模式和存活率方面的经验:回顾性分析钦奈政府罗亚佩塔医院肿瘤外科 2004 年至 2013 年期间 39 例外阴浸润癌手术患者的病例记录:中位年龄为 55 岁。外阴根治术是首选手术。31名患者接受了淋巴结切除术。血清肿形成和腹股沟皮肤坏死是最常见的术后并发症。中位随访时间为32个月,8名患者(20.5%)复发(全身复发1例,区域复发4例,局部复发3例)。估计5年无病生存率(DFS)为65.4%,总生存率(OS)为85.1%。单变量分析显示,分期和淋巴结受累对 OS 有明显影响。结节累及囊外扩散(ECS)对DFS和OS均有显著影响:结论:外阴癌的治疗应在多学科合作下进行个体化治疗。由于数据匮乏,尤其是来自印度的数据,因此有必要开展更多的研究,最好是多中心研究,同时考虑到发病率较低的问题。
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引用次数: 0
Invasive Candida Infection after Upper Gastrointestinal Tract Surgery for Gastric Cancer. 胃癌上消化道手术后侵袭性念珠菌感染。
IF 1.5 Q4 ONCOLOGY Pub Date : 2017-01-01 Epub Date: 2017-11-06 DOI: 10.1155/2017/6058567
Evgeni Brotfain, Gilbert Sebbag, Michael Friger, Boris Kirshtein, Abraham Borer, Leonid Koyfman, Dmitry Frank, Yoav Bichovsky, Jochanan G Peiser, Moti Klein

Upper gastrointestinal tract (GIT) surgical procedures are more likely to cause nosocomial Candida peritonitis than lower GIT procedures and they thus constitute an independent risk factor for mortality. Because of the severity of postsurgical fungal infections complications, intensivists and surgeons need to be extremely aware of their clinical importance in critically ill postsurgical intensive care unit (ICU) patients. We analyzed the clinical and microbiological data of 149 oncologic patients who were hospitalized in the ICU at Soroka Medical Center between January 2010 and January 2015 after undergoing upper GIT surgery for gastric cancer. Invasive fungal infections related to secondary peritonitis following oncologic upper GIT surgery had a higher mortality rate than patients with nonfungal postoperative infectious complications. The presence of gastroesophageal junction leakage and advanced age were found to be independent risk factors for invasive fungal infection after oncologic upper GIT surgery.

上消化道(GIT)手术比下消化道手术更容易引起院内念珠菌性腹膜炎,因此它们构成了死亡的独立危险因素。由于术后真菌感染并发症的严重性,重症监护医师和外科医生需要非常清楚其在重症监护病房(ICU)患者中的临床重要性。我们分析了2010年1月至2015年1月在Soroka医疗中心ICU住院的149例肿瘤患者的临床和微生物学资料,这些患者接受了上消化道手术治疗胃癌。肿瘤上消化道手术后继发腹膜炎相关的侵袭性真菌感染的死亡率高于非真菌术后感染并发症的患者。发现胃食管交界部渗漏和高龄是肿瘤上消化道手术后侵袭性真菌感染的独立危险因素。
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引用次数: 7
The Role of [18F]FDG-PET/CT in Predicting Malignant Transformation of Plexiform Neurofibromas in Neurofibromatosis-1 [18F]FDG-PET/CT在预测神经纤维瘤病丛状神经纤维瘤恶性转化中的作用[j]
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-12-12 DOI: 10.1155/2016/6162182
D. Tovmassian, Muzib Abdul Razak, K. London
Background. Malignant peripheral nerve sheath tumours (MPNSTs) are difficult to diagnose and treat and contribute to significant morbidity and mortality for patients with Neurofibromatosis-1 (NF-1). FDG-PET/CT is being increasingly used as an imaging modality to discriminate between benign and malignant plexiform neurofibromas. Objectives. To assess the value of FDG-PET/CT in differentiating between benign and malignant peripheral nerve lesions for patients with Neurofibromatosis-1. Methods. A systematic review of the literature was performed prior to application of stringent selection criteria. Ultimately 13 articles with 796 tumours were deemed eligible for inclusion into the review. Results. There was a significant difference between mean SUVmax of benign and malignant lesions (1.93 versus 7.48, resp.). Sensitivity ranged from 89 to 100% and specificity from 72 to 94%. ROC analysis was performed to maximise sensitivity and specificity of SUVmax cut-off; however no clear value was identified (range 3.1–6.1). Significant overlap was found between the SUVmax of benign and malignant lesions making differentiation of lesions difficult. Many of the studies suffered from having a small cohort and from not providing histological data on all lesions which underwent FDG-PET/CT. Conclusion. This systematic review is able to demonstrate that FDG-PET/CT is a useful noninvasive test for discriminating between benign and malignant lesions but has limitations and requires further prospective trials.
背景。恶性周围神经鞘肿瘤(MPNSTs)难以诊断和治疗,并导致神经纤维瘤病-1 (NF-1)患者的显著发病率和死亡率。FDG-PET/CT越来越多地被用作区分良性和恶性丛状神经纤维瘤的成像方式。目标。目的探讨FDG-PET/CT对神经纤维瘤病患者周围神经良恶性病变的鉴别价值。方法。在应用严格的选择标准之前,对文献进行了系统的回顾。最终,13篇涉及796个肿瘤的文章被认为有资格纳入该综述。结果。良性和恶性病变的平均SUVmax差异有统计学意义(分别为1.93和7.48)。敏感性为89% ~ 100%,特异性为72% ~ 94%。进行ROC分析以最大化SUVmax截止值的敏感性和特异性;然而,没有明确的数值(范围3.1-6.1)。良性和恶性病变的SUVmax之间存在明显的重叠,使得病变的鉴别变得困难。许多研究的缺点是队列小,而且没有提供所有经FDG-PET/CT检查的病变的组织学数据。结论。本系统综述能够证明FDG-PET/CT是一种有用的非侵入性检测方法,用于区分良性和恶性病变,但存在局限性,需要进一步的前瞻性试验。
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引用次数: 49
Preoperative Radiation Therapy Followed by Reexcision May Improve Local Control and Progression-Free Survival in Unplanned Excisions of Soft Tissue Sarcomas of the Extremity and Chest-Wall 术前放疗后再切除可改善肢体和胸壁软组织肉瘤非计划切除的局部控制和无进展生存
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-10-10 DOI: 10.1155/2016/5963167
H. Saeed, D. King, C. Johnstone, J. Charlson, D. Hackbarth, J. Neilson, M. Bedi
Background. The management for unplanned excision (UE) of soft tissue sarcomas (STS) has not been established. In this study, we compare outcomes of UE versus planned excision (PE) and determine an optimal treatment for UE in STS. Methods. From 2000 to 2014 a review was performed on all patients treated with localized STS. Clinical outcomes including local recurrence-free survival (LRFS), progression-free survival (PFS), and overall survival (OS) were evaluated using the Kaplan-Meier estimate. Univariate (UVA) and multivariate (MVA) analyses were performed to determine prognostic variables. For MVA, Cox proportional hazards model was used. Results. 245 patients were included in the analysis. 14% underwent UE. Median follow-up was 2.8 years. The LR rate was 8.6%. The LR rate in UE was 35% versus 4.2% in PE patients (p < 0.0001). 2-year PFS in UE versus PE patients was 4.2 years and 9.3 years, respectively (p = 0.08). Preoperative radiation (RT) (p = 0.01) and use of any RT for UE (p = 0.003) led to improved PFS. On MVA, preoperative RT (p = 0.04) and performance status (p = 0.01) led to improved PFS. Conclusions. UEs led to decreased LC and PFS versus PE in patients with STS. The use of preoperative RT followed by reexcision improved LC and PFS in patients who had UE of their STS.
背景。软组织肉瘤(STS)的非计划切除(UE)的处理尚未建立。在这项研究中,我们比较了UE与计划切除(PE)的结果,并确定了STS中UE的最佳治疗方法。方法。从2000年到2014年,对所有接受局限性STS治疗的患者进行了回顾。临床结果包括局部无复发生存期(LRFS)、无进展生存期(PFS)和总生存期(OS)使用Kaplan-Meier估计进行评估。进行单因素(UVA)和多因素(MVA)分析以确定预后变量。对于MVA,采用Cox比例风险模型。结果:245例患者纳入分析。14%接受了UE。中位随访时间为2.8年。LR率为8.6%。UE患者的LR率为35%,PE患者为4.2% (p < 0.0001)。UE与PE患者的2年PFS分别为4.2年和9.3年(p = 0.08)。术前放疗(RT) (p = 0.01)和使用任何RT治疗UE (p = 0.003)均可改善PFS。在MVA上,术前RT (p = 0.04)和运动状态(p = 0.01)改善了PFS。结论。与PE相比,UEs导致STS患者LC和PFS降低。术前放疗后再切除可改善STS患者的LC和PFS。
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引用次数: 21
Neoadjuvant Therapy in Differentiated Thyroid Cancer 分化型甲状腺癌的新辅助治疗
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-09-22 DOI: 10.1155/2016/3743420
Rajan P. Dang, D. McFarland, V. Le, Nadia Camille, B. Miles, M. Teng, E. Genden, K. Misiukiewicz
Objectives. Invasion of differentiated thyroid cancer (DTC) into surrounding structures can lead to morbid procedures such as laryngectomy and tracheal resection. In these patients, there is a potential role for neoadjuvant therapy. Methods. We identified three studies involving the treatment of DTC with neoadjuvant chemotherapy: two from Slovenia and one from Japan. Results. These studies demonstrate that in selected situations, neoadjuvant chemotherapy can have a good response and allow for a more complete surgical resection, the treatment of DTC. Additionally, the SELECT trial shows that the targeted therapy lenvatinib is effective in the treatment of DTC and could be useful as neoadjuvant therapy for this disease due to its short time to response. Pazopanib has also demonstrated promise in phase II data. Conclusions. Thus, chemotherapy in the neoadjuvant setting could possibly be useful for managing advanced DTC. Additionally, some of the new tyrosine kinase inhibitors (TKIs) hold promise for use in the neoadjuvant setting in DTC.
目标。分化型甲状腺癌(DTC)侵袭周围结构可导致诸如喉切除术和气管切除术等病态手术。在这些患者中,新辅助治疗有潜在的作用。方法。我们确定了三项涉及新辅助化疗治疗DTC的研究:两项来自斯洛文尼亚,一项来自日本。结果。这些研究表明,在特定的情况下,新辅助化疗可以有良好的反应,并允许更完整的手术切除,治疗DTC。此外,SELECT试验表明,靶向治疗lenvatinib治疗DTC是有效的,由于其反应时间短,可作为该疾病的新辅助治疗。Pazopanib在II期数据中也显示出前景。结论。因此,新辅助化疗可能对晚期DTC的治疗有用。此外,一些新的酪氨酸激酶抑制剂(TKIs)有望用于DTC的新辅助治疗。
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引用次数: 14
A Structured Assessment to Decrease the Amount of Inconclusive Endometrial Biopsies in Women with Postmenopausal Bleeding 减少绝经后出血妇女不确定子宫内膜活检数量的结构化评估
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-03-13 DOI: 10.1155/2016/3039261
M. Breijer, N. Visser, N. van Hanegem, A. V. D. van der Wurff, B. Opmeer, H. V. van Doorn, B. Mol, J. Pijnenborg, A. Timmermans
Objective. To determine whether structured assessment of outpatient endometrial biopsies decreases the number of inconclusive samples. Design. Retrospective cohort study. Setting. Single hospital pathology laboratory. Population. Endometrial biopsy samples of 66 women with postmenopausal bleeding, collected during the usual diagnostic work-up and assessed as insufficient for a reliable histological diagnosis. Methods. Endometrial biopsy samples were requested from the pathology laboratories. The retrieved samples were systematically reassessed by a single pathologist specialized in gynecology. Main Outcome Measure. Disagreement between initial assessment and conclusion after structured reassessment. Results. We retrieved 36 of 66 endometrial biopsy samples from six different pathology laboratories. Structured reassessment of the retrieved samples by a single pathologist specialized in gynecology did not change the conclusion in 35 of the 36 samples. The remaining sample contained a large amount of endometrial tissue and the diagnosis at reassessment was endometrial hyperplasia without atypia. All other samples contained insufficient material for a reliable diagnosis. Conclusion. A structured reassessment of endometrial biopsies samples, which were classified as inconclusive due to insufficient material, did not change the conclusion. Although it might be helpful for pathologists to have diagnostic criteria for adequacy and/or inadequacy of an endometrial biopsy sample, the gain in efficiency is likely to be small.
目标。确定门诊子宫内膜活检的结构化评估是否减少了不确定样本的数量。设计。回顾性队列研究。设置。单一医院病理实验室。人口。66例绝经后出血妇女的子宫内膜活检样本,在常规诊断检查中收集,评估为不足以进行可靠的组织学诊断。方法。要求病理实验室提供子宫内膜活检样本。检索到的样本由一位专门从事妇科的病理学家系统地重新评估。主要结果测量。有组织的重新评估后,初步评估与结论不一致。结果。我们从六个不同的病理实验室提取了66个子宫内膜活检样本中的36个。由一名专门从事妇科的病理学家对检索到的样本进行结构化重新评估,36个样本中有35个样本的结论没有改变。剩余样本含有大量子宫内膜组织,重新评估诊断为子宫内膜增生,无异型性。所有其他样本所含的材料不足以作出可靠的诊断。结论。对子宫内膜活检样本的结构化重新评估,由于材料不足被归类为不确定,并没有改变结论。虽然对病理学家来说,子宫内膜活检样本是否充足和/或不充足的诊断标准可能是有帮助的,但效率的提高可能很小。
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引用次数: 8
Prognostic Relevance of the Peritoneal Surface Disease Severity Score Compared to the Peritoneal Cancer Index for Colorectal Peritoneal Carcinomatosis 腹膜表面疾病严重程度评分与结直肠癌腹膜癌指数的预后相关性
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-02-23 DOI: 10.1155/2016/2495131
J. Ng, W. Ong, C. Chia, G. Tan, K. Soo, M. Teo
Background. Peritoneal Carcinomatosis Index (PCI) is a widely established scoring system that describes disease burden in isolated colorectal peritoneal carcinomatosis (CPC). Its significance may be diminished with complete cytoreduction. We explore the utility of the recently described Peritoneal Surface Disease Severity Score (PSDSS) and compare its prognostic value against PCI. Methods. The endpoints were overall survival (OS), progression-free survival (PFS), and survival less than 18 months (18 MS). Results. Fifty patients underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for CPC from 2003 to 2014, with 98% achieving complete cytoreduction. Median OS was 28.8 months (95% CI, 18.0–39.1); median PFS was 9.4 months (95% CI, 7.7–13.9). Univariate analysis showed that higher PCI was significantly associated with poorer OS (HR 1.11; 95% CI, 1.03–1.20) and PFS (HR 1.09; 95% CI, 1.03–1.14). Conversely, PSDSS was not associated with either endpoint. Multivariate analysis showed that PCI, but not PSDSS, was predictive of OS and PFS. PCI was also able to discriminate survival outcomes better than PSDSS for both OS and PFS. There was no association between 18 MS and either score. Conclusion. PCI is superior to PSDSS in predicting OS and PFS and remains the prognostic score of choice in CPC patients undergoing CRS/HIPEC.
背景。腹膜癌指数(PCI)是一种广泛建立的评分系统,用于描述孤立性结直肠腹膜癌(CPC)的疾病负担。随着细胞完全减少,其意义可能减弱。我们探讨了最近描述的腹膜表面疾病严重程度评分(PSDSS)的效用,并将其与PCI的预后价值进行比较。方法。终点是总生存期(OS)、无进展生存期(PFS)和小于18个月的生存期(18 MS)。结果。2003年至2014年,50例CPC患者接受了细胞减少手术和腹腔热化疗(CRS/HIPEC), 98%的患者细胞完全减少。中位OS为28.8个月(95% CI, 18.0-39.1);中位PFS为9.4个月(95% CI, 7.7-13.9)。单因素分析显示,较高的PCI与较差的OS显著相关(HR 1.11;95% CI, 1.03-1.20)和PFS (HR 1.09;95% ci, 1.03-1.14)。相反,PSDSS与任何一个终点都无关。多因素分析显示PCI能预测OS和PFS,而PSDSS不能。对于OS和PFS, PCI也能够比PSDSS更好地区分生存结果。18ms与两种评分均无相关性。结论。PCI在预测OS和PFS方面优于PSDSS,并且仍然是接受CRS/HIPEC的CPC患者的预后评分选择。
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引用次数: 38
Neoadjuvant Chemotherapy in Locally Advanced and Borderline Resectable Nonsquamous Sinonasal Tumors (Esthesioneuroblastoma and Sinonasal Tumor with Neuroendocrine Differentiation) 局部晚期交界性可切除非鳞状鼻窦肿瘤(神经神经母细胞瘤和神经内分泌分化鼻窦肿瘤)的新辅助化疗
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-02-03 DOI: 10.1155/2016/6923730
V. Patil, A. Joshi, V. Noronha, Vibhor Sharma, S. Zanwar, S. Dhumal, S. Kane, P. Pai, A. D'cruz, P. Chaturvedi, A. Bhattacharjee, K. Prabhash
Introduction. Sinonasal tumors are chemotherapy responsive which frequently present in advanced stages making NACT a promising option for improving resection and local control in borderline resectable and locally advanced tumours. Here we reviewed the results of 25 such cases treated with NACT. Materials and Methods. Sinonasal tumor patients treated with NACT were selected for this analysis. These patients received NACT with platinum and etoposide for 2 cycles. Patients who responded and were amenable for gross total resection underwent surgical resection and adjuvant CTRT. Those who responded but were not amenable for resection received radical CTRT. Patients who progressed on NACT received either radical CTRT or palliative radiotherapy. Results. The median age of the cohort was 42 years (IQR 37–47 years). Grades 3-4 toxicity with NACT were seen in 19 patients (76%). The response rate to NACT was 80%. Post-NACT surgery was done in 12 (48%) patients and radical chemoradiation in 9 (36%) patients. The 2-year progression free survival and overall survival were 75% and 78.5%, respectively. Conclusion. NACT in sinonasal tumours has a response rate of 80%. The protocol of NACT followed by local treatment is associated with improvement in outcomes as compared to our historical cohort.
介绍。鼻窦肿瘤对化疗有反应,经常出现在晚期,使NACT成为改善切除和局部控制边缘可切除和局部晚期肿瘤的有希望的选择。在这里,我们回顾了25例使用NACT治疗的结果。材料与方法。我们选取了接受NACT治疗的鼻窦肿瘤患者作为研究对象。这些患者联合铂和依托泊苷接受NACT治疗2个周期。对大体全切除有反应且可接受的患者接受手术切除和辅助CTRT。那些有反应但不适合切除的患者接受根治性CTRT。NACT进展的患者接受根治性CTRT或姑息性放疗。结果。队列的中位年龄为42岁(IQR 37-47岁)。19例患者(76%)出现NACT 3-4级毒性。NACT的有效率为80%。12例(48%)患者行nact术后手术,9例(36%)患者行根治性放化疗。2年无进展生存率和总生存率分别为75%和78.5%。结论。NACT治疗鼻窦肿瘤的有效率为80%。与我们的历史队列相比,NACT之后的局部治疗方案与结果的改善有关。
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引用次数: 31
A Review of the Literature on Extrarenal Retroperitoneal Angiomyolipoma. 肾外腹膜后血管瘤文献综述
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-01-01 Epub Date: 2016-02-17 DOI: 10.1155/2016/6347136
Anthony Kodzo-Grey Venyo

Background: Extrarenal retroperitoneal angiomyolipomas are rare.

Aim: To review the literature.

Results: Angiomyolipomas, previously classified as hamartomas, are now classified as benign tumours. Thirty cases of primary retroperitoneal angiomyolipomas have been reported. Diagnosis of the disease upon is based radiological and pathological findings of triphasic features of (a) fat and (b) blood vessels and myoid tissue. Immunohistochemistry tends to be positive for HMB45, MART1, HHF35, calponin, NKI-C3, and CD117. The lesion is common in women. Treatment options have included the following: (a) radical surgical excision of the lesion with renal sparing surgery or radical nephrectomy in cases where malignant tumours could not be excluded and (b) selective embolization of the lesion alone or prior to surgical excision. One case of retroperitoneal angiomyolipoma was reported in a patient 15 years after undergoing radical nephrectomy for angiomyolipoma of kidney and two cases of distant metastases of angiomyolipoma have been reported following radical resection of the tumour.

Conclusions: With the report of two cases of metastases ensuing surgical resection of the primary lesions there is need for academic pathologists to debate and review angiomyolipomas to decide whether to reclassify angiomyolipomas as slow-growing malignant tumours or whether the reported cases of metastases were de novo tumours or metastatic lesions.

背景:肾外腹膜后血管肌脂肪瘤非常罕见:目的:回顾文献:结果:血管肌脂肪瘤以前被归类为hamartomas,现在被归类为良性肿瘤。已有 30 例原发性腹膜后血管肌脂肪瘤的报道。该病的诊断依据是放射学和病理学发现的(a)脂肪和(b)血管及肌层组织的三相特征。免疫组化结果显示,HMB45、MART1、HHF35、calponin、NKI-C3 和 CD117 呈阳性。这种病变常见于女性。治疗方法包括以下几种:(a) 对病灶进行根治性手术切除,在无法排除恶性肿瘤的情况下进行保肾手术或根治性肾切除术;(b) 单独或在手术切除前对病灶进行选择性栓塞。有报告称,一名患者因肾脏血管脂肪瘤接受根治性肾切除术 15 年后出现腹膜后血管脂肪瘤,还有报告称,两例血管脂肪瘤患者在接受肿瘤根治性切除术后出现远处转移:结论:随着两例原发病灶手术切除后转移病例的报道,学术界病理学家有必要对血管脂肪瘤进行讨论和审查,以决定是否将血管脂肪瘤重新归类为生长缓慢的恶性肿瘤,或者所报道的转移病例是新发肿瘤还是转移病灶。
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引用次数: 27
Current Practice of Therapeutic Mammaplasty: A Survey of Oncoplastic Breast Surgeons in England. 治疗性乳房成形术的当前实践:英国肿瘤乳房外科医生的调查。
IF 1.5 Q4 ONCOLOGY Pub Date : 2016-01-01 Epub Date: 2016-03-23 DOI: 10.1155/2016/1947876
Shweta Aggarwal, Sekhar Marla, Donald Nyanhongo, Sita Kotecha, Narendra Nath Basu

Introduction: Therapeutic mammaplasty (TM) is a useful technique in the armamentarium of the oncoplastic breast surgeon (OBS). There is limited guidance on patient selection, technique, coding, and management of involved margins. The practices of OBS in England remain unknown.

Methods: Questionnaires were sent to all OBS involved with the Training Interface Group. We assessed the number of TM cases performed per surgeon, criteria for patient selection, pedicle preference, contralateral symmetrisation, use of routine preoperative MRI, management of involved margins, and clinical coding.

Results: We had an overall response rate of 43%. The most common skin resection technique utilised was wise pattern followed by vertical scar. Superior-medial pedicle was preferred by the majority of surgeons (62%) followed by inferior pedicle (34%). Twenty percent of surgeons would always proceed to a mastectomy following an involved margin, whereas the majority would offer reexcision based on several parameters. The main absolute contraindication to TM was tumour to breast ratio >50%. One in five surgeons would not perform TM in smokers and patients with multifocal disease.

Discussion: There is a wide variation in the practice of TM amongst OBS. Further research and guidance would be useful to standardise practice, particularly management of involved margins and coding for optimal reimbursement.

简介:治疗性乳房成形术(TM)是乳腺肿瘤外科医生(OBS)的一项有用的技术。在患者选择、技术、编码和受病灶边缘管理方面的指导有限。OBS在英国的做法尚不为人所知。方法:对参与培训界面组的所有在线商学院进行问卷调查。我们评估了每位外科医生的TM病例数量、患者选择标准、椎弓根偏好、对侧对称性、常规术前MRI的使用、受病灶边缘的处理和临床编码。结果:总有效率为43%。最常用的皮肤切除技术是智慧模式,其次是垂直疤痕。大多数外科医生(62%)选择上内侧椎弓根,其次是下椎弓根(34%)。20%的外科医生总是在乳房边缘受累后进行乳房切除术,而大多数医生会根据几个参数进行再切除。TM的主要绝对禁忌症是肿瘤与乳房的比例大于50%。五分之一的外科医生不愿为吸烟者和多灶性疾病患者实施TM手术。讨论:OBS之间的TM实践有很大的差异。进一步的研究和指导将有助于使实践标准化,特别是对所涉差额的管理和最佳补偿的编码。
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引用次数: 6
期刊
International Journal of Surgical Oncology
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