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Implementation of a robotic surgical program in gynaecological oncology and comparison with prior laparoscopic series. 妇科肿瘤机器人手术方案的实施及与先前腹腔镜系列的比较。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-02-15 DOI: 10.1155/2015/814315
Natalia Povolotskaya, Robert Woolas, Dirk Brinkmann

Background: Robotic surgery in gynaecological oncology is a rapidly developing field as it offers several technical advantages over conventional laparoscopy. An audit was performed on the outcome of robotic surgery during our learning curve and compared with recent well-established laparoscopic procedure data.

Method: Following acquisition of the da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA), we prospectively analysed all cases performed over the first six months by one experienced gynaecologist who had been appropriately trained and mentored. Data on age, BMI, pathology, surgery type, blood loss, morbidity, return to theatre, hospital stay, and readmission rate were collected and compared with a consecutive series over the preceding 6 months performed laparoscopically by the same team.

Results: A comparison of two consecutive series was made. The mean age was somewhat different, 55 years in the robotic versus 69 years in the laparoscopic group, but obesity was a feature of both groups with a mean of BMI 29.3 versus 28.06, respectively. This difference was not statistically significant (P = 0.54). Three subgroups of minimal access surgical procedures were performed: total hysterectomy and bilateral salpingooophorectomy (TH + BSO), total hysterectomy and bilateral salpingooophorectomy plus bilateral pelvic lymphadenectomy (TH + BSO + BPLND), and radical hysterectomy plus bilateral pelvic lymphadenectomy (RH + BPLND). The mean time taken to perform surgery for TH + BSO was longer in the robotic group, 151.2 min compared to 126.3 min in the laparoscopic group. TH + BSO + BPLND surgical time was similar to 178.3 min in robotic group and 176.5 min in laparoscopic group. RH + BPLND surgical time was similar, 263.6 min (robotic arm) and 264.0 min (laparoscopic arm). However, the numbers in this initial analysis were small especially in the last two subgroups and do not allow for statistical analysis. The rate of complications necessitating intervention (Clavien-Dindo classification grade 2/3) was higher in the robotic arm (22.7%) compared to the laparoscopic approach (4.5%). The readmission rate was higher in the robotic group (18.2%) compared to the laparoscopic group (4.5%). The return to theatre in the robotic group was 18.2% and 4.5% in laparoscopic group. Uncomplicated robotic surgery hospital stay appeared to be shorter, 1.3 days compared to the uncomplicated laparoscopic group, 2.5 days. There was no conversion to the open procedure in either arm. Estimated blood loss in all cases was less than 100 mL in both groups.

Conclusion: Robotic surgery is comparable to laparoscopic surgery in blood loss; however, the hospital stay in uncomplicated cases appears to be longer in the laparoscopic arm. Surgical robotic time is equivalent to laparoscopic in complex cases but may be longer in cases not requiring lymph node dissection. The

背景:妇科肿瘤机器人手术是一个快速发展的领域,因为它比传统的腹腔镜手术具有许多技术优势。在我们的学习曲线期间,对机器人手术的结果进行了审计,并与最近建立的腹腔镜手术数据进行了比较。方法:在获得达芬奇手术系统(Intuitive Surgical, Inc., Sunnyvale, California, USA)后,我们前瞻性地分析了前六个月内由一位经过适当培训和指导的经验丰富的妇科医生进行的所有病例。收集年龄、BMI、病理、手术类型、出血量、发病率、返回手术室、住院时间和再入院率的数据,并与前6个月由同一团队进行的连续系列腹腔镜手术进行比较。结果:对两个连续系列进行了比较。平均年龄略有不同,机器人组为55岁,而腹腔镜组为69岁,但肥胖是两组的一个特征,平均BMI分别为29.3和28.06。差异无统计学意义(P = 0.54)。进行了三个亚组最小通道手术:全子宫切除术和双侧输卵管卵巢切除术(TH + BSO),全子宫切除术和双侧输卵管卵巢切除术加双侧盆腔淋巴结切除术(TH + BSO + BPLND),根治性子宫切除术加双侧盆腔淋巴结切除术(RH + BPLND)。机器人组进行TH + BSO手术的平均时间更长,为151.2分钟,而腹腔镜组为126.3分钟。TH + BSO + BPLND手术时间机器人组为178.3 min,腹腔镜组为176.5 min。RH + BPLND手术时间相似,机械臂263.6 min,腹腔镜臂264.0 min。然而,在最初的分析中,数字很小,特别是在最后两个亚组中,因此不允许进行统计分析。需要干预的并发症发生率(Clavien-Dindo分类等级2/3)在机械臂中(22.7%)高于腹腔镜入路(4.5%)。机器人组的再入院率(18.2%)高于腹腔镜组(4.5%)。机器人组复诊率为18.2%,腹腔镜组为4.5%。简单机器人手术组的住院时间似乎更短,为1.3天,而简单腹腔镜组为2.5天。两组患者均未转为开腹手术。两组患者的估计失血量均小于100 mL。结论:机器人手术在失血量方面与腹腔镜手术相当;然而,在无并发症的病例中,腹腔镜臂的住院时间似乎更长。在复杂的情况下,手术机器人的时间相当于腹腔镜,但在不需要淋巴结清扫的情况下可能更长。机器人手术团队的学习曲线可能与较高的发病率有关。对外科医生的益处需要进一步的研究来阐明这种多用途的新颖手术入路的全貌。
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引用次数: 9
Pelvic exenteration: experience from a rural cancer center in developing world. 盆腔切除:来自发展中国家农村癌症中心的经验。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-02-08 DOI: 10.1155/2015/729658
Sampada B Dessai, Satheesan Balasubramanian, Vijay M Patil, Santam Chakraborty, Atanu Bhattacharjee, Syam Vikram

Background: Pelvic exenteration (PE) is a morbid procedure. Ours is a rural based cancer center limited trained surgical oncology staff. Hence, this audit was planned to evaluate morbidity and outcomes of all patients undergoing PE at our center.

Methods: This is a IRB approved retrospective audit of all patients who underwent PE at our center from January 2010 to August 2013. The toxicity grades were retrospectively assigned according to the CTCAE version 4.02 criteria. Chi-square test was done to identify factors affecting grades 3-5 morbidity. Kaplan Meier survival analysis has been used for estimation of median PFS and OS.

Results: 34 patients were identified, with the median age of 52 years (28-73 years). Total, anterior, posterior, and modified posterior exenterations were performed in 4 (11.8%), 5 (14.7%), 14 (41.2%), and 11 (32.4%) patients, respectively. The median time for surgery was 5.5 hours (3-8 hours). The median blood loss was 500 mL (200-4000 mL). CTCAE version 4.02 grades 3-4 toxicity was seen in nine patients (25.7%). The median estimated progression free survival was 31.76 months (25.13-38.40 months). The 2-year overall survival was 97.14%.

Conclusion: PE related grades 3-5 morbidity of 25.7% and mortality of 2.9% at our resource limited center are encouraging.

背景:盆腔切除(PE)是一种病态的手术。我们是一个农村癌症中心有限的训练有素的外科肿瘤工作人员。因此,本次审核计划评估所有在本中心接受PE治疗的患者的发病率和预后。方法:这是一项IRB批准的回顾性审计,对2010年1月至2013年8月在我中心接受PE治疗的所有患者进行了回顾性审计。根据CTCAE 4.02版标准回顾性分配毒性等级。卡方检验确定影响3-5级发病的因素。Kaplan Meier生存分析用于估计中位PFS和OS。结果:共发现34例患者,中位年龄52岁(28-73岁)。分别对4例(11.8%)、5例(14.7%)、14例(41.2%)和11例(32.4%)患者进行了完全、前路、后路和改良后路拔牙。手术时间中位数为5.5小时(3-8小时)。中位失血量为500 mL (200-4000 mL)。CTCAE 4.02版3-4级毒性9例(25.7%)。中位估计无进展生存期为31.76个月(25.13-38.40个月)。2年总生存率为97.14%。结论:在我们资源有限的中心,3-5级PE相关的发病率为25.7%,死亡率为2.9%,这是令人鼓舞的。
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引用次数: 0
Clear cell adenocarcinoma of the urethra: review of the literature. 尿道透明细胞腺癌:文献综述。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-01-20 DOI: 10.1155/2015/790235
Anthony Kodzo-Grey Venyo

Background: Clear cell adenocarcinoma of the urethra (CCAU) is extremely rare and a number of clinicians may be unfamiliar with its diagnosis and biological behaviour.

Aims: To review the literature on CCAU.

Methods: Various internet databases were used.

Results/literature review: (i) CCAU occurs in adults and in women in the great majority of cases. (ii) It has a particular association with urethral diverticulum, which has been present in 56% of the patients; is indistinguishable from clear cell adenocarcinoma of the female genital tract but is not associated with endometriosis; and probably does not arise by malignant transformation of nephrogenic adenoma. (iii) It is usually, readily distinguished from nephrogenic adenoma because of greater cytological a-typicality and mitotic activity and does not stain for prostate-specific antigen or prostatic acid phosphatase. (iv) It has been treated by anterior exenteration in women and cystoprostatectomy in men and at times by radiotherapy; chemotherapy has rarely been given. (v) CCAU is aggressive with low 5-year survival rates. (vi) There is no consensus opinion of treatment options that would improve the prognosis.

Conclusions: Few cases of CCAU have been reported. Urologists, gynaecologists, pathologists, and oncologists should report cases of CCAU they encounter and enter them into a multicentric trial to determine the best treatment options that would improve the prognosis.

背景:尿道透明细胞腺癌(CCAU)极为罕见,许多临床医生可能对其诊断和生物学行为不熟悉。目的:回顾CCAU的相关文献。方法:利用各种网络数据库。结果/文献回顾:(i) CCAU发生在成人和妇女在绝大多数情况下。(ii)与尿道憩室有特殊关系,56%的患者存在尿道憩室;与女性生殖道透明细胞腺癌难以区分,但与子宫内膜异位症无关;并可能不是由肾源性腺瘤的恶性转化引起的。(iii)通常很容易与肾源性腺瘤区分开,因为它有更大的细胞学a-典型性和有丝分裂活性,并且不染色前列腺特异性抗原或前列腺酸性磷酸酶。治疗方法为妇女前路切除和男子膀胱前列腺切除术,有时用放射治疗;很少给予化疗。(5) CCAU侵袭性强,5年生存率低。(六)对于改善预后的治疗方案尚无一致意见。结论:CCAU病例报道较少。泌尿科医生、妇科医生、病理学家和肿瘤学家应报告他们遇到的CCAU病例,并将其纳入多中心试验,以确定改善预后的最佳治疗方案。
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引用次数: 34
Now, later of never: multicenter randomized controlled trial call--is surgery necessary after atypical breast core biopsy results in mammographic screening settings? 现在,多中心随机对照试验呼吁——在乳房x光检查结果显示非典型乳房核心活检后,是否需要手术?
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-04-21 DOI: 10.1155/2015/192579
Nikita Makretsov

Breast cancer mammographic screening leads to detection of premalignant and preinvasive lesions with an increasing frequency. Nevertheless, current epidemiologic evidence indicates that the screening reduces breast cancer specific mortality, but not overall mortality in breast cancer patients. The evidence is lacking whether aggressive eradication of DCIS (preinvasive form of breast carcinoma) by surgery and radiation is of survival benefit, as long-term breast cancer specific mortality in a cohort of patients with DCIS is already in a single digit percent range. Furthermore, it is currently not known whether the aggressive surgical eradication of atypical breast lesions which fall short of diagnosis of DCIS is of any benefit for the patients. Here we propose a model for a randomized controlled trial to generate high level evidence and solve this dilemma.

乳腺癌乳房x线摄影筛查导致发现癌前病变和侵袭性病变的频率越来越高。然而,目前的流行病学证据表明,筛查可以降低乳腺癌患者的特定死亡率,但不能降低乳腺癌患者的总体死亡率。由于一组DCIS患者的长期乳腺癌特异性死亡率已经在个位数范围内,因此缺乏通过手术和放疗积极根除DCIS(侵袭前乳腺癌)是否有利于生存的证据。此外,目前尚不清楚是否积极的手术根除非典型乳腺病变,不能诊断DCIS对患者有任何好处。在这里,我们提出了一个随机对照试验模型,以产生高水平的证据,并解决这一困境。
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引用次数: 1
Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC. 腹膜癌:术中参数在开放(竞技场)与封闭腹部HIPEC。
IF 1.5 Q2 Medicine Pub Date : 2015-01-01 Epub Date: 2015-02-15 DOI: 10.1155/2015/610597
E Halkia, A Tsochrinis, D T Vassiliadou, A Pavlakou, A Vaxevanidou, A Datsis, E Efstathiou, J Spiliotis

Background: Peritoneal carcinomatosis (PC) is associated with a poor prognosis. Cytoreductive surgery (CRS) and HIPEC play an important role in well-selected patients with PC. The aim of the study is to present the differences in the intraoperative parameters in patients who received HIPEC in two different manners, open versus closed abdomen.

Patients and methods: The population includes 105 patients with peritoneal carcinomatosis from colorectal, gastric, and ovarian cancer, sarcoma, mesothelioma, and pseudomyxoma peritonei. Group A (n = 60) received HIPEC using the open technique and Group B (n = 45) received HIPEC with the closed technique. The main end points were morbidity, mortality, and overall hospital stay.

Results: There were two postoperative deaths (3.3%) in the open group versus no deaths in the closed group. Twenty-two patients in the open group (55%) had grade III-IV complications versus 18 patients in the closed group (40%). There are more stable intraoperative conditions in the closed abdomen HIPEC in CVP, pulse rate, and systolic pressure parameters.

Conclusions: Both methods are equal in the HIPEC procedures. Perhaps the closed method is the method of choice for frail patients due to more stable hemodynamic parameters.

背景:腹膜癌(PC)预后不良。细胞减少手术(CRS)和HIPEC在精心挑选的PC患者中发挥重要作用。本研究的目的是介绍两种不同方式(开腹和闭腹)HIPEC患者术中参数的差异。患者和方法:人群包括105例来自结直肠癌、胃癌、卵巢癌、肉瘤、间皮瘤和腹膜假性黏液瘤的腹膜癌。A组(n = 60)采用开放式技术进行HIPEC, B组(n = 45)采用封闭式技术进行HIPEC。主要终点是发病率、死亡率和总住院时间。结果:开放组术后死亡2例(3.3%),封闭组无死亡。开放组22例(55%)出现III-IV级并发症,而封闭组18例(40%)。闭腹HIPEC术中CVP、脉搏率和收缩压参数更为稳定。结论:两种方法在HIPEC手术中是相同的。由于血流动力学参数更稳定,封闭方法可能是体弱患者的首选方法。
{"title":"Peritoneal carcinomatosis: intraoperative parameters in open (coliseum) versus closed abdomen HIPEC.","authors":"E Halkia,&nbsp;A Tsochrinis,&nbsp;D T Vassiliadou,&nbsp;A Pavlakou,&nbsp;A Vaxevanidou,&nbsp;A Datsis,&nbsp;E Efstathiou,&nbsp;J Spiliotis","doi":"10.1155/2015/610597","DOIUrl":"https://doi.org/10.1155/2015/610597","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal carcinomatosis (PC) is associated with a poor prognosis. Cytoreductive surgery (CRS) and HIPEC play an important role in well-selected patients with PC. The aim of the study is to present the differences in the intraoperative parameters in patients who received HIPEC in two different manners, open versus closed abdomen.</p><p><strong>Patients and methods: </strong>The population includes 105 patients with peritoneal carcinomatosis from colorectal, gastric, and ovarian cancer, sarcoma, mesothelioma, and pseudomyxoma peritonei. Group A (n = 60) received HIPEC using the open technique and Group B (n = 45) received HIPEC with the closed technique. The main end points were morbidity, mortality, and overall hospital stay.</p><p><strong>Results: </strong>There were two postoperative deaths (3.3%) in the open group versus no deaths in the closed group. Twenty-two patients in the open group (55%) had grade III-IV complications versus 18 patients in the closed group (40%). There are more stable intraoperative conditions in the closed abdomen HIPEC in CVP, pulse rate, and systolic pressure parameters.</p><p><strong>Conclusions: </strong>Both methods are equal in the HIPEC procedures. Perhaps the closed method is the method of choice for frail patients due to more stable hemodynamic parameters.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2015-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2015/610597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33141112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 39
Incisional surgical site infection after elective open surgery for colorectal cancer. 结直肠癌择期开放手术后切口手术部位感染。
IF 1.5 Q2 Medicine Pub Date : 2014-01-01 Epub Date: 2014-03-27 DOI: 10.1155/2014/419712
Kosuke Ishikawa, Takaya Kusumi, Masao Hosokawa, Yasunori Nishida, Sosuke Sumikawa, Hiroshi Furukawa

Background: The purpose of this study was to clarify the incidence and risk factors for incisional surgical site infections (SSI) in patients undergoing elective open surgery for colorectal cancer.

Methods: We conducted prospective surveillance of incisional SSI after elective colorectal resections performed by a single surgeon for a 1-year period. Variables associated with infection, as identified in the literature, were collected and statistically analyzed for their association with incisional SSI development.

Results: A total of 224 patients were identified for evaluation. The mean patient age was 67 years, and 120 (55%) were male. Thirty-three (14.7%) patients were diagnosed with incisional SSI. Multivariate analysis suggested that incisional SSI was independently associated with TNM stages III and IV (odds ratio [OR], 2.4) and intraoperative hypotension (OR, 3.4).

Conclusions: The incidence of incisional SSI in our cohort was well within values generally reported in the literature. Our data suggest the importance of the maintenance of intraoperative normotension to reduce the development of incisional SSI.

背景:本研究的目的是阐明结肠直肠癌择期开放手术患者手术切口感染(SSI)的发生率和危险因素。方法:我们对一名外科医生在择期结肠直肠癌切除术后切口SSI进行了为期1年的前瞻性监测。收集文献中发现的与感染相关的变量,并对其与切口SSI发展的关系进行统计分析。结果:共确定224例患者进行评估。患者平均年龄67岁,男性120例(55%)。33例(14.7%)患者诊断为切口SSI。多因素分析表明,切口SSI与TNM III期和IV期(优势比[OR], 2.4)和术中低血压(OR, 3.4)独立相关。结论:我们的队列中切口SSI的发生率在文献中普遍报道的值范围内。我们的数据提示术中维持正常血压对于减少切口SSI的发生具有重要意义。
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引用次数: 32
Prognostic factors and survival in patients treated surgically for recurrent metastatic uterine leiomyosarcoma. 手术治疗复发性转移性子宫平滑肌肉瘤患者的预后因素和生存率。
IF 1.5 Q2 Medicine Pub Date : 2014-01-01 Epub Date: 2014-06-22 DOI: 10.1155/2014/919323
Han L T Hoang, Kelsey Ensor, Gerald Rosen, H Leon Pachter, Joseph S Raccuia

Background: Uterine leiomyosarcoma (LMS) is a rare diagnosis, which is seldom cured when it recurs with metastatic disease. We evaluated patients who present with first time recurrence treated surgically to determine prognostic factors associated with long-term survival.

Methods: Over a 16-year period, 41 patients were operated on for recurrent uterine sarcoma. Data examined included patient age, date of initial diagnosis, tumor histology, grade at the initial diagnosis, cytopathology changes in tumor activity from the initial diagnosis, residual tumor after all operations, use of adjuvant therapy, dates and sites of all recurrences, and disease status at last followup.

Results: 24 patients were operated for first recurrence of metastatic uterine LMS. Complete tumor resection with histologic negative margins was achieved in 16 (67%) patients. Overall survival was significantly affected by the FIGO stage at the time of the initial diagnosis, the ability to obtain complete tumor resection at the time of surgery for first time recurrent disease, single tumor recurrence, and recurrence greater than 12 months from the time of the initial diagnosis. Median disease-free survival was 14 months and overall survival was 27 months.

Conclusion: Our findings suggest that stage 1 at the time of initial diagnosis, recurrence greater than 12 months, isolated tumor recurrence, and the ability to remove ability to perform complete tumor resection at the time of the first recurrence can afford improved survival in selected patientsat the time of the first recurrence can afford improved survival in selected patients.

背景:子宫平滑肌肉瘤(LMS)是一种罕见的诊断,当它与转移性疾病复发时很少治愈。我们对首次手术复发的患者进行评估,以确定与长期生存相关的预后因素。方法:16年来对41例复发性子宫肉瘤进行手术治疗。检查的资料包括患者的年龄、初诊日期、肿瘤组织学、初诊时的分级、初诊时肿瘤活动性的细胞病理学变化、所有手术后的残留肿瘤、辅助治疗的使用、所有复发的日期和部位以及最后随访时的疾病状态。结果:24例转移性子宫LMS首次复发均行手术治疗。16例(67%)患者实现了组织学边缘阴性的肿瘤完全切除。初诊时的FIGO分期、首次复发疾病手术时获得肿瘤完全切除的能力、单次肿瘤复发以及自初诊时复发大于12个月对总生存率有显著影响。中位无病生存期为14个月,总生存期为27个月。结论:我们的研究结果表明,在初次诊断时处于1期,复发大于12个月,孤立肿瘤复发,以及在第一次复发时进行完全肿瘤切除的能力可以改善选定患者的生存,第一次复发时可以改善选定患者的生存。
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引用次数: 13
Emergency surgery for metastatic melanoma. 转移性黑色素瘤的紧急手术
IF 1.5 Q2 Medicine Pub Date : 2014-01-01 Epub Date: 2014-10-28 DOI: 10.1155/2014/987170
Dimitrios Mantas, Petros Tsaparas, Petros Charalampoudis, Helen Gogas, Gregory Kouraklis

Visceral metastases from malignant melanoma (stage M1c) confer a very poor prognosis, as documented on the most recent revised version of the TNM/AJCC staging system. Emergency surgery for intra-abdominal complications from the disease is rare. We report on our 5-year single institution experience with surgical management of metastatic melanoma to the viscera in the emergent setting. From 2009 to 2013, 14 patients with metastatic melanoma were admitted emergently due to an acute abdomen. Clinical manifestations encompassed intestinal obstruction and bleeding. Surgical procedures involved multiple enterectomies with primary anastomoses in 8 patients, and one patient underwent splenectomy, one adrenalectomy, one right colectomy, one gastric wedge resection, one gastrojejunal anastomosis, and one transanal debulking, respectively. The 30-day mortality was 7 percent. Median follow-up was 14 months. Median overall survival was 14 months. Median disease free survival was 7.5 months. One-year overall survival was 64.2 percent and 2-year overall survival was 14.2 percent. Emergency surgery for metastatic melanoma to the viscera is rare. Elective curative surgery combined with novel cytotoxic systemic therapies is under investigation in an attempt to grant survival benefit in melanoma patients with visceral disease.

根据最新修订的TNM/AJCC分期系统,恶性黑色素瘤(M1c期)的内脏转移预后非常差。急诊手术治疗腹腔并发症的疾病是罕见的。我们报告我们5年的单一机构经验,转移性黑色素瘤的手术管理到内脏在紧急情况下。从2009年到2013年,14例转移性黑色素瘤患者因急腹症被紧急收治。临床表现包括肠梗阻和出血。8例患者行多处肠切除术并一期吻合,1例患者分别行脾切除术、肾上腺切除术、右结肠切除术、胃楔形切除术、胃空肠吻合术和经肛门减压术。30天死亡率为7%。中位随访时间为14个月。中位总生存期为14个月。中位无病生存期为7.5个月。1年总生存率为64.2%,2年总生存率为14.2%。紧急手术治疗转移到内脏的黑色素瘤是罕见的。选择性治疗性手术联合新型细胞毒性全身疗法正在研究中,试图提高黑色素瘤合并内脏疾病患者的生存率。
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引用次数: 8
The treatment of peritoneal carcinomatosis in advanced gastric cancer: state of the art. 晚期胃癌腹膜癌病的治疗:最新进展。
IF 1.5 Q2 Medicine Pub Date : 2014-01-01 Epub Date: 2014-02-17 DOI: 10.1155/2014/912418
Giulia Montori, Federico Coccolini, Marco Ceresoli, Fausto Catena, Nicola Colaianni, Eugenio Poletti, Luca Ansaloni

Gastric cancer (GC) is the fourth most common cancer and the second leading cause of cancer death in the world; 53-60% of patients show disease progression and die of peritoneal carcinomatosis (PC). PC of gastric origin has an extremely inauspicious prognosis with a median survival estimate at 1-3 months. Different studies presented contrasting data about survival rates; however, all agreed with the necessity of a complete cytoreduction to improve survival. Hyperthermic intraperitoneal chemotherapy (HIPEC) has an adjuvant role in preventing peritoneal recurrences. A multidisciplinary approach should be empowered: the association of neoadjuvant intraperitoneal and systemic chemotherapy (NIPS), cytoreductive surgery (CRS), HIPEC, and early postoperative intraperitoneal chemotherapy (EPIC) could increase the rate of completeness of cytoreduction (CC) and consequently survival rates, especially in patients with Peritoneal Cancer Index (PCI) ≤6. Neoadjuvant chemotherapy may improve survival also in PC from GC and adjuvant chemotherapy could prevent recurrence. In the last decade an interesting new drug, called Catumaxomab, has been developed in Germany. Two studies showed that this drug seems to improve progression-free survival in patients with GC; however, final results for both studies have still to be published.

胃癌(GC)是世界上第四大常见癌症和第二大癌症死亡原因;53-60%的患者出现疾病进展并死于腹膜癌(PC)。胃源性PC预后极不乐观,中位生存期估计为1-3个月。不同的研究提供了关于存活率的对比数据;然而,所有人都同意完全细胞减少以提高生存率的必要性。腹腔高温化疗(HIPEC)对预防腹膜复发有辅助作用。应加强多学科方法:联合新辅助腹腔和全身化疗(NIPS)、细胞减少手术(CRS)、HIPEC和术后早期腹腔化疗(EPIC)可以提高细胞减少(CC)的完整性,从而提高生存率,特别是在腹膜癌指数(PCI)≤6的患者中。新辅助化疗可提高胃癌患者的生存率,并可预防胃癌复发。在过去的十年里,德国开发出了一种有趣的新药,叫做Catumaxomab。两项研究表明,这种药物似乎可以改善胃癌患者的无进展生存期;然而,这两项研究的最终结果仍有待公布。
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引用次数: 87
The aetiology of delay to commencement of adjuvant chemotherapy following colorectal resection. 结直肠癌术后延迟开始辅助化疗的原因分析。
IF 1.5 Q2 Medicine Pub Date : 2014-01-01 Epub Date: 2014-03-17 DOI: 10.1155/2014/670212
G S Simpson, R Smith, P Sutton, A Shekouh, C McFaul, M Johnson, D Vimalachandran

Purpose: Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol.

Method: A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012.

Results: 166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy (P = 0.05). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation (P = 0.032), anastaomotic leak (P = 0.027), and preoperative albumin (P = 0.027). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance (P = 0.143).

Conclusion: A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome.

目的:结直肠切除术后及时给予辅助化疗可改善预后。我们的目的是评估在接受结肠直肠癌切除术作为增强恢复方案的一部分的患者中延迟辅助化疗的相关因素。方法:对2007年至2012年结肠直肠癌患者前瞻性数据库中收集的患者数据进行单因素和多因素分析。结果:166例患者行结肠切除术后辅助化疗。术后中位住院时间为6天,至开始辅助化疗时间为50天。住院时间越长,辅助化疗时间越长(P = 0.05)。与住院时间和辅助化疗开始时间独立相关的因素包括造口形成(P = 0.032)、吻合口漏(P = 0.027)和术前白蛋白(P = 0.027)。腹腔镜手术的使用与辅助化疗时间缩短相关,但没有达到显著性(P = 0.143)。结论:许多与辅助治疗延迟相关的独立变量之前没有被描述过。可能需要进一步的工作来阐明这些变量对长期结果的影响。
{"title":"The aetiology of delay to commencement of adjuvant chemotherapy following colorectal resection.","authors":"G S Simpson,&nbsp;R Smith,&nbsp;P Sutton,&nbsp;A Shekouh,&nbsp;C McFaul,&nbsp;M Johnson,&nbsp;D Vimalachandran","doi":"10.1155/2014/670212","DOIUrl":"https://doi.org/10.1155/2014/670212","url":null,"abstract":"<p><strong>Purpose: </strong>Timely administration of adjuvant chemotherapy following colorectal resection is associated with improved outcome. We aim to assess the factors which are associated with delay to adjuvant chemotherapy in patients who underwent colorectal resection as part of an enhanced recovery protocol.</p><p><strong>Method: </strong>A univariate and multivariate analysis of patient data collected as part of a prospectively maintained database of colorectal cancer patients between 2007 and 2012.</p><p><strong>Results: </strong>166 patients underwent colorectal resection followed by adjuvant chemotherapy. Median postoperative hospital stay was 6 days, and time to commencement of adjuvant chemotherapy was 50 days. Longer inpatient stay correlated with increased time to adjuvant chemotherapy (P = 0.05). Factors found to be independently associated with duration of hospital stay and time to commencement of adjuvant chemotherapy included stoma formation (P = 0.032), anastaomotic leak (P = 0.027), and preoperative albumin (P = 0.027). The use of laparoscopic surgery was associated with shorter time to adjuvant chemotherapy but did not reach significance (P = 0.143).</p><p><strong>Conclusion: </strong>A number of independent variables associated with delay to adjuvant therapy previously not described have been identified. Further work may be required to elucidate the effect that these variables have on long-term outcome.</p>","PeriodicalId":45960,"journal":{"name":"International Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2014/670212","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32285143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 13
期刊
International Journal of Surgical Oncology
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