Concomitance abdominal aortic aneurysm and cancer: vascular surgeon dilemma. Retrospective analysis and literature review

Background & objective: Radiofrequency ablation (RFA) of solid tumors is a minimally invasive procedure intended to treat primary and/or metastatic, benign or malignant solid tumors; via thermal tissue destruction by means of targeted thermal energy guided coagulative necrosis. This procedure can be performed under sedation, general anesthesia (GA) or regional blocks. However, no defined modality exists. We analyzed the different anesthetic modalities and drug combinations which can provide optimal surgical conditions and a successful outcome. Secondary objectives were to analyze common adverse events associated with each anesthesia technique Methodology: In this retrospective study, a total of 100 patients were included based on completeness of records, valid consent from 2008-2018. Outcome measures were; demographic characteristics, ASA status, comorbidities, anesthetic management including drug combinations used, pain management modality, and complications - both intra-operative and post-operative complications. Data was assessed and analyzed using descriptive statistics. Results: Majority of the patients were male (55%), ASA physical class II/III (83%). Anesthesia drug combinations were classified as ketamine and non-ketamine based (85:15). Primary sites for RFA were liver (75%) followed by bone, kidney, adrenal and lungs. Main complications observed were pain and hypotension. Incidence of complications were higher in non-ketamine group. Conclusions: Most cases of radiofrequency ablation can be performed successfully under sedation with local anesthesia. Despite being minimally invasive, it requires complete preparation with general anesthesia back-up, and pre-operative assessment/investigations. Ketamine based combinations exhibited better patient compliance with lower complication rates than non-ketamine-based combinations. Abbreviations: GA - General anesthesia; MAC - Monitored anesthesia care; p-RFA - Percutaneous radiofrequency ablation; RFA - Radiofrequency ablation; TIVA - Total intravenous anesthesia; Keywords: Keta-dex, Ketamine, Radiofrequency ablation, RFA, Pain, Sedation, Monitored anesthesia care, MAC Citation: Pahade A, Mowar A, Vikas J, Singh V, Chowdhury C. Monitored anesthesia care for percutaneous radiofrequency ablation of oncological lesions: a retrospective analysis and literature review. Anaesth. pain intensive care 2024;28(3):534−540. DOI: 10.35975/apic.v28i3.2462 Received: January 24, 2024; Reviewed: March 29, 2024; Accepted: March 29, 2024

Purpose: The aim of this study was to analyze results of stereotactic radiosurgery (SRS) as adjuvant therapy for resected brain metastases. Methods: Medical records of patients treated at a single institution with SRS to the postoperative cavity of brain metastases were retrospectively reviewed. Patients who completed the prescribed SRS regimen following gross-total resection and had no previous whole brain radiotherapy were included in the study. Kaplan-Meier analyses were used to estimate local (LC) and intracranial control (IC), and overall survival (OS) rates. Results: Between April 2005 and July 2010, 77 patients (median age 63 years) with 89 metastases met the inclusion criteria. The median prescription dose was 18 Gy (12–27 Gy) delivered in 1–3 fractions for a median target volume of 7.6 cm³ (0.5–59 cm³). The 6-month, 1-year, and 2-year LC rates were 76.1, 76.1, and 74.3%, respectively. The 6-month, 1-year, and 2-year IC rates were 75.2, 54, and 43.6%, respectively. With a median follow-up of 13.8 months, the median OS was 14.5 months (1.9–51.4 months) after SRS. The overall 6-month, 1-year, and 2-year OS rates were 91, 62.5, and 43.6%, respectively. Complications included 2 patients with radiation necrosis. Conclusion: Adjuvant radiosurgery to the tumor cavity of resected brain metastases is well-tolerated and achieves LC in the majority of patients.

Post-operative venous sinus thrombosis (POVST) is an uncommon complication from a craniotomy for brain tumor resection. There are few data in how to treat POVST, including the use of anticoagulation and follow-up. It has been found that POVST is more common in dural-based lesions especially located on or near a sinus, however treatment has not been standardized. We retrospectively reviewed our POVST cases between January 2018 to December 2020 for brain tumor resection, whether we chose to start anticoagulation or not, and the eventual outcome. We also performed a literature review on the topic to compare findings and management. We identified 14 cases of POVST; 8 of the cases were for extra-axial masses. Of the 14, 6 POVST had clot involving the superior sagittal sinus (SSS), with 3 being discharged with a direct oral anticoagulant (DOAC) and one being discharged on warfarin. With transverse sinus involvement, 6 cases were noted (with no SSS clot), with 2 started on a DOAC and 2 being started on ASA 81mg. In the sigmoid sinus there were 2 cases and did not receive anticoagulation. Of the 14 total cases, 1 was symptomatic (new-onset seizures) necessitating surgical recanalization and no other cases had symptoms attributed to the POVST. Two patients died from unrelated reasons prior to receiving any outpatient imaging, and all other patients had recanalization of their involved sinuses within 2-5 months. There were no complications in patients receiving anticoagulation. Our literature review didn't show a standardized method in POVST treatment. There is also disagreement in what anticoagulation should be used, and if it is necessary. Based on our retrospective analysis and literature review, if the clot is symptomatic, involves the SSS, or propagates, we recommend anticoagulation. Outside the SSS, it should be determined on a case-by-case basis, but anticoagulation may not be necessary.

BackgroundAirway management in tracheobronchial surgeries, especially carinal resection and reconstruction, remains one of the greatest challenges to thoracic surgeons. This study investigated the safety and effectiveness of venovenous extracorporeal membrane oxygenation (VV-ECMO) for respiratory support during tracheobronchial surgeries.MethodsThe data of patients who underwent VV-ECMO-assisted tracheobronchial surgeries at the Shanghai Chest Hospital from August 2006 to August 2021 were retrospectively reviewed. The clinicopathological, perioperative, and follow-up outcomes were analyzed.ResultsA total of 7 patients (4 males and 3 females) with a median age of 56 years (range, 11–70 years) were included in the study. The following tracheobronchial surgeries were conducted: carinal resection and reconstruction with complete pulmonary parenchyma preservation (n=4), left main bronchus and hemi-carinal sleeve resection (n=1), right upper sleeve lobectomy and hemi-carinal resection (n=1), and tracheal resection and reconstruction (n=1). The mean time on VV-ECMO was 167.7±65.8 min, and the mean operative time was 192.4±55.0 min. The average estimated blood loss was 271.4±125.4 mL. No perioperative death or reimplantation of VV-ECMO occurred. Postoperative complications were observed in 2 patients, including 1 case of respiratory failure due to preoperative severe chronic obstructive pulmonary disease (COPD) and 1 case of chylothorax. The median hospital stay was 11 days (range, 7–46 days). The median follow-up time was 30 months (range, 21–33 months). All the patients remained alive, and no postoperative readmission occurred during the follow-up period.ConclusionsVV-ECMO is a safe and feasible ventilation mode when intraoperative oxygen saturation cannot be well maintained during tracheobronchial surgery.

It has been advocated that reduction of nasal bone fractures should be followed by internal packing and/or external splinting. Despite the ample literature concerning the advantages and limitations of various splint types, the necessity and effectiveness of external splinting has not been well documented. To present the authors' experience and review the literature on treatment of nasal bone fractures, focusing on the indications and effectiveness of external splinting following closed reduction. Retrospective analysis and literature review. Medical records of all patients, treated at the Department of Oral and Maxillofacial Surgery of the "KAT" General Hospital of Attica between January 2010 and December 2016 for facial trauma including nasal bone fractures, were retrospectively reviewed. Patient demographic data, fracture type, applied treatment, complications, and final outcome were registered. A total of 77 patients (58 males; 19 females) were included in the study. The age range was 18 to 65 years (mean, 37.8). Closed reduction without external splinting was performed in 63 patients and open reduction with internal fixation in 6; 8 severely comminuted fractures were treated with closed reduction and external splinting. The mean follow-up was 4.8 months. All severely comminuted fractures presented complications. External splinting following closed reduction of nasal bone fractures should not be used routinely but only in selected patients with severe comminution. Since the pertinent literature is inconclusive on the indications and effectiveness of external splinting, randomized controlled studies are warranted to fully elucidate the issue.

Very limited data are available on childhood gastric cancer. Using a retrospective survey and literature review, we assessed the clinical features of gastric cancer in children and adolescents. We collected information on childhood gastric cancer from pediatricians of 518 hospitals that issue the title of "certified board pediatrician" approved by Japan Pediatric Society, using a questionnaire on background, diagnosis year, onset symptoms, tumor location, histology, nodular gastritis, Helicobacter pylori testing, treatment, and prognosis. Studies were collected using PubMed and the NPO Japan Medical Abstracts Society database. Data for childhood gastric cancer were abstracted from the Japanese Vital Statistics database. Of the 518 hospitals, 349 returned the questionnaire, which identified four patients. Literature review identified 77 cases of gastric cancer, and we analyzed data for 80 children <16years old. Most patients were >10years old, and there were no sex differences. Onset symptoms ranged from abdominal pain to non-localized. Sixteen of 44 children had a family history of cancer; 10 had a family history of gastric cancer. Histologically, approximately 80% had undifferentiated-type carcinoma. Prognosis was extremely poor, and two of three tested children were positive for H.pylori infection. Childhood gastric cancer death has been declining. Childhood gastric cancer is rare in Japan, and information on H.pylori in childhood gastric cancer patients is limited. Declining childhood gastric cancer rates may reflect the decreasing prevalence of infection but further study is necessary to clarify the relationship between H.pylori and gastric cancer.

This study aims to investigate cervical kyphosis in children, which has gained increasing attention in recent years due to its higher incidence and its association with tumor surgeries, and to shed light on the unique anatomical and biomechanical differences between pediatric and adult populations regarding cervical sagittal alignment. Additionally, it explores the diverse causes and management approaches, which often pose significant challenges. Furthermore, this study presents the management outcomes from three spine centers in the Middle East. A retrospective analysis was conducted on patient records from 2009 to 2021 in three centers located in Saudi Arabia, Egypt, and Jordan. Demographic and clinical data were collected, imaging studies were reviewed, and various treatment modalities and their corresponding outcomes were documented and analyzed. Additionally, a literature review on pediatric cervical kyphosis and its management was performed. Seventeen patients were included in this study. The average age at presentation was 11.9 years. Among the participants, 14 underwent surgical treatment, 1 was treated with Minerva orthosis, and 2 were observed. The mean follow-up period was 32.4 months. In surgically treated patients, a statistically significant higher degree of correction was achieved when combining anterior and posterior surgeries compared to performing standalone anterior or posterior surgery (P-value = 0.014). Although rare, pediatric cervical kyphosis is a significant condition within the spectrum of pediatric deformities and frequently occurs as a component of syndromes or as a result of iatrogenic factors. Neck pain and myelopathy are the most commonly observed symptoms. Thorough evaluation and complex surgical interventions are typically required for most cases.

Surgical strategy of concomitant abdominal aortic aneurysm and gastric cancer

Family History As a Positive Prognostic Factor in Gastric Cancer

The benefits of primary tumor resection in metastatic disease remains a matter of debate. Existing data are almost exclusively limited to results from retrospective analyses. Data from prospective, randomized trials are currently not available. The results from two prospective observational studies involving gastric and rectal cancer patients are presented and discussed in the context of the available literature. Based on data collected within the prospective quality assurance studies on gastric and rectal cancer conducted by the Institute for Quality Assurance in Surgery at Otto von Guericke University, Magdeburg, Germany, the long-term outcome after palliative primary tumor resection in patients with International Union Against Cancer (UICC) stage IV rectal cancer (2005-2008, n = 2046) and metastatic gastric cancer (2007-2009, n = 687) was analyzed and compared to published data. The median survival time following palliative primary tumor resection of UICC stage IV rectal cancer in the patients analyzed was 20 months. In patients with hepatic metastases undergoing metastasectomy the median survival was 38 months. This increased to 58 months for patients with lymph node negative primary tumors. In metastatic gastric cancer patients undergoing palliative (R2) gastric resection and also patients not undergoing surgery showed a prognostic benefit from palliative chemotherapy; however, the median survival time was significantly prolonged if palliative chemotherapy was preceded by resection of the primary tumor (11 versus 7 months, p < 0.001). Together with previously published data, the results from the two observational studies on rectal and gastric cancer presented here suggest a prognostic benefit from palliative resection of the primary tumor in metastatic disease.

This study was to investigate the application value of whole-body dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging in recurrent anastomotic tumors of digestive tract after gastric and esophageal cancer surgery. Postoperative patients with gastric and esophageal cancer have a high risk of tumor recurrence, and traditional imaging methods have certain limitations in early detection of recurrent tumors. Whole-body dynamic 18F-FDG PET/CT imaging, due to its high sensitivity and specificity, can provide comprehensive information on tumor metabolic activity, which is expected to improve the early diagnosis rate of postoperative recurrent tumors, and provide an important reference for clinical treatment decision-making. To investigate the clinical value of whole-body dynamic 18F-FDG PET/CT imaging in differentiating anastomotic recurrence and inflammation after the operation of upper digestive tract tumors. A retrospective analysis was performed on 53 patients with upper digestive tract tumors after operation and systemic dynamic 18F-FDG PET/CT imaging indicating abnormal FDG uptake by anastomosis, including 29 cases of gastric cancer and 24 cases of esophageal cancer. According to the follow-up results of gastroscopy and other imaging examinations before and after PET/CT examination, the patients were divided into an anastomotic recurrence group and anastomotic inflammation group. Patlak multi-parameter analysis software was used to obtain the metabolic rate (MRFDG), volume of distribution maximum (DVmax) of anastomotic lesions, and MRmean and DVmean of normal liver tissue. The lesion/background ratio (LBR) was calculated by dividing the MRFDG and DVmax of the anastomotic lesion by the MRmean and DVmean of the normal liver tissue, respectively, to obtain LBR-MRFDG and LBR-DVmax. An independent sample t test was used for statistical analysis, and a receiver operating characteristic curve was used to analyze the differential diagnostic efficacy of each parameter for anastomotic recurrence and inflammation. The dynamic 18F-FDG PET/CT imaging parameters MRFDG, DVmax, LBR-MRFDG, and LBR-DVmax of postoperative anastomotic lesions in gastric cancer and esophageal cancer showed statistically significant differences between the recurrence group and the inflammatory group (P < 0.05). The parameter LBR-MRFDG showed good diagnostic efficacy in differentiating anastomotic inflammation from recurrent lesions. In the gastric cancer group, the area under the curve (AUC) value was 0.935 (0.778, 0.993) when the threshold was 1.83, and in the esophageal cancer group, the AUC value was 1. When 86 is the threshold, the AUC value is 0.927 (0.743, 0.993). Whole-body dynamic 18F-FDG PET/CT imaging can accurately differentiate the diagnosis of postoperative anastomotic recurrence and inflammation of gastric cancer and esophageal cancer and has the potential to be an effective monitoring method for patients with upper digestive tract tumors after surgical treatment.

Anatomical repair of a congenital aneurysm of the distal abdominal aorta in a newborn

The modern open surgical management of abdominal aortic aneurysm (AAA) has changed little since its inception in the 1950s. Endoaneurysmorrhaphy, first described by Rudolph Matas in 1888, involved ligating the branches of an aneurysm from within the aneurysm sac. Approximately 25 years later at the

Purpose: The International Agency for Research on Cancer classified Helicobacter pylori (H. pylori) as a carcinogen in 1994, despite conflicting results at the time. Since then, colonization of the stomach with H. pylori has been increasingly accepted as an important cause of stomach cancer and of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. Infection with the bacteria is also associated with a reduced risk of esophageal adenocarcinoma. We hypothesized that patients with non-cardiac gastric cancer will be likely to have active H. pylori infection when they are diagnosed for gastric cancer compared to patients with gastric cardia cancer. Methods: A retrospective chart review was performed from January 1995 to December 2005 on patients who had an inpatient or outpatient upper endoscopic evaluation. Patient who did not have gastric cancer were excluded. Eligible patients were assigned to two groups: patient who has gastric cardia cancer (cancer of the top inch of stomach) and patient who has non-cardiac gastric cancer (cancer in of all other areas of stomach). Logistic regression analysis was performed using prevalence of active H. pylori infection (on gastric biopsy or pathology report) as predictor variable in both groups. Results: One hundred twenty-two patients were diagnosed with gastric tumors; 13 patients were excluded (nine B cell lymphoma patients, three GIST patients, one carcinoid patient), and 109 patients with gastric adenocarcinoma met inclusion criteria. Demographic and clinical data are shown in Table 1.TableConclusion: Patients with non-cardiac gastric cancer were more likely to have history of H. pylori infection and active H. pylori infection when they are diagnosed for gastric cancer compared to patients with gastric cardia cancer.

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