Resection Of Abdominal Tumor Research Articles

Trace of delirium after robotic lower abdominal tumor resection at different end-tidal carbon dioxide: a RCT trial

BackgroundPostoperative delirium (POD) often occurs in oncology patients, further increasing the medical and financial burden. Robotic technology in lower abdominal tumors resection reduces surgical trauma but increases risks such as carbon dioxide (CO2) absorption. This study aimed to investigate the differences in their occurrence of POD at different end-tidal CO2 levels.MethodThis study was approved by the Ethics Committee of Affiliated Hospital of He Bei University (HDFY-LL-2022-169). The study was registered with the Chinese Clinical Trials Registry on URL: http://www.chictr.org.cn, Registry Number: ChiCTR2200056019 (Registry Date: 27/08/2022). In patients scheduled robotic lower abdominal tumor resection from September 1, 2022 to December 31, 2022, a comprehensive delirium assessment was performed three days postoperatively using the CAM scale with clinical review records. Intraoperative administration of different etCO2 was performed depending on the randomized grouping after intubation. Group L received lower level etCO2 management (31-40mmHg), and Group H maintained the higher level(41-50mmHg) during pneumoperitoneum. Data were analyzed using Pearson Chi-Square or Wilcoxon Rank Sum tests and multiple logistic regression. Preoperative mental status score, alcohol impairment score, nicotine dependence score, history of hypertension and diabetes, duration of surgery and worst pain score were included in the regression model along with basic patient information for covariate correction analysis.ResultsAmong the 103 enrolled patients, 19 (18.4%) developed postoperative delirium. The incidence of delirium in different etCO2 groups was 21.6% in Group L and 15.4% in Group H, respectively, with no statistical differences. In adjusted multivariate analysis, age and during of surgery were statistically significant predictors of postoperative delirium. The breath-hold test was significantly lower postoperatively, but no statistical differences were found between two groups.ConclusionWith robotic assistant, the incidence of postoperative delirium in patients undergoing lower abdominal tumor resection was not modified by different end-tidal carbon dioxide management, however, age and duration of surgery were positively associated risk factors.

Robotic-assisted Pediatric Thoracic and Abdominal Tumor Resection: An Initial Multi-center Review

IntroductionRobotic-assisted minimally invasive surgery (RA-MIS) for tumor resection is an emerging technology in the pediatric population with significant promise but unproven safety and feasibility. MethodsA multi-center retrospective review of patients ≤18 years undergoing RA-MIS tumor resection from December 2015–March 2023 was performed. Patient demographics, perioperative variables, and complication rates were analyzed. ResultsThirty-nine procedures were performed on 38 patients (17 thoracic, 22 abdominal); 37% female and 68% non-Hispanic White. Median age at surgery was 8.3 years (IQR 5.7, 15.7); the youngest was 1.7 years-old. Thoracic operations included resections of neuroblastic tumors (n = 16) and a single paraganglioma. The most common abdominal operations included resections of neuroblastic tumors (n = 5), pheochromocytomas (n = 3), and angiomyolipomas (n = 3). Six patients underwent retroperitoneal lymph node dissection (RPLND) for paratesticular tumors. Median operating time for the cohort was 2:52 h (IQR 2:04, 4:31). Two thoracic cases required open conversion due to poor visualization and lack of working domain. All patients underwent complete tumor resection; one had tumor spillage from a positive margin (Wilms tumor). Median LOS was 1.5 days (IQR 1.1, 3.0). Postoperatively, one patient developed a chyle leak requiring interventional radiology drainage, but none required a return to the operating room. ConclusionsRobotic-assisted surgery is safe and feasible for tumor resection in carefully selected pediatric patients, achieving complete resection with minimal morbidity and short LOS. Resection should be performed by those with robotic expertise for optimal outcomes. Level of EvidenceIV. Type of StudyOriginal Clinical Research.

Laparoscopic abdominal tumor resection: Further evidence for expanding on the current SIOP criteria based upon a Single Centre, Single Surgeon series of 28 children

Laparoscopic abdominal tumor resection: Further evidence for expanding on the current SIOP criteria based upon a Single Centre, Single Surgeon series of 28 children

Half-Dose Sugammadex After Neostigmine Versus Neostigmine as a Routine Reversal Agent: A Pilot Randomized Trial

PurposeThe use of sugammadex at a lower dose after a routine reversal dose of neostigmine may prevent residual neuromuscular blockade (rNMB). Our goal was to investigate the effects of the use of half-dose sugammadex for reversing rNMB after administration of neostigmine, and compare these effects to a routine full-dose of neostigmine. DesignProspective, single-blinded, randomized trial. MethodsNinety-eight patients having lower abdominal tumor resection surgery under general anesthesia were randomized into two groups. Group N (Neostigmine) (n = 48) patients received standard reversal dose of intravenous neostigmine 0.05 mg/kg and atropine 0.02 mg/kg before extubationl Group N + S (Neostigmine + Sugammadex) (n = 50) patients received 1 mg/kg of intravenous sugammadex three minutes after a standard neostigmine reversal dose. The primary end-point was the incidence of a train-of-four (TOF) ratio less than 0.9 at tracheal extubation. Secondary end-points were periods between the start of administration of reversal agents and extubation or operating room discharge in minutes to achieve recovery of TOF ratio < 0.9 to 0.7 and TOF ratio ≥ 0.9. FindingsThe demographic data were not different between the two groups (P > .005). The incidence of rNMB presented as TOF ratio < 0.9 to 0.7 was present in 52% of Group N patients compared to 8% in Group N + S patients (P < .0001). The time to recovery between administering reversal and extubation as well as operating room discharge in Group N were; 18.52 ± 6.34 minutes and 23.27 ± 6.95 minutes, respectively, whereas; in Group N + S, they were; 12.86 ± 5.05 and 17.82 ± 4.99 minutes, respectively. (P < .0001, P < .0001, respectively). Adverse events were similar between groups (P > .05). ConclusionsA half-dose sugammadex (1 mg/kg) after full-dose reversal of neostigmine provides a lower incidence of rNMB and shorter recovery times as compared to full-dose neostigmine reversal agent. This practice is safe and effective in case of rNMB.

Intraoperative radiotherapy in abdominal surgery-Own experiences

HintergrundDie intraoperative Radiotherapie (IORT) kann bei lokal weit fortgeschrittenen Tumoren und zu erwartender bzw. nicht vermeidbarer R1-Situation ergänzend zur chirurgischen Resektion eingesetzt werden. Ziel ist eine verbesserte lokale Tumorkontrolle und damit ein besseres Langzeitüberleben. Indikationen sind sowohl primäre intraabdominelle und retroperitoneale Tumoren als auch Rezidivtumoren. Im Rahmen der vorliegenden Arbeit werden die eigenen Erfahrungen mit der Durchführung einer IORT bei viszeralchirurgischen Resektionen zusammengefasst.MethodikPatienten, die von Januar 2008 bis Dezember 2018 eine IORT kombiniert mit abdomineller Tumorresektion in der Klinik für Allgemein- und Viszeralchirurgie des Universitätsklinikums Freiburgs erhalten hatten, wurden in diese Arbeit eingeschlossen und hinsichtlich Kurz- und Langzeitergebnisse evaluiert.ErgebnisseDie häufigste Indikation zur Durchführung einer IORT stellten Sarkome gefolgt von Rektum- und Analkarzinomen dar. Die mediane angewandte Strahlendosis der IORT betrug 15 Gy (8–19 Gy). Bei einem medianen „comprehensive complication index“ (CCI) von 11,9 traten bei 24 % der Patienten Komplikationen (Dindo-Clavien ≥ °III) auf. Die 90-Tage-Mortalität betrug 0 %. Besonders für Analkarzinomrezidive war die lokale Kontrolle nach einem Jahr trotz R0-Resektion unzureichend.SchlussfolgerungIn unserem Patientenkollektiv war die IORT mit vertretbarer Morbidität einsetzbar. Dennoch sind Indikationsstellung und Patientenselektion kritische Punkte für die Durchführung der Behandlung. Der Effekt der IORT zur Verbesserung der lokalen Kontrolle und damit auch des Langzeitüberlebens sollte in weiteren Studien evaluiert werden.

Use of ultrasound in diagnosing postoperative small-bowel intussusception in pediatric surgical oncology patients: a single-center retrospective review.

Postoperative intussusception can be a complication of abdominal surgery and often poses a diagnostic dilemma. The purpose of this study was to evaluate the utility of ultrasonography in the diagnosis of intussusception in children who had recently undergone resection of a primary solid tumor. We performed a retrospective review of all pediatric surgical oncology patients undergoing laparotomy for excision of an abdominal tumor at our institution from 1995 to 2015. We reviewed those with documented postoperative intussusception. In addition we searched the radiology database for all ultrasound examinations requested to rule out postoperative intussusception during our study interval. We analyzed demographics, primary diagnosis, surgical procedure, presentation, diagnostic investigations and definitive treatment. At our institution 852 laparotomies for abdominal tumor resection were performed during the study period, resulting in 10 postoperative intussusceptions (1.2% of cases), of which half were following neuroblastoma resection and the other half following nephrectomy for Wilms tumor. Postoperative intussusception was suspected if the patient had increasing nasogastric output, abdominal distension or feeding intolerance. Ultrasound was used to diagnose intussusception in 9/10 cases, on postoperative day 6 (standard deviation [SD] 5.6days) on average, with a sensitivity of 89% (8/9; one false negative; 95% confidence interval [CI] 0.52, 1.00) and a specificity of 100% (no false positives; 95% CI 0.96, 1.00). Ultrasound was highly accurate in diagnosing postoperative intussusception in children who underwent resection of retroperitoneal tumors.

Effect of hyperthermic intrathoracic chemotherapy (HITHOC) on the malignant pleural effusion: A systematic review and meta-analysis.

Background:Although hyperthermic intraperitoneal chemotherapy (HIPEC) has been widely used to treat malignant ascites or as a preventive strategy for microscopic carcinomatosis following surgical resection of abdominal tumors, application of hyperthermic intrathoracic chemotherapy (HITHOC) in the treatment of malignant pleural effusion is limited. The objective of the current study was to conduct a systematic review and meta-analysis on the application of HITHOC in the palliative treatment of malignant pleural effusion.Methods:After thorough searching of online databases, total 27 articles were included into qualitative systematic review and 5 of them were used to conduct qualitative meta-analysis.Results:It was found that most of HITHOC was used in combination of cytoreductive surgery (CRS) including pleurectomy/decortication or after surgical resection of primary tumors, which mainly were lung cancer, thymoma or thymic carcinoma, breast cancer, and ovarian cancer. Patients who received HITHOC had significantly longer median survival length compared to the patients without HITHOC (Hedges g = 0.763, P < 0.001). In addition, HITHOC therapy was favored (Hedges g = 0.848, P < 0.001) in terms of median survival length, tumor-free survival rate, with tumor survival rate or Karnofsky performance status (KPS) scale.Conclusion:HITHOC is a safe and effective therapy in controlling pleural effusion and increasing patient's survival rate.

Clinical Report on Pharmacological Prevention of Deep Vein Thrombosis after Radical Resection of Abdominal Tumors

Aim: The aim of this paper is to summarize the experience and results of deep vein thrombosis prevention after standardized abdominal tumor resection and lymph node dissection, and to investigate standardized treatment methods for postoperative thrombosis prevention. Methods: We performed a retrospective analysis of the clinical data for 548 patients who were given low molecular weight heparin, low molecular weight dextran, or IV salvia to prevent thrombosis development between January 2007 and April 2010 after standardized abdominal tumor resection and lymph node dissection. Patients were divided into the following three groups based on the treatment period and treatment schedule: group 1 included 163 patients who had been treated between January 2007 and March 2008 and received a 7-day course of daily low molecular weight dextran (500 mL) and salvia injection (0.2 g) postoperatively; group 2 included 149 patients who had been treated between April 2008 and March 2009 and received a 7-day course of daily low molecular weight dextran (500 mL), salvia injection (0.2 g), and low molecular weight heparin (40 mg) postoperatively; group 3 included 236 patients who had been treated between April 2009 and April 2010 and postoperatively received a 7-day course of daily low molecular weight dextran (500 mL) and salvia injection (0.2 g), and on postoperative day 3 were started on an additional 7-day course of daily low molecular weight heparin (40 mg). Then, we performed comparative analysis of the treatment efficacy and concomitant symptoms. Results: In group 1, 64 of the 163 cases (39.3%) were positive for D-dimer, and 15 (9.2%) cases were positive for DVT based on Doppler imaging of the lower extremities. In group 2, 38 cases (25.5%) were positive for D-dimer and 3 cases (2.0%) for DVT. In group 3, 62 cases (26.3%) were positive for D-dimer and 6 cases (2.5%) for DVT. In general, the administration of low molecular weight heparin for anticoagulation in groups 2 and 3 led to significant reduction of thromboses when compared to group 1. However, altering the initiation day of low molecular weight heparin administration between groups 2 and 3 did not result in significant differences in the rate of thrombosis formation. Through clinical observation, early administration of low molecular weight heparin may increase adverse effects. Conclusion: We have demonstrated the superior efficacy of postoperative administration of low molecular weight dextran and IV salvia with additional subcutaneous injection of low molecular weight heparin on postoperative day 3 to prevent DVT development after radical resection of abdominal tumors.

A Novel Mutation (P236S) in the Succinate Dehydrogenase Subunit B Gene in a Japanese Patient with a Posterior Mediastinal Paraganglioma

Succinate dehydrogenase subunit B gene (SDHB) is associated with the development of hereditary paraganglioma (PGL) and pheochromocytoma (PCC). Here we describe a novel germline mutation in SDHB in a 69-year-old Japanese woman with a posterior mediastinal PGL. We summarize the clinical presentation, diagnostic work-up, and pathological features of a patient with a posterior mediastinal PGL and review the pertinent literature. Direct sequencing of SDHB and SDHD was performed. The patient presented with a posterior mediastinal tumor and was normotensive. She underwent abdominal tumor resection at the age of 38 years, but clinical and pathological diagnoses were unknown. She had no family history of hypertension, PGL, or PCC. Imaging studies suggested that the tumor was neurogenic. Endocrinological examinations showed normal plasma catecholamine levels. The tumor was completely removed without metastasis. Pathological findings confirmed PGL. Immunohistochemical staining showed that the tumor cells were positive for chromogranin A, synaptophysin, and CD56, and the Ki67 index was low (<1 %). The patient has not experienced recurrence or metastasis for the last 5 years. DNA sequencing revealed a novel P236S (c.843 C > T) mutation in SDHB. The P236S germline mutation in SDHB was associated with posterior mediastinal PGL. Strict follow-up of the patient is necessary because the SDHB mutation may be related to malignancy.

Carcinologic resection of abdominal tumors involving retroperitoneal vessels: Results of a synergical multidisciplinary approach between oncologic and vascular surgical teams.

e20521 Background: Abdominal tumors involving retroperitoneal vessels are rare but often constitute a terminal condition because of the presumed inextirpability of the tumor. In order to address th...

Rectal cancer treatment and outcome in the elderly: an audit based on the Swedish rectal cancer registry 1995–2004

BackgroundLimited information is available regarding the effect of age on choice of surgical and oncological treatment for rectal cancer. The objective of this study was to assess the influence of age on treatment and outcome of rectal cancer.MethodsWe utilized data in the Swedish Rectal Cancer Registry (SRCR) from patients treated for rectal cancer in Sweden in 1995–2004.ResultsA total of 15,104 patients with rectal cancer were identified, 42.4% of whom were 75 years or older. Patients ≥75 years were less likely to have distant metastases than younger patients (14.8% vs. 17.8%, P < 0.001), and underwent abdominal tumor resection less frequently (68.5% vs. 84.4%, P < 0.001). Of 11,725 patients with abdominal tumor resection (anterior resection [AR], abdominoperineal excision [APE], and Hartmann's procedure [HA]), 37.4% were ≥75 years. Curative surgery was registered for 85.0% of patients ≥ 75 years and for 83.9% of patients < 75 years, P = 0.11. Choice of abdominal operation differed significantly between the two age groups for both curative and non-curative surgery, The frequency of APE was similar in both age groups (29.5% vs. 28.6%), but patients ≥75 years were more likely to have HA (16.9% vs. 4.9%) and less likely to have preoperative radiotherapy (34.3vs. 67.2%, P < 0.001). The relative survival rate at five years for all patients treated with curative intent was 73% (70–75%) for patients ≥75 years and 78% (77–79%) for patients < 75 years of age. Local recurrence rate was 9% (8–11%) for older and 8% (7–9%) for younger patients.ConclusionTreatment of rectal cancer is influenced by patient's age. Future studies should include younger and older patients alike to reveal whether or not age-related differences are purposive. Local recurrence following surgery for low tumors and quality of life aspects deserve particular attention.

Laparoscopic Resection of a Retroperitoneal Schwannoma Adherent to Vital Vessels

Despite the wide acceptance of laparoscopic resection of abdominal tumors, few cases of laparoscopic removal of retroperitoneal schwannoma have been reported to date. We present a case of retroperitoneal schwannoma, encircled with the celiac artery, common hepatic artery, splenic artery, splenic vein, and portal vein, which was resected successfully using laparoscopic surgical technique. During the procedure, an attempt was made to approach the neoplasm via the inferior border of the pancreas, but it was hard to separate the superior mesenteric vein. We changed the position to separate the tumor from the anterior border of the splenic vein with success. Without any complications, the patient was discharged on the sixth postoperative day. In contrast to the open procedure for resection of a tumor in this location, laparoscopy has the advantage of precise visualization, which helps to resect retroperitoneal schwannoma completely.

Left Renal Vein Graft for Vascular Reconstruction in Abdominal Malignancy

Advanced abdominal malignancies are occasionally invasive for the major blood vessels, such as the portal vein (PV), inferior vena cava (IVC), and major hepatic veins (HVs), and complete removal of the tumors is required for patients undergoing vascular resection and reconstruction. We used left renal vein (LRV) grafts for vascular reconstruction in patients with these malignancies and evaluated their clinical relevance. A total of 113 patients underwent vascular resection including the PV (42 patients), IVC (68 patients), and HV (3 patients) for hepatobiliary-pancreatic or abdominal tumor resection. Of these, 11 patients underwent vascular reconstruction with a LRV graft of the PV, superior mesenteric vein (SMV), and HVs in 3 patients each, and the IVC in 2 patients. The HVs were resected with segmentectomy involving Couinaud's segments VII, VIII, and IV; VII, VIII, and II; or III, IV, VIII in each patient. The PV and SMV were resected in 5 patients undergoing pancreaticoduodenectomy for pancreatic carcinoma, and in 1 patient being treated with extended right hepatectomy and pancreaticoduodenectomy for hepatic hilar carcinoma. The IVC was partially resected in 1 patient with advanced colon cancer and 1 with malignant schwannoma. The mean graft length of LRV obtained was 3.6 (3.5-4.0) cm. The graft was used as a tube in 9 patients, and as a patch in 2 patients. The mean duration of clamping time was 41.9 (35-60) min. Portal vein thrombosis was encountered in 2 patients, and anastomotic stenosis in 1 patient. Other morbidity was not related to vascular reconstruction. One patient who underwent extended right hepatectomy and pancreaticoduodenectomy died of liver failure in the hospital. The serum creatinine level after surgery did not deteriorate except in the one patient who died in the hospital. Graft patency was maintained during the follow-up period in all patients. A LRV graft may enhance the possibility of vascular reconstruction without deteriorating serum creatinine level, and it provides sound graft patency.

Laparoscopic surgery for cancer patients.

Laparoscopy is an effective tool for diagnosis and staging of malignancies. Laparoscopic resection of abdominal tumors has been performed rarely, with two exceptions: laparoscopic adrenalectomy and laparoscopic resection of colorectal cancer. One of the best applications of minimally invasive surgery is the use of laparoscopic techniques for palliation of abdominal cancer. Requiring thorough training and preparation of surgeons and mandating their strict credentialing will reduce the risk of complications from laparoscopic surgery.