Excision Of Malignant Tumors Research Articles

Inferior vena cava resection and reconstruction for retroperitoneal tumor excision

This study reviews the results of en bloc resection of the inferior vena cava (IVC) for malignant tumor excision and reconstruction. A prospective database was reviewed. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>one segment resected). Repairs were divided into primary, patch, or circumferential. Tumor type, perioperative morbidity, mortality, and graft patency were recorded. Between 1990 and 2011, 47 patients (21 women; mean age, 56; range, 35-89 years) underwent IVC resection for en bloc tumor excision. Sarcomas were most common (36 [77%]: 30 primary IVC). Eleven patients had primary IVC repair, nine patch repair (two autogenous), and 27 had circumferential replacement with a polytetrafluoroethylene ringed graft. Extensive IVC reconstruction in 18 patients included the entire IVC, with renal (RV) and hepatic vein reimplantation in eight; suprarenal and perirenal in six (seven RVs reimplanted); and infrarenal and perirenal in four (four RVs reimplanted). Nine single-segment IVC replacements were infrarenal. Morbidity was 10.6%: one each with bowel obstruction, chyle leak, renal failure with complete recovery (left RV reimplant, right nephrectomy), reoperation for bleeding, and IVC graft thrombosis. Morbidity did not differ by type of reconstruction. There was no mortality. Follow-up ranged from 1.5 to 216 months (18 years) with a mean of 3.5 years. Computed tomography or duplex scans were available in 28 of 47 patients and in 15 of 27 patients in group 3 at a mean follow-up of 36 and 20 months, respectively. One IVC graft thrombosis was documented at 10 months after chemotherapy/sepsis. Tumor recurrence caused three graft stenoses. Cumulative 5-year patency in group 3 was 80% (imaging) and 92% (clinical). Lower extremity edema was universally avoided. Cumulative 5-year survival for the series was 45% ± 8.5%. Mean long-term survival was 5.8 ± 0.56 years (range, 4 months-17 years), with a significant difference between primary or patch (mean, 6.5 years) and circumferential or extensive repair (mean, 4.2 years; P < .005). Cumulative (47% vs 52%) and mean (3.1 vs 3.6 years; P > .12) survival was similar between patients with single-segment and extensive IVC resection and replacement. IVC resection and reconstruction for en bloc tumor excision is safe, even when extensive repairs are necessary. Replacement of the IVC with prosthetic graft avoids extremity venous complications and likely contributes to quality of survival. Survival depends on tumor behavior and degree of IVC involvement, where primary and patch repair has a better prognosis than circumferential resection.

Proximal ulna endoprosthetic replacement for bone tumours in young patients

The optimal reconstructive method after resection of malignant bone tumours of the proximal ulna is unknown.We report the outcome of endoprosthetic replacement in a young patient population. This was a retrospective review of four patients[three males and one female; mean age 17.5 (range 11–31)years] who underwent limb salvage with a proximal ulnar endoprosthetic replacement following excision of malignant bone tumour. Mean follow-up was 85 (range 14–194) months. All patients were alive at final follow-up and reported an improvement in pain. One patient required transhumeral amputation for intralesional excision complicating a local recurrence at one month. Two patients developed fixed flexion deformities of the elbow, one of whom required radial-head excision. Mean Musculoskeletal Tumour Society (MSTS)score and Toronto Extremity Salvage Score (TESS) were 27(range 25–28) and 81 (73–88), respectively. Custom-made proximal ulna endoprosthetic replacement following resection of malignant bone tumours in young patients provides a stable reconstruction option with satisfactory function and without apparent compromise in patient survival.

Reconstruction of a large soft tissue defect using the flap after excision of malignant tumor

Reconstruction of a large soft tissue defect using the flap after excision of malignant tumor

Two-Order Targeted Brain Tumor Imaging by Using an Optical/Paramagnetic Nanoprobe across the Blood Brain Barrier

Surgical resection is a mainstay of brain tumor treatments. However, the completed excision of malignant brain tumor is challenged by its infiltrative nature. Contrast enhanced magnetic resonance imaging is widely used for defining brain tumor in clinic. However its ability in tumor visualization is hindered by the transient circulation lifetime, nontargeting specificity, and poor blood brain barrier (BBB) permeability of the commercially available MR contrast agents. In this work, we developed a two-order targeted nanoprobe in which MR/optical imaging reporters, tumor vasculature targeted cyclic [RGDyK] peptides, and BBB-permeable Angiopep-2 peptides are labeled on the PAMAM-G5 dendrimer. This nanoprobe is supposed to first target the α(V)β(3) integrin on tumor vasculatures. Increased local concentration of nanoprobe facilitates the association between BBB-permeable peptides and the low-density lipoprotein receptor-related protein (LRP) receptors on the vascular endothelial cells, which further accelerates BBB transverse of the nanoprobe via LRP receptor-mediated endocytosis. The nanoprobes that have penetrated the BBB secondly target the brain tumor because both α(V)β(3) integrin and LRP receptor are highly expressed on the tumor cells. In vivo imaging studies demonstrated that this nanoprobe not only efficiently crossed intact BBB in normal mice, but also precisely delineated the boundary of the orthotropic U87MG human glioblastoma xenograft with high target to background signal ratio. Overall, this two-order targeted nanoprobe holds the promise to noninvasively visualize brain tumors with uncompromised BBB and provides the possibility for real-time optical-image-guided brain tumor resection during surgery.

Transanal Single-Port Surgery for the Resection of Large Polyps

Introduction: Transanal endoscopic microsurgery (TEM) is widely used for the excision of both benign and malignant rectal tumours. It is relatively expensive and can be a challenging technique. A recent development in laparoscopic surgery is the single-port technique (single-incision laparoscopic surgery, SILS). The SILS port is a flexible multichannel port for transumbilical laparoscopic surgery. Even though not developed for transanal use the port could be ideal because of its shape and texture. Methods: 12 patients underwent transanal resection using an SILS port and normal laparoscopic instruments. Results: 10 out of 12 patients were treated successfully with the SILS port. Two polyps were resected using an open transanal technique because the distance between the SILS port and the polyp was too small. The average operative time was 55 min (range 40–80 min). All patients could be discharged on the first postoperative day. There were no major complications. Conclusion: Our current data show that transanal surgery using a single port is a relatively easy procedure with operative times comparable to TEM. More surgeons will therefore be able to perform transanal endoscopic surgery.

Oral reconstruction using free fibular flap and do after surgical excision of malignant tumor in mandible

Successful reconstruction of defective jaw after cancer surgery for cancer patients must be a formidable challenge for a oral and maxillofacial surgeon.

Reconstruction of Surgical Defects After Partial Maxillectomies: A Two-Stage Procedure

The reconstruction of the maxilla after massive excisions for cancer and tumors is a challenging problem due to the anatomical complexity of the region. Nevertheless, the reconstruction is crucial to offer the patient a functional, comfortable and aesthetic outcome. This presentation describes a treatment protocol for the reconstruction of defects after partial maxillectomy for excision of benign or malignant tumors: 1) following the resection, a temporalis myofascial flap is transposed to cover the maxillary defect, 2) 3-dimensional treatment planning is made and from a stereo lithographic model a template is manufactured, to illustrate the size, shape and volume of the bone transplant, 3) after 12 months, bone grafting from the iliac crest is performed to reconstruct the maxillary bone, 4) 4 months later dental implants are installed for rehabilitation with fixed prostheses. Three cases are presented to illustrate the treatment principles. In the first two cases, bone grafting was performed intraorally by a secondary surgical procedure through the temporalis flap. Bi-cortical bone grafts were harvested from the posterior or anterior iliac crest. In the third case it was performed as a mono-cortical bone transplantation through a modified lateral rhinotomy incision and through the temporalis flap. The implant installation was performed four months later. Case 1: A 48-year-old woman referred from the oto-rhino-laryngologists for reconstruction after hemimaxillectomy due to squamous cell carcinoma. A primary reconstruction was performed with a temporalis flap. The patient had radiotherapy and subsequently hyperbaric oxygen treatment. Bone harvesting from the anterior iliac crest was performed, and from an intraoral approach the graft was fixated as a bicortical block to the left maxilla through a dissection of the temporalis flap. Finally, the area was reconstructed with three dental implants and a titanium composite bridge. Case 2: A 38-year-old woman referred from the oto-rhino-laryngologists for reconstruction after hemimaxillectomy due to sarcoma. Primary reconstruction with a temporalis flap was performed. Bone was harvested from the anterior iliac crest and from an intraoral approach adapted as a bicortical block to the left maxilla through a dissection in the temporalis flap. Finally, a reconstruction with three dental implants and a titanium composite bridge was performed. Case 3: A 22-year-old male with a primary diagnosis of myxoma referred from the oto-rhino-laryngologists for reconstruction after hemimaxillectomy and closure with a temporalis flap. Bone was harvested from the posterior iliac crest and through an extraoral approach a monocortical block was fixated to the maxilla after dissection through the temporal flap. Final reconstruction with three implants and a titanium composite bridge was performed. The functional and aesthetic results have been satisfactory. One implant of nine was lost after 14 days. After that the implant and prosthetic survival rate was 100%. Within the limitations of these three cases, rehabilitation of the hemimaxillectomized patients with the two-stage procedure is a reliable and safe alternative to the primary reconstruction procedure. The bicortical block transplantation undergoes less resorption than the monoblock transplantation and is preferred.

Inferior Vena Cava Resection and Reconstruction for Retroperitoneal Tumor Excision

The purpose of this study was to review the results of resection and reconstruction of the inferior vena cava (IVC) for en bloc malignant tumor excision. We conducted a retrospective review of all patients having IVC resection for en bloc malignant tumor excision. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>1 segment resected). Repairs were divided into primary, patch, or circumferential. Tumor type, perioperative morbidity, mortality, clinical graft patency, and survival (social security death index) were recorded. Between 1992 and 2010, 48 patients (24 female) had IVC resection for tumor en bloc excision. Sarcomas were most common (33; 69%: 5 [10%] primary IVC). Thirteen patients had primary IVC repair, nine patch repairs (one autogenous), and 26 had circumferential replacement with polytetrafluoroethylene (PTFE) ringed graft (12-16 mm). Extensive IVC reconstructions were performed in 17 cases of which seven involved the entire IVC with renal vein (RV) and hepatic vein reimplantation, six were suprarenal and perirenal (seven RV reimplanted), and four were infrarenal and perirenal (four RV reimplanted). All single segment (9) repairs were infrarenal. Overall morbidity was 6% (one bowel obstruction requiring surgery, one chyle leak resolved with medical therapy, and one renal failure with complete recovery [L RV reimplant, R nephrectomy]). There was no difference in morbidity between primary, patch, circumferential, and extensive reconstruction. There was no mortality. One IVC graft thrombosis was documented on follow-up (after chemotherapy/sepsis). There were two graft stenosis associated with tumor recurrence. Lower extremity edema was universally avoided. Mean long-term survival was 3.34 years (4 months to 11 years) with a significant difference between primary or patch (mean 66.7 months) and circumferential or extensive repair (mean 39.7 months; P < .005). There was no survival difference between single segment and extensive IVC repair (36.7 vs 42.8 months; P > .12). IVC resection and reconstruction for en bloc tumor excision is safe even when extensive repairs are necessary. Replacement of the IVC with a prosthetic graft avoids extremity venous complications and likely contributes to quality of survival. Survival is dependent on tumor behavior and degree of IVC involvement where primary and patch repair has a better prognosis than circumferential resection.

P063. Reconstruction of eyelid defects after cutaneous malignant tumor excision

P063. Reconstruction of eyelid defects after cutaneous malignant tumor excision

Versatile use of rhomboid flaps for closure of skin defects.

The aim of this study is to present our clinical experience with rhomboid flaps. Twenty-four patients who were operated on between January 2006 and October 2010 were included in the study. All defects were reconstructed using rhomboid flaps. Twenty-four patients were operated on for various reasons, and 26 rhomboid flaps were performed. Eleven of the 24 cases were male, and the median age of participants was 47.5 years. Eight cases were operated on under general anesthesia, and 13 were locally anesthetized; the remaining cases were operated on under regional anesthesia. In 17 cases, the defect was due to a benign or malignant tumor excision, and five cases were operated on due to burn contracture. There were no occurrences of partial or total flap necrosis or hematoma in our series. Our series indicates that rhomboid flaps can be safely used to reconstruct small to moderately sized skin defects.

Transanal endoscopic microsurgery for rectal cancer. Long-term oncologic results

Local excision of malignant rectal tumors remains controversial due to the lack of prospective studies. The principal aim of this paper is to analyze survival and recurrence of patients with rectal cancer who were operated by transanal endoscopic microsurgery with curative intention. In 1997, we started a prospective protocol for patients who had T1/T2 rectal tumors: transanal local full-thickness excision was considered curative in T1 low risk (group A); patients with T1 high-risk and T2 low-risk tumors received postoperative radiotherapy (group B). From 1997 to 2006, 88 patients were enrolled. Sixty eight entered the study after the preoperative workup and 20 patients with an initial diagnosis of adenoma after postoperative definitive pathological assessment. After definitive histological findings, 54 patients were to group A, 28 to group B, and 6 had immediate radical surgery. One patient was lost for follow-up. At a mean follow-up of 71 months, 7 (4 from group A and 3 from group B) out of 81 patients recurred. Five-year overall survival was of 94% and cancer-specific survival of 96%. Our data support that transanal endoscopic microsurgery is an adequate treatment for T1 low-risk tumor, and no additional measures are required. For T2 low-risk lesions, our study showed a higher local recurrence rate than that reported after radical surgery but a similar survival outcome.

Ultrasound-Guided Excision of Nonpalpable Malignant Soft Tissue Tumors of the Abdomen

The use of intraoperative ultrasound to guide the excision of sonographically visible but nonpalpable lesions is a newer modality. Its use in intraoperative localization of recurrent malignant soft tissue tumors has not been reported. This report describes a technique of intraoperative localization by ultrasound to guide the excision of recurrent nonpalpable malignant soft tissue tumors of the abdominal wall in two patients. Tumors of both patients were successfully localized intraoperatively by ultrasonography and excised with adequate margins. This technique leads to reduced patient discomfort and anxiety, the avoidance of organizational requirements on the day of surgery, and allows for adequate margins of resection.

Transanal endoscopic microsurgery (TEM): a minimally invasive procedure for treatment of selected rectal neoplasms

Transanal endoscopic microsurgery (TEM) provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. TEM aims to provide an alternative to conventional abdominal surgery (low anterior resection or abdominoperineal amputations), which carries not inconsiderable morbidity and mortality. Based on review of the literature and in the authors experience, this review present the method and indications for TEM.

Utility of a Three-Dimensional Endoscopic System in Skull Base Surgery

We evaluated the utility of a three-dimensional (3-D) endoscopic system for skull base surgery. We performed a retrospective case series in a tertiary care medical center. Thirty-six patients underwent skull base (nonpituitary) resections via 3-D endoscopic system. Fifteen patients (42%) were operated for excision of malignant tumors, 19 (53%) for excision of benign lesions, and 3 (8.3%) for skull base reconstruction. The tumors involved the cribriform plate (n = 13), sphenoid sinus and planum (n = 17), clivus (n = 7), and sella (n = 7). Complete tumor resection was achieved in 31 patients and subtotal resection in two. Five patients (14%) had postoperative complications. There was one case of meningitis, and there were no cases of cerebrospinal fluid leak. The surgeon's ability to recognize anatomic structures at the skull base was evaluated using the 3-D and two-dimensional systems. The 3-D technique was superior to the conventional technique for identification of the sella, carotid prominence, optic prominence, cribriform plate, sphenoid, and fovea ethmoidalis. The two systems were equal for detection of the turbinates, clivus, maxillary, ethmoids, and frontal sinuses. Endoscopic skull base surgery with stereoscopic viewing is feasible and safe. Further studies are required to evaluate the advantage of binocular vision in skull base surgery.

Transanal Endoscopic Microsurgery Resection of Rectal Tumors: Outcomes and Recommendations

Transanal endoscopic microsurgery provides a minimally invasive alternative to radical surgery for excision of benign and malignant rectal tumors. The purpose of this study was to review our experience with transanal endoscopic microsurgery to clarify its role in the treatment of different types of rectal pathology. A prospective database documented all patients undergoing transanal endoscopic microsurgery from October 1996 through June 2008. We analyzed patient and operative factors, complications, and tumor recurrence. For recurrence analysis, we excluded patients with fewer than 6 months of follow-up, previous excisions, known metastases at initial presentation, and those who underwent immediate radical resection following transanal endoscopic microsurgery. Two hundred sixty-nine patients underwent transanal endoscopic microsurgery for benign (n = 158) and malignant (n = 111) tumors. Procedure-related complications (21%) included urinary retention (10.8%), fecal incontinence (4.1%), fever (3.8%), suture line dehiscence (1.5%), and bleeding (1.5%). Local recurrence rates for 121 benign and 83 malignant tumors were 5% for adenomas, 9.8% for T1 adenocarcinoma, 23.5% for T2 adenocarcinoma, 100% for T3 adenocarcinoma, and 0% for carcinoid tumors. All 6 (100%) recurrent adenomas were retreated with endoscopic techniques, and 8 of 17 (47%) recurrent adenocarcinomas underwent salvage procedures with curative intent. Transanal endoscopic microsurgery is a safe and effective method for excision of benign and malignant rectal tumors. Transanal endoscopic microsurgery can be offered for (1) curative resection of benign tumors, carcinoid tumors, and select T1 adenocarcinomas, (2) histopathologic staging in indeterminate cases, and (3) palliative resection in patients medically unfit or unwilling to undergo radical resection.

Reconstruction of a large soft tissue defect following excision of malignant tumor using the flap

Reconstruction of a large soft tissue defect following excision of malignant tumor using the flap

The interdisciplinary management of a Class II division 1 malocclusion with an associated mandibular defect following surgical excision of fibromatosis: A clinical report

Surgical excision of malignant or nonmalignant tumors of the maxillofacial region can result in significant anatomical loss/compromise. Correction of the residual defect can be complicated by the presence of an underlying malocclusion and can be a significant clinical challenge if large numbers of teeth have been lost in surgery. This clinical report discusses the interdisciplinary treatment to rehabilitate a patient with a history of surgical removal of fibromatosis. Treatment involved the use of osseointegrated implants to facilitate orthodontic correction of an underlying malocclusion. The implants were subsequently used in the prosthodontic rehabilitation of the residual surgical defect.

Functional and aesthetic results obtained by modified Bernard reconstruction technique after tumour excision in lower lip cancers

In this study, we investigated the functional and aesthetic results in new lip formation using modified Bernard reconstruction technique after tumour excision in lower lip cancers. The study included 47 patients. All were operated due to lower labial squamous cell carcinoma and underwent defect reconstruction using modified Bernard technique. The patients were separated into two groups as: 50-70% and 70% total defect occurring after surgical excision. The functional and aesthetic assessments were done after at least 1 year had passed, and the results were compared statistically with a control group. Of the 18 patients with 50-70% defect, sensibility was normal in 16 (89%) and complete competence was determined in all (100%). In 17 patients (94%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in all patients. Nasolabial asymmetry was detected in one patient (6%) and apparent mentolabial scar tissue was detected in two patients (11%). The new vermilion was of equal width to the upper lip vermilion in 15 patients (83%). Of the 29 patients with 70% total defect, sensibility was normal in 21 (72%) and complete competence was detected in 27 patients (93%). Sialorrhoea on fluid intake was detected in one patient (3.5%) and sialorrhoea at rest in one patient (3.5%). In 22 patients (76%), complete and symmetric pouting and mouth-opening movements were ensured. Normal mouth opening was noted in 27 (93%) of the 29 patients. Asymmetry in nasolabial fold was detected in one patient (3.5%), apparent scar tissue in nasolabial fold in one patient (3.5%) and commissure asymmetry in one patient (3.5%). In 25 patients (86%), the new vermilion was of equal width to the upper lip vermilion. No statistically significant difference was found (p>0.05) among the two patient groups and the control group in terms of functional and aesthetic results. Modified Bernard technique provides a good degree of lip mobility and sensation after excision of lower lip malignant tumour and produces acceptable results.

A new method for osteotomies in oncologic nasal surgery: Piezosurgery

Objective Piezosurgery is a recently developed system for cutting bone without necrosis and nonmineralized tissues damage. The aim of this work has been to test Piezosurgery as a new bony scalpel in nasal surgery. Methods In this nonrandomized study, we have performed Piezosurgery in the excision of malignant nasal tumors through a paralateronasal approach. We have used Piezosurgery on 10 patients affected by nasal adenocarcinoma. The piezoelectric device uses low-frequency ultrasonic waves (24.7–29.5 kHz); the applied power can be modulated between 2.8 and 16 W and is programmed in accordance to the density of the bone. The equipment consists of 2 hand pieces, 2 inserts, and 2 peristaltic pumps; the microvibrations that are created in the piezoelectric hand piece cause the inserts to vibrate linearly between 60 and 210 μm. Results In all the patients, Piezosurgery provided excellent control without bleeding and harming effects on the adjacent structures. No patients experienced adverse effects. Conclusion Piezosurgery is a new and revolutionary osteotomy technique using the microvibrations of scalpels at ultrasonic frequency, so that soft tissue will not be damaged even upon accidental contact with the cutting tip. The safety of Piezosurgery as regards soft tissues was confirmed. No adverse effects were detected during unintentional contact with the tumor, nerve, vessel, and mucoperiosteum; this renders the piezoelectric device ideal for this application.

Repairs of complex groin wounds with contralateral rectus abdominis myocutaneous flaps

Management of complex groin wounds posterior to complications of vascular prosthetic surgery, malignant tumor excision, and irradiation therapy for recurrent cancers continued to pose a difficult task in reconstructive surgery. Pedicled and microsurgical myocutaneous flaps are valuable tools for wound repairs, but applications of these flaps are limited when the healthy vascular vessels are not available around the wound. In this report, we present our experience on the use of the contralateral rectus abdominis myocutaneous flaps for the coverage of the groin complex wounds in 13 patients. All the flaps were completely survived and the wounds healed uneventfully. The results suggest that the contralateral myocutaneous flap can be used for the repair of the groin wound with presence of significant comorbidities in the area, in which the ipsilateral local flaps and microsurgical flaps are not available.