Excision Of Metastatic Lesion Research Articles

Neuroblastoma with ovarian and pancreatic metastasis

Neuroblastoma metastasis to the pancreas and ovaries is rare. We report a 12-year-old girl diagnosed with primary left adrenal neuroblastoma and metastases to the local lymph nodes, left orbit, left ovary, and multiple bones. After 4 courses of chemotherapy, the orbital and bone metastases disappeared; the ovarian tumor remained and the lymph node metastases were shown to be pancreatic metastases. Left adrenal tumor resection with spleen-preserving partial pancreas resection and left ovariectomy was performed. Pathological examination of surgical specimens showed viable tumor cells in the ovary but none in the pancreas. Additional chemotherapy, autologous bone marrow transplantation, I 131 -MIBG radiotherapy, and radiation therapy were performed after surgery. This case was a case where it was possible to resect a rare metastatic site, and it is thought that there are many points to discuss about the metastatic pathway, evaluation about reactivity of chemotherapy, and indication about excision of metastatic lesions.

Fatal arterial hemorrhage after microwave ablation of multiple liver metastases: The lessons learned

We report the case of a 71-year-old female patient with previous history of rectal cancer. The primary cancer was resected and three cycles of chemotherapy were completed. Excision of metastatic lesions was also performed from the left liver lobe. Due to the presence of new liver lesions on the right lobe, intra-operative microwave ablation was decided. Three hours post ablation the patient bled massively and angiography revealed extravasation from a peripheral branch of the right hepatic artery. Successful embolization was performed; however, the patient died 5 days later on liver failure. We would like to present the case and discuss the technical options and the key points to help avoiding similar complications in the future.

Surgical Management of Epidural Spinal Metastasis

From 1974 through 1983, 18 patients with metastatic epidural spinal tumors were admitted, and 12 cases were operated on, in order to relieve pain and neurological deficits. The age distribution of the 12 cases was between 4 and 74 years. Complete motor paralysis was seen in six cases, and incomplete motor paralysis, in five cases. One showed no deficit except pain. Pain, either local or of radicular origin, was most common and present in 11 cases. Laminectomy and partial tumor removal were performed in six cases. Since 1981, more extensive excision of tumors and posterior fixation using Harrington rods or methylmethacrylate were performed on four cases. The remaining two cases, with lesions in the cervical vertebral body, received vertebrectomy with fixation using methylmethacrylate in one, and autograft in the other. Postoperatively, pain relief was obtained in nine out of the 11 patients (82%). Among them two patients with extensive tumor removal and one with vertebrectomy became pain-free. Improvement of motor deficit was obtained in three of the five patients with incomplete paralysis treated by either laminectomy or extensive tumor removal, and in two of the six patients with complete paralysis, treated by the latter procedure. Among these five recovered patients four became ambulatory. Our overall results suggest that extensive excision of metastatic lesion with either anterior or posterior fixation had better outcomes than simple decompressive laminectomy alone for pain relief and recovery from motor deficits.